Dutch doctors have found that few patients who ask for euthanasia are making a rational request for a good death. Writing in the Journal of Clinical Oncology, researchers say that contrary to their own clinical experience and their initial hypothesis, depressed patients were four times more likely to request euthanasia and half of all requests were made by depressed patients.

In an accompanying editorial, Dr Ezekiel J. Emanuel, a bioethicist at the US National Institutes of Health, says that most, if not all, studies have shown that psychological distress, including depression and hopelessness, is a major factor in euthanasia requests.

He says that there is “woefully little evidence” to suggest that excruciating, unremitting pain normally prompts such requests. Of the first 15 patients who requested legal physician-assisted suicide in Oregon, only 1 (7%) had severe pain. When euthanasia was legal in Australia’s Northern Territory, seven patients were helped to die — three had no pain and the pain of the other four was well controlled. In other words, says Dr Emanuel, such patients are not asking for the withdrawal of burdensome treatment. Rather they want plain old suicide”.

Oncologists are poor at diagnosing depression, writes Dr Emanuel. One reason for this is probably their view that it is natural for terminally ill patients to be depressed because their life is drawing to a close. But this is obviously incorrect, he notes, because 75 to 85% of terminally ill patients are not depressed.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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