DURHAM, N.C. -- Researchers at Duke University Medical Center have found
that the very population most likely to be affected by legalizing physician-assisted
suicide is the group that favors it the least.
In a survey of 168 frail, elderly patients at Duke's Geriatric Evaluation
and Treatment Clinic, researchers found that 39.9 percent of them favored
physician-assisted suicide for terminally ill patients. In contrast, the
survey found that 59.3 percent of the patients' relatives -- 146 spouses,
children and siblings -- favored the measure under the same circumstance.
Neither group felt as favorable toward assisted suicide for patients with
chronic illness or mental disability, said Duke psychiatrist Dr. Harold
Koenig, lead investigator of the study. And there was little evidence that
overburdened caretaker relatives were more likely to favor assisted suicide.
"To the best of our knowledge, ours is the first systematic study in
a clinical setting to examine attitudes of frail, elderly patients and families
toward physician-assisted suicide," Koenig said. Results of his study,
co-written by Diane Wildman-Hanlon and Dr. Kenneth Schmader, are published
in the Oct. 28 issue of Archives of Internal Medicine.
Their survey, supported by the National Institute of Mental Health's Clinical
Research Center for the Study of Psychopathology in the Elderly, also showed
that the types of patients most opposed to the idea were those most vulnerable
to external influence and who had the least control over their circumstances.
These patients generally included women, blacks, poorly educated patients
and patients with mild to moderate dementia. Those with severe mental or
physical handicaps were excluded from the study.
"These findings are provocative and of great concern because the frail
elderly, poorly educated and demented members of our society have little
power to influence public policy that may directly affect them," Koenig
said. "If physician-assisted suicide is made legal, then this population
may warrant special protective measures."
Koenig undertook his research because he felt there was a lack of data on
how elderly people feel toward physician-assisted suicide, a controversial
issue now stirring public and professional debate. Considerable research
has been done on attitutes toward this measure -- most of it showing that
two-thirds of adults approve of it -- but the respondents were generally
healthy and younger than age 60. "This is the group least likely to
to be affected either personally or by public policy changes in this area,"
Koenig said.
Koenig polled elderly patients and their relatives at Duke University Hospital
over a 20-month period.
Besides finding that frail, elderly people favor the measure less than their
relatives, the survey found that spouses and children were only marginally
able to predict their elderly relatives' attitudes toward physician-assisted
suicide. Koenig said that finding makes the use of advanced directives or
"living wills" more important. Living wills are legal documents
stating a person's preference to die rather than live by artficial means,
should such a situation arise.
The survey also found that relatives of the patient had difficulty agreeing
among themselves as to what course of action to take with regard to the
patient, Koenig said.
"Our data highlights a situation of concern in which relatives often
feel different from patients, they often don't know how the patient feels,
and they often can't agree among themselves on how they think the patient
feels," said Koenig.
He said the survey results are important because if assisted suicide is
legalized on a wide-scale basis, relatives may be called upon to make decisions
on behalf of patients who become incompetent, cognitively impaired, or otherwise
unable to make a choice for themselves.
However, he cautioned that additional research should be conducted in other
parts of the country to rule out variables that might be unique to this
particular population. For example, the majority of patients in the Duke
survey were white women with conservative Protestant religious backgrounds
who had significant physical and/or mental health problems. Thirteen percent
of the patients were black, and the mean age of the patients was 76. Compared
to older adults in the United States, patients in the Duke survey were relatively
well-educated and financially secure, yet substantially more frail in their
general health status.
"In general we feel that our findings should be applicable to similar
clinical settings in the North Carolina area, the southeastern United States,
and possibly in other parts of the country, as well," he said.
Koenig said that patients who felt more favorable toward assisted suicide
tended to be male, white, better educated and less cognitively impaired.
Older female patients, and those with more conservative religious backgrounds,
tended to feel less favorable toward assisted suicide, Koenig said. Factors
that did not affect attitude toward assisted suicide included marital status,
living situation, psychiatric disorders other than dementia, and physical
health status.
Although patients were not asked for the reasons behind their responses,
those who were in favor often volunteered the opinion that assisted suicide
would relieve their pain and suffering. Those opposed to it often cited
religious beliefs.