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Most terminally ill cancer patients favor right to die

ARCHIVES INTERNAL MEDICINE, Vol. 160 No. 16

A study reported in the September 11th issue of the Archives of Internal Medicine and carried by Reuters Health News service reports that “Most terminally ill cancer patients favor right to die.”

The article, titled, Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide, reports the results of a survey of 70 terminally ill cancer patients. Findings show that “the majority of terminally ill cancer patients support the legalization of euthanasia and physician-assisted suicide when symptoms become too painful to bear.

Terminally ill patients who oppose the legalization of euthanasia and physician-assisted suicide usually do so on religious or moral grounds. To the authors, the findings suggest that a compromise between those who support and those who oppose euthanasia and physician-assisted suicide is unlikely. Dr. Keith G. Wilson with The Rehabilitation Centre in Ottawa, Canada, and his colleagues stated that: “It is apparent from these reasons that people with different opinions about legalization are not simply arguing for different sides of the same issue; rather, their positions are grounded in different issues altogether.”

The researchers interviewed 70 terminally ill cancer patients with an average age of 65 about their attitudes toward the right to choose death. The investigators found that 73% of patients believed that euthanasia and physician-assisted suicide are acceptable practices, and 21% thought neither practice was acceptable and should not be legalized.

Overall, 58% said that if such practices were legal, they might decide to hasten their own death if pain and physical symptoms were to become intolerable. “For these individuals, there might be some comfort in knowing that euthanasia or assisted suicide were available, in the event that their worst fears about pain and symptoms indeed came true,” the authors write.

Of these, 8 patients (12%) said they would have made such a request at the time of their interview. These patients were less interested or derived less pleasure from life activities than all other patients, and had a higher rate of depression, the investigators found. There was no difference in the level of pain, however.

“People who are against legalization are motivated primarily by religious or secular moral concerns, which place the sanctity of human life above other considerations,” Wilson and colleagues write. “Those who are in favor of legalization are more concerned about the relief of uncontrollable pain and suffering, as well as with the rights of the individual to exercise choice and control.”

The authors note that cancer patients account for the largest group selecting euthanasia in areas where it is legal.

The team points out some of the uncertainties about legalizing the right to die, including never knowing for sure when a life-threatening disease has crossed a threshold to become a terminal illness. The desire for a hastened death was associated with depression. Weakness and fatigue also correlated with the desire to die, the researchers add.

Still, the findings suggest that pain is not the only reason terminally ill patients wish to die.

“Psychological and existential dimensions of suffering–which are perhaps no less central in determining quality of life–also emerge as important reasons behind patient requests for physician-hastened death,” the study concludes.

Arch Intern Med. 2000;160:2454-2460

Author Information Keith G. Wilson, PhD; John F. Scott, MD, MDiv; Ian D. Graham, PhD; Jean F. Kozak, PhD; Susan Chater, MB; Raymond A. Viola, MD, MSc; Barbara J. de Faye, MA; Lynda A. Weaver, MHA; Dorothyann Curran, BA

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