Patients desire euthanasia as a means of limiting loss of self

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Last Updated: 2001-08-02 18:30:24 EDT (Reuters Health)

By Anthony J. Brown, MD

WESTPORT, CT (Reuters Health) – Patients who desire euthanasia or assisted suicide appear to view these options as a means of limiting feelings of loss of self, according to the findings of study involving HIV-infected patients, published in the August 4th issue of The Lancet.

To assess patient attitudes toward the life-ending measures, Dr. James V. Lavery and colleagues, from the University of Toronto, interviewed 32 people with HIV infection or AIDS, most of whom had decided to pursue euthanasia or assisted suicide. The researchers identified two main factors that seemed to affect patient desire for euthanasia or assisted suicide.

Disintegration, the first factor, occurs when a patient begins to experience symptoms and loss of function, the researchers note. The second factor, the loss of community, occurs when the patient has fewer and fewer opportunities to initiate and maintain close relationships with others. These factors result in a perceived loss of self, which the patients felt could be limited through euthanasia or assisted suicide.

"We were really interested in the question of why people desire euthanasia and assisted suicide," Dr. Lavery told Reuters Health. "To our surprise, no one appeared to have asked that question directly before," he said. "The research that has been done has really focused on the attitudes and opinions of physicians and the general public," he noted.

"It seems that patients cross some line, not just with their disease progression but also with their integration into the community, beyond which they perceive a loss of self," Dr. Lavery said. "At this point, the patients often referred to themselves in nonhuman terms such as a 'doll' or 'a sack of potatoes'," he added.

"We have some hope that these findings will encourage investigators to look at other dimensions of euthanasia and assisted suicide," Dr. Lavery stated.

In a related editorial, Drs. Anthony L. Back and Robert A. Pearlman, from the University of Washington, Seattle, comment that "physician-assisted suicide seems to be a window into a particular set of concerns that patients have about dying–relating to loss of self, loss of dignity, and the social context of dying."

Drs. Back and Pearlman believe that "understanding these concerns may shed light on what palliative medicine can do for all dying persons, whether they desire physician-assisted suicide or not."

Lancet 2001;358:344-345,362-367.

-Westport Newsroom 203 319 2700

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