TY - JOUR
T1 - Predictors of pursuit of physician-assisted death
AU - Smith, Kathryn A.
AU - Harvath, Theresa A.
AU - Goy, Elizabeth R.
AU - Ganzini, Linda
N1 - Funding Information:
This study was funded by a grant from the Northwest Health Foundation (grant number 2003-353). This material is the result of work supported with resources and the use of facilities at the Portland Veterans Affairs Medical Center. The funding sources were not involved in the conduct of the study or development of the submission. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. The authors declare no conflicts of interest.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Context Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act. The States of Washington, Montana, Vermont, and New Mexico have since provided legal sanction for PAD. Through 2013, 1173 Oregonians have received a prescription under the Death with Dignity Act and 752 have died after taking the prescribed medication in Oregon. Objectives To determine the predictive value of personal and interpersonal variables in the pursuit of PAD. Methods Fifty-five Oregonians who either requested PAD or contacted a PAD advocacy organization were compared with 39 individuals with advanced disease who did not pursue PAD. We compared the two groups on responses to standardized measures of depression, hopelessness, spirituality, social support, and pain. We also compared the two groups on style of attachment to intimate others and caregivers as understood through attachment theory. Results We found that PAD requesters had higher levels of depression, hopelessness, and dismissive attachment (attachment to others characterized by independence and self-reliance), and lower levels of spirituality. There were moderate correlations among the variables of spirituality, hopelessness, depression, social support, and dismissive attachment. There was a strong correlation between depression and hopelessness. Low spirituality emerged as the strongest predictor of pursuit of PAD in the regression analysis. Conclusion Although some factors motivating pursuit of PAD, such as depression, may be ameliorated by medical interventions, other factors, such as style of attachment and sense of spirituality, are long-standing aspects of the individual that should be supported at the end of life. Practitioners must develop respectful awareness and understanding of the interpersonal and spiritual perspectives of their patients to provide such support.
AB - Context Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act. The States of Washington, Montana, Vermont, and New Mexico have since provided legal sanction for PAD. Through 2013, 1173 Oregonians have received a prescription under the Death with Dignity Act and 752 have died after taking the prescribed medication in Oregon. Objectives To determine the predictive value of personal and interpersonal variables in the pursuit of PAD. Methods Fifty-five Oregonians who either requested PAD or contacted a PAD advocacy organization were compared with 39 individuals with advanced disease who did not pursue PAD. We compared the two groups on responses to standardized measures of depression, hopelessness, spirituality, social support, and pain. We also compared the two groups on style of attachment to intimate others and caregivers as understood through attachment theory. Results We found that PAD requesters had higher levels of depression, hopelessness, and dismissive attachment (attachment to others characterized by independence and self-reliance), and lower levels of spirituality. There were moderate correlations among the variables of spirituality, hopelessness, depression, social support, and dismissive attachment. There was a strong correlation between depression and hopelessness. Low spirituality emerged as the strongest predictor of pursuit of PAD in the regression analysis. Conclusion Although some factors motivating pursuit of PAD, such as depression, may be ameliorated by medical interventions, other factors, such as style of attachment and sense of spirituality, are long-standing aspects of the individual that should be supported at the end of life. Practitioners must develop respectful awareness and understanding of the interpersonal and spiritual perspectives of their patients to provide such support.
KW - Physician-assisted death
KW - attachment
KW - depression
KW - end-of-life care
KW - euthanasia
KW - hopelessness
KW - pain
KW - spirituality
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U2 - 10.1016/j.jpainsymman.2014.06.010
DO - 10.1016/j.jpainsymman.2014.06.010
M3 - Article
C2 - 25116913
AN - SCOPUS:84924416499
SN - 0885-3924
VL - 49
SP - 555
EP - 561
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 3
ER -