TY - JOUR
T1 - Psychiatric evaluation of death-hastening requests
T2 - Lessons from dialysis discontinuation
AU - Cohen, Lewis M.
AU - Steinberg, Maurice D.
AU - Hails, Kevin C.
AU - Dobscha, Steven K.
AU - Fischel, Steven V.
N1 - Funding Information:
The Dialysis Discontinuation Study was funded through a grant from the Greenwall Foundation, New York, NY . It was also supported by a grant from the Project on Death in America, a program of the Open Society, New York, NY. Dr. Cohen is a Fellow in the Faculty Scholars Program of the Project on Death in America. He is also the principal investigator of the Renal Palliative Care Initiative, which is a demonstration project funded by the Excellence in End-of-Life Care Program of the Robert Wood Johnson Foundation .
PY - 2000
Y1 - 2000
N2 - The authors aim to facilitate the psychiatric evaluation of death- hastening decisions, such as cessation of life-support treatment or physician-assisted suicide, by deriving principles for evaluating patients from a literature review and a recently completed prospective study on dialysis discontinuation conducted by consultation psychiatrists. Factors are delineated and suggestions are provided for the evaluation of requests to accelerate dying. Included are the authors' method for determining major depression in the context of terminal illness and their 'vector analysis' in assessing patient requests to stop dialysis. As our society heatedly examines the care provided to the terminally ill, psychiatry also needs to reconsider whether actions that foreshorten life can be normative and permissible. Familiarity with competency, psychiatric diagnosis, and ease in communication and negotiation between patient, family, and staff are resources that psychiatrists can bring to these complicated assessments. Challenging areas include diagnosing depression, establishing the adequacy of palliative care, and appreciating issues related to personality features, family dynamics, and ethnic differences.
AB - The authors aim to facilitate the psychiatric evaluation of death- hastening decisions, such as cessation of life-support treatment or physician-assisted suicide, by deriving principles for evaluating patients from a literature review and a recently completed prospective study on dialysis discontinuation conducted by consultation psychiatrists. Factors are delineated and suggestions are provided for the evaluation of requests to accelerate dying. Included are the authors' method for determining major depression in the context of terminal illness and their 'vector analysis' in assessing patient requests to stop dialysis. As our society heatedly examines the care provided to the terminally ill, psychiatry also needs to reconsider whether actions that foreshorten life can be normative and permissible. Familiarity with competency, psychiatric diagnosis, and ease in communication and negotiation between patient, family, and staff are resources that psychiatrists can bring to these complicated assessments. Challenging areas include diagnosing depression, establishing the adequacy of palliative care, and appreciating issues related to personality features, family dynamics, and ethnic differences.
UR - http://www.scopus.com/inward/record.url?scp=0034117530&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034117530&partnerID=8YFLogxK
U2 - 10.1176/appi.psy.41.3.195
DO - 10.1176/appi.psy.41.3.195
M3 - Article
C2 - 10849450
AN - SCOPUS:0034117530
SN - 0033-3182
VL - 41
SP - 195
EP - 203
JO - Psychosomatics
JF - Psychosomatics
IS - 3
ER -