Investigate Development Case: Death with Dignity: Physician-Assisted Suicide
Consult the Research to understand more about the right to die movement, living with a terminal illness, and the effect of depression on decision making.
In the USA, California, Colorado, District of Columbia, Oregon, Washington, and Vermont have laws that allow terminally ill adults to get prescriptions for lethal doses of medications from their physicians. Patients must be capable of making health care decisions and have a terminal disease that will lead to death within six months (Death with Dignity, 2017).
While illegal in most countries, at least eight countries have legalized physician-assisted suicide. These include Belgium, Canada, Columbia, Finland, Germany, Luxembourg, and Switzerland (ProCon.org, 2017).
In November 2014, Pope Francis denounced the right to die movement by saying that it is a “false sense of compassion” to consider euthanasia as an act of dignity, when in fact it’s a sin against God and creation.
Studies of people with serious illnesses have revealed that being a burden on family is a significant concern about the end of life (Singer et al., 1999; Steinhauser et al., 2000). More recently, Chochinov et al. (2005) studied patients nearing death and found that the more of a burden a patient felt, the lower they reported their will to live.
Research by Mount Sinai School of Medicine (Kelley et al., 2012) studied 3,209 Medicare recipients during their last five years of life and examined their out-of-pocket health care expenditures. Those with cancer spent an average of $31,069, and 43 percent of people spent more than their total assets, (excluding the value of their home).
In a meta-analysis investigating the prevalence of depression among cancer patients, Mitchell et al., (2011) reported that approximately 16.3% of cancer patients meet diagnostic criteria for major depressive disorder. Best estimates are that between 15% and 50% of cancer patients experience depressive symptoms, and 5% to 20% will meet diagnostic criteria for major depressive disorder (Chochinov et al 1994; Hotopf et al 2002; Massie et al 2004; Shuster et al 1999; Bottomley et al 1998; Keith et al 2007).
Research shows that people with depression have difficulty making decisions (e.g., Klerman, 1980; Nezu & Perri, 1989; Radford et al., 1986). Indecisiveness is a symptom that is common enough in depressed individuals to be included in the DSM-V criteria for the disorder (American Psychiatric Association, 2013).
The choices made by depressed people may be sub-optimal compared to the choices made by non-depressed people (Chambers et al., 1996; Kulin et al., 1998; Leykin et al., 2000; Leykin & DeRubeis, 2014; Suri et al., 2004).
Leahy (1999, 2000, 2001, 2002) found that depressed people have a negatively biased “portfolio”, believing that they have few assets and low future potential. Individuals with higher levels of depressive symptoms perceived themselves as having fewer resources available.
Is Ben’s decision making being affected by his depression?
Ben: Everything feels like it’s getting harder to manage – the pain is unbearable some days. I have no energy or patience to play with the kids, Sara gave up work months ago to help take care of me and we are racking up some serious debt. I just feel I don’t have the energy to fight anymore – I’ve gone on longer than I wanted to, mostly because of my family’s wishes. I’m stripped of all my dignity and privacy – it’s too much.
Doc: We can certainly review your pain meds today. It sounds like your depression is still making life harder too, so perhaps we should also review your antidepressants and you might consider going back to talk to your therapist.
Ben: I don’t think it’s the depression – I’m still taking my antidepressants. It’s true I have stopped seeing my therapist – there just didn’t seem any point and it uses up energy that I don’t have. I’ve just had enough of living like this. I’ve managed for years, but now I’ve had enough. I really wanted to ask you today again about getting the medication for me to end it. This is no life – you can see that!
Doc: I’m sorry you feel so terrible and hopeless Ben. I would like to refer you to a psychologist for an assessment in the next few days. We can meet again when I have the results and discuss this further.
On October 5, 2015, at 9:10 A M, Sara wrote:
Thanks for stopping by the other day to take the kids, Ben was having a terrible day and they had arrived home early from childcare. I don’t know what to do with Ben anymore, we don’t have long left and all he’s talking about now is wanting to take matters into his own hands and end his suffering. I have no idea what to say or do for the best. I can’t bear to see him in so much pain and so unhappy, he can’t do any of the things he wants to do and he’s struggling around the kids. Our finances are a mess, but I don’t care about that. I just want to support him, and somehow try to enjoy the time we have left together. Anyways, thanks again Sue and see you soon.
Sara x x x
Sue replied to Sara’s e-mail today at 11:36 A M.
Email subject: R E: Thanks
It was no problem at all, we all had fun at the park. I really wish Ben would stop talking about that terrible idea of his. His father and I refuse to talk about it with him when he brings it up. That is no way out, I know he is no longer a practising Catholic like us, but I really would have thought his beliefs were enough to help him through. I’m sorry we can’t help more financially, we’ve done everything we can think of. Make sure he stops talking about that idea of his and we will get through these last few months together as a family and with God’s help. God bless you.
Sue x x x
Overdue bills and close accounts
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