The British Medical Journal today published a new study that suggests that physicians and other healthcare workers in Oregon are doing a horrible job in recognizing and formally assessing mental health issues in people who ask for help under Oregon’s assisted suicide law. The law requires that physicians and healthcare workers assess for mental health concerns and make referrals when necessary.
In 2007, 46 people died from assisted suicide in Oregon. The number of these people referred for a mental health evaluation? Zero.
In the study, researchers examined the cases of 58 people who were terminally ill and had either requested aid in dying from a physician or contacted an aid in dying advocacy organization. Out of the 58, 18 participants received a prescription for a lethal drug and 9 of those 18 went ahead and used it, ending their lives. Of those 18 who received a prescription, 3 of them met criteria for depression and all three ended their lives with the prescription.
This is a complex issue, because death and dying and being diagnosed with a terminal illness is highly likely to be a significant factor in any ordinary person being diagnosed with clinical depression. I can’t imagine having such a diagnosis and not being depressed. So the law appears to be generally badly written if the intent really was to screen anyone who might be depressed and treat them for it.
The assumption by the researchers is that if depression were being properly assessed and treated, perhaps fewer people would go through with the assisted suicide. But that’s hardly borne out by their data. One of the three people who died and was determined to have depression was apparently successfully treated for her depression. She took the lethal dose anyway.
The data set is so small, however, that it’s difficult to determine whether their findings are generalizable. Indeed, while other studies have found similar levels of depression in patients who are dying, no other study has found the prescription of lethal drugs for people with depression as this study did:
Other studies and surveys from Oregon have indicated that aid in dying among depressed patients is very rare. Physicians in Oregon who received requests for aid in dying from 143 patients after enactment of the Death with Dignity Act reported that 20% were depressed—a proportion comparable to what we found in this study. None of the depressed patients on whom they submitted information received a prescription for a lethal drug.
This suggests further research is needed to confirm these results.
Naturally, we believe that physicians and their colleagues need to be doing a better job of mental health assessments. And we agree with the researchers that these are difficult issues to tease apart:
The study participants themselves were divided in whether to attribute their interest in aid in dying to low mood. Although diagnosing depression can be relatively straightforward, determining its role in influencing decision making is more difficult, even by expert assessment.
Is the depression causing an interest in dying sooner rather than later? Or is a person simply depressed over their terminal illness, and making a rational (one might even argue, logical) decision about choosing a death of their own making.
Because ultimately the Oregon law was crafted so that people might die with dignity, instead of having a prolonged, low quality and painful life. Depression or no, we still think it’s a good law that should be replicated in more states.
Read the news article on the study: Assisted Suicide: Depressed Patients May Be Overlooked