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Is fear the motivation for physician aid in dying?
Individuals exploring physician aid in dying in Oregon appear to be motivated by worries about future pain and loss of autonomy rather than current symptoms, according to a report in the March 9, 2009, issue of Archives of Internal Medicine.
Researchers surveyed 56 individuals who requested physician aid in dying or contacted a related advocacy organization. Participants were asked to rate the importance of 29 reasons for seeking this option on a scale of 1 (least important) to 5 (most important), according to researcher Linda Ganzini, MD, MPH, professor of psychiatry and medicine senior scholar, Center for Ethics in Health Care, Oregon Health and Science University (OHSU), Portland. Ganzini conducted the research with colleagues at OHSU and at Portland Veterans' Affairs Medical Center.
The most important reasons, with median (midpoint) scores of 5, were wanting to die at home and control the surrounding circumstances of death; loss of independence; and concerns about future pain, poor quality of life, and inability to care for one's self. All current physical symptoms were rated as unimportant.1
The data suggest that when patients first request physician aid in dying, they do so in anticipation of future suffering that they perceive as intolerable, not because of physical symptoms or quality of life at the time of the request, the authors write. "Their desire to die is not strong, and they do not believe that their life is poor in quality, meaningless, or worthless. Rather, they appear to be protecting against the risk of future experience they do not believe they can endure," they wrote. "When confronted with a request for physician aid in dying, health care providers should first work to bolster the patient's sense of control and to educate and reassure the patient regarding management of future symptoms."