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Desire for death in the terminally ill
H M Chochinov1, K G Wilson, M Enns
1Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
The American Journal of Psychiatry
|August 1, 1995
Summary
The desire for death in terminally ill patients is often linked to depression, a treatable condition. This desire can also decrease over time, highlighting the importance of psychiatric care in end-of-life discussions.
Area of Science:
- Palliative Care
- Psychiatry
- Medical Ethics
Background:
- Euthanasia and physician-assisted suicide are significant medical and social concerns.
- Understanding the desire for death in terminally ill patients is crucial for ethical end-of-life care.
Purpose of the Study:
- To determine the prevalence of the desire for death in terminally ill patients.
- To assess the stability of this desire over time.
- To investigate the association between the desire for death and psychiatric disorders, particularly depression.
Main Methods:
- Semistructured interviews were conducted with 200 terminally ill inpatients.
- The interviews assessed the desire for death and evaluated for major and minor depressive episodes using Research Diagnostic Criteria.
- Patients also completed the Beck Depression Inventory and provided ratings of pain and social support. Follow-up interviews were conducted after a 2-week interval when possible.
Main Results:
- While 44.5% of patients occasionally wished for death, only 8.5% expressed a serious, pervasive desire to die.
- The desire for death strongly correlated with depression, pain, and low family support.
- Diagnosed depressive syndromes were present in 58.8% of patients desiring death, compared to 7.7% of those who did not.
- In a follow-up, four of six patients showed a decreased desire to die within two weeks.
Conclusions:
- The desire for death in terminally ill patients is significantly associated with clinical depression, a treatable condition.
- This desire can be transient and may decrease over time, particularly with appropriate psychiatric intervention.
- Discussions on euthanasia and physician-assisted suicide must consider the impact of psychiatric factors and the potential for change in patient desires.