FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 339:967-973 October 1, 1998 Number 14 Next

	Full Text PDF Editorial by Rowland, L. P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease that causes gradual paralysis, respiratory failure, and death, usually within three to five years after it has been diagnosed. Between 1995 and 1997, we surveyed patients with this disease in Oregon and Washington, as well as their family care givers, in order to determine their attitudes toward assisted suicide. Patients were considered to be willing to contemplate assisted suicide if they agreed with the statement, "Under some circumstances I would consider taking a prescription for a medicine whose sole purpose was to end my life," and disagreed with the statement, "I would never request or take a prescription for a medication whose sole purpose was to end my life." The Oregon Death with Dignity Act, which legalized physician-assisted suicide, was approved by Oregon voters in 1994 but did not go into effect until October 1997, after data collection for this study had been completed.

Results Of 140 eligible persons with ALS, 100 (71 percent) agreed to participate in the study, as did 91 family care givers. The mean age of the patients with ALS was 54 years; the mean duration of illness since the diagnosis was 2.8 years. Fifty-six patients (56 percent) said they would consider assisted suicide, and 44 of the 56 agreed with the statement, "If physician-assisted suicide were legal, I would request a lethal prescription from a physician." One patient would have taken the medication immediately, and 36 would have kept it for future use. As compared with the patients who were opposed to assisted suicide, those who would consider it were more likely to be men, had a higher level of education, were less likely to be religious, had higher scores for hopelessness, and rated their quality of life as lower. In 66 of 91 instances (73 percent), care givers and patients had the same attitude toward assisted suicide.

Conclusions In Oregon and Washington, a majority of persons with ALS whom we surveyed would consider assisted suicide. Many would request a prescription for a lethal dose of medication well before they intended to use it.

Source Information

From the Departments of Psychiatry (L.G., B.H.M.), Neurology (W.S.J.), and Medicine (S.W.T., M.A.L.) and the Center for Ethics in Health Care (L.G., S.W.T.), Oregon Health Sciences University; the Portland Veterans Affairs Medical Center (L.G.); and Providence ElderPlace (M.A.L.) — all in Portland, Oreg. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, Providence Health Systems, or Oregon Health Sciences University.

Address reprint requests to Dr. Ganzini at the Mental Health Division (P-7-1DMH), Portland Veterans Affairs Medical Center, P.O. Box 1034, Portland, OR 97207.

Full Text of this Article

Related Letters:

Geography of U.S. Biomedical Publications, 1990 to 1997
Thompson D. F.
Extract | Full Text  
N Engl J Med 1999; 340:817-818, Mar 11, 1999. Correspondence

This article has been cited by other articles:

• Fang, F., Valdimarsdottir, U., Furst, C. J., Hultman, C., Fall, K., Sparen, P., Ye, W. (2008). Suicide among patients with amyotrophic lateral sclerosis. Brain 0: awn161v1-awn161 [Abstract] [Full Text]  
• Mitsumoto, H., Rabkin, J. G. (2007). Palliative Care for Patients With Amyotrophic Lateral Sclerosis: "Prepare for the Worst and Hope for the Best". JAMA 298: 207-216 [Abstract] [Full Text]  
• McPherson, C. J, Wilson, K. G, Murray, M. A. (2007). Feeling like a burden to others: a systematic review focusing on the end of life. Palliat Med 21: 115-128 [Abstract]  
• Rosenfeld, B., Breitbart, W., Gibson, C., Kramer, M., Tomarken, A., Nelson, C., Pessin, H., Esch, J., Galietta, M., Garcia, N., Brechtl, J., Schuster, M. (2006). Desire for Hastened Death Among Patients With Advanced AIDS. Psychosomatics 47: 504-512 [Abstract] [Full Text]  
• Hudson, P. L, Kristjanson, L. J, Ashby, M., Kelly, B., Schofield, P., Hudson, R., Aranda, S., O'Connor, M., Street, A. (2006). Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review.. Palliat Med 20: 693-701 [Abstract]  
• Lynd-Balta, E. (2006). Using Literature and Innovative Assessments to Ignite Interest and Cultivate Critical Thinking Skills in an Undergraduate Neuroscience Course. cellbioed 5: 167-174 [Abstract] [Full Text]  
• Emanuel, E. J. (2005). Depression, Euthanasia, and Improving End-of-Life Care. JCO 23: 6456-6458 [Full Text]  
• Kubler, A., Winter, S., Ludolph, A. C., Hautzinger, M., Birbaumer, N. (2005). Severity of Depressive Symptoms and Quality of Life in Patients with Amyotrophic Lateral Sclerosis. Neurorehabil Neural Repair 19: 182-193 [Abstract]  
• Johansen, S., Holen, J. Chr., Kaasa, S., Kaasa, S., Loge, J. H., Materstvedt, L. J. (2005). Attitudes towards, and wishes for, euthanasia in advanced cancer patients at a palliative medicine unit. Palliat Med 19: 454-460 [Abstract]  
• (2005). July 12 Highlights and Commentary: ALS, depression, and desire for a hastened death: (How) are they related?. Neurology 65: 1-1 [Full Text]  
• Olney, R. K., Lomen-Hoerth, C. (2005). Exit strategies in ALS: An influence of depression or despair?. Neurology 65: 9-10 [Full Text]  
• Rabkin, J. G., Albert, S. M., Del Bene, M. L., O'Sullivan, I., Tider, T., Rowland, L. P., Mitsumoto, H. (2005). Prevalence of depressive disorders and change over time in late-stage ALS. Neurology 65: 62-67 [Abstract] [Full Text]  
• Albert, S. M., Rabkin, J. G., Del Bene, M. L., Tider, T., O'Sullivan, I., Rowland, L. P., Mitsumoto, H. (2005). Wish to die in end-stage ALS. Neurology 65: 68-74 [Abstract] [Full Text]  
• Carter, G. T., VandeKieft, G. K., Barron, D. W. (2005). Whose life is it, anyway? The federal government vs. the state of Oregon on the legality of physician-assisted suicide. AM J HOSP PALLIAT CARE 22: 249-251  
• Kubler, A., Nijboer, F., Mellinger, J., Vaughan, T. M., Pawelzik, H., Schalk, G., McFarland, D. J., Birbaumer, N., Wolpaw, J. R. (2005). Patients with ALS can use sensorimotor rhythms to operate a brain-computer interface. Neurology 64: 1775-1777 [Abstract] [Full Text]  
• Hwang, K. (2005). Attitudes of Persons With Physical Disabilities Toward Physician-Assisted Death: An Exploratory Assessment of the Vulnerability Argument. Journal of Disability Policy Studies 16: 16-21 [Abstract]  
• Appel, S. H. (2004). Euthanasia and physician-assisted suicide in ALS: A commentary. AM J HOSP PALLIAT CARE 21: 405-406  
• Dobratz, M. (2004). A Comparative Study of Variables That Have an Impact on Noncancer End-of-Life Diagnoses. Clin Nurs Res 13: 309-325 [Abstract]  
• Chio, A, Gauthier, A, Montuschi, A, Calvo, A, Di Vito, N, Ghiglione, P, Mutani, R (2004). A cross sectional study on determinants of quality of life in ALS. J. Neurol. Neurosurg. Psychiatry 75: 1597-1601 [Abstract] [Full Text]  
• Kelly, B. J., Burnett, P. C., Pelusi, D., Badger, S. J., Varghese, F. T., Robertson, M. M. (2004). Association Between Clinician Factors and a Patient's Wish to Hasten Death: Terminally Ill Cancer Patients and Their Doctors. Psychosomatics 45: 311-318 [Abstract] [Full Text]  
• Sullivan, M. D. (2003). Hope and Hopelessness at the End of Life. AJGP 11: 393-405 [Abstract] [Full Text]  
• Ganzini, L., Goy, E. R., Miller, L. L., Harvath, T. A., Jackson, A., Delorit, M. A. (2003). Nurses' Experiences with Hospice Patients Who Refuse Food and Fluids to Hasten Death. NEJM 349: 359-365 [Abstract] [Full Text]  
• Walsh, S. M., Bremer, B. A., Felgoise, S. H., Simmons, Z. (2003). Religiousness is related to quality of life in patients with ALS. Neurology 60: 1527-1529 [Abstract] [Full Text]  
• Quill, T. E., Cassel, C. K. (2003). Professional Organizations' Position Statements on Physician-Assisted Suicide: A Case for Studied Neutrality. ANN INTERN MED 138: 208-211 [Abstract] [Full Text]  
• PESSIN, H., ROSENFELD, B., BREITBART, W. (2002). Assessing Psychological Distress Near the End of Life. American Behavioral Scientist 46: 357-372 [Abstract]  
• Cohen, L. M., Dobscha, S. K., Hails, K. C., Pekow, P. S., Chochinov, H. M. (2002). Depression and Suicidal Ideation in Patients Who Discontinue the Life-Support Treatment of Dialysis. Psychosom. Med. 64: 889-896 [Abstract] [Full Text]  
• WERTH, J. L. Jr., BLEVINS, D., TOUSSAINT, K. L., DURHAM, M. R. (2002). The Influence of Cultural Diversity on End-of-life Care and Decisions. American Behavioral Scientist 46: 204-219 [Abstract]  
• Jennekens, F. G.I., Kater, L., Leeman, C. P., Druck, P., Veldink, J. H., van den Berg, L. H., van der Wal, G., Ganzini, L., Block, S. (2002). Physician-Assisted Death. NEJM 347: 1041-1043 [Full Text]  
• Ganzini, L., Johnston, W. S., Silveira, M. J. (2002). The final month of life in patients with ALS. Neurology 59: 428-431 [Abstract] [Full Text]  
• Bascom, P. B., Tolle, S. W. (2002). Responding to Requests for Physician-Assisted Suicide: "These Are Uncharted Waters for Both of Us. . . .". JAMA 288: 91-98 [Abstract] [Full Text]  
• Back, A. L., Starks, H., Hsu, C., Gordon, J. R., Bharucha, A., Pearlman, R. A. (2002). Clinician-Patient Interactions About Requests for Physician-Assisted Suicide: A Patient and Family View. Arch Intern Med 162: 1257-1265 [Abstract] [Full Text]  
• Veldink, J. H., Wokke, J. H.J., van der Wal, G., Vianney de Jong, J.M.B., van den Berg, L. H. (2002). Euthanasia and Physician-Assisted Suicide among Patients with Amyotrophic Lateral Sclerosis in the Netherlands. NEJM 346: 1638-1644 [Abstract] [Full Text]  
• Ganzini, L., Block, S. (2002). Physician-Assisted Death -- A Last Resort?. NEJM 346: 1663-1665 [Full Text]  
• Emanuel, E. J. (2002). Euthanasia and Physician-Assisted Suicide: A Review of the Empirical Data From the United States. Arch Intern Med 162: 142-152 [Full Text]  
• Tiernan, E, Casey, P, O'Boyle, C, Birkbeck, G, Mangan, M, O'Siorain, L, Kearney, M (2002). Relations between desire for early death, depressive symptoms and antidepressant prescribing in terminally ill patients with cancer. JRSM 95: 386-390 [Abstract] [Full Text]  
• Bradley, W. G., Anderson, F., Bromberg, M., Gutmann, L., Harati, Y., Ross, M., Miller, R. G. (2001). Current management of ALS: Comparison of the ALS CARE Database and the AAN Practice Parameter. Neurology 57: 500-504 [Abstract] [Full Text]  
• Farsides, B., Dunlop, R. J (2001). Measuring quality of life: Is there such a thing as a life not worth living?. BMJ 322: 1481-1483 [Full Text]  
• Rowland, L. P., Shneider, N. A. (2001). Amyotrophic Lateral Sclerosis. NEJM 344: 1688-1700 [Full Text]  
• Chochinov, H. M., Wilson, K. G., Graham, I. D., Kozak, J. F., Chater, S., Viola, R. A., de Faye, B. J., Weaver, L. A. (2001). Interventions in End-of-Life Care. Arch Intern Med 161: 1117-1118 [Full Text]  
• Breitbart, W., Rosenfeld, B., Pessin, H., Kaim, M., Funesti-Esch, J., Galietta, M., Nelson, C. J., Brescia, R. (2000). Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer. JAMA 284: 2907-2911 [Abstract] [Full Text]  
• Emanuel, E. J., Fairclough, D. L., Emanuel, L. L. (2000). Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers. JAMA 284: 2460-2468 [Abstract] [Full Text]  
• Daaleman, T. P., VandeCreek, L. (2000). Placing Religion and Spirituality in End-of-Life Care. JAMA 284: 2514-2517 [Full Text]  
• Wilson, K. G., Scott, J. F., Graham, I. D., Kozak, J. F., Chater, S., Viola, R. A., de Faye, B. J., Weaver, L. A., Curran, D. (2000). Attitudes of Terminally Ill Patients Toward Euthanasia and Physician-Assisted Suicide. Arch Intern Med 160: 2454-2460 [Abstract] [Full Text]  
• Singer, P. A (2000). Recent advances: Medical ethics. BMJ 321: 282-285 [Full Text]  
• Emanuel, E. J., Fairclough, D. L., Slutsman, J., Emanuel, L. L. (2000). Understanding Economic and Other Burdens of Terminal Illness: The Experience of Patients and Their Caregivers. ANN INTERN MED 132: 451-459 [Abstract] [Full Text]  
• Rabkin, J. G., Wagner, G. J., Del Bene, M. (2000). Resilience and Distress Among Amyotrophic Lateral Sclerosis Patients and Caregivers. Psychosom. Med. 62: 271-279 [Abstract] [Full Text]  
• Baumrucker, S. J. (1999). Listening to ALS. AM J HOSP PALLIAT CARE 16: 696-697  
• Carter, G. T., Bednar-Butler, L. M., Abresch, R. T., Ugalde, V. O. (1999). Expanding the role of hospice care in amyotrophic lateral sclerosis. AM J HOSP PALLIAT CARE 16: 707-710 [Abstract]  
• Emanuel, E. J., Fairclough, D. L., Slutsman, J., Alpert, H., Baldwin, D., Emanuel, L. L. (1999). Assistance from Family Members, Friends, Paid Care Givers, and Volunteers in the Care of Terminally Ill Patients. NEJM 341: 956-963 [Abstract] [Full Text]  
• Mitsumoto, H. (1999). Patient choices in ALS. Neurology 53: 248-248 [Full Text]  
• Albert, S. M., Murphy, P. L., Del Bene, M. L., Rowland, L. P. (1999). A prospective study of preferences and actual treatment choices in ALS. Neurology 53: 278-278 [Abstract] [Full Text]  
• Enck, R. E. (1999). Recent issues in physician-assisted suicide. AM J HOSP PALLIAT CARE 16: 500-501  
• Ganzini, L., Johnston, W. S., Hoffman, W. F. (1999). Correlates of suffering in amyotrophic lateral sclerosis. Neurology 52: 1434-1434 [Abstract] [Full Text]  
• Chochinov, H. M., Wilson, K., Ganzini, L., Johnston, W. S. (1999). Patients with Amyotrophic Lateral Sclerosis and Physician-Assisted Suicide. NEJM 340: 817-817 [Full Text]  
• Back, A., Ganzini, L., Sullivan, M., Menzel, P., Rieger, D., Emanuel, L. (1999). Responding to Patient Requests for Physician-Assisted Suicide. JAMA 281: 227-229 [Full Text]  
• Rowland, L. P. (1998). Assisted Suicide and Alternatives in Amyotrophic Lateral Sclerosis. NEJM 339: 987-989 [Full Text]  
• Poenisch, C. (1998). Merian Frederick's Story. NEJM 339: 996-998 [Full Text]