Intervention and Prevention: The Proper Response to Request for Hastened Death

The assisted suicide movement has the media eating out of the palm of its collective hand, by often getting reporters to adopt their lexicon--the euphemistic "aid in dying" as opposed to the accurately descriptive "assisted suicide"--and writing as if suicide were a necessity--even though the cases from Oregon show that almost all assisted suicides involve fears of loss of dignity or of burdening others, etc. And the media virtually never mention that proper hospice care includes intervention and prevention whenever a patient requests to end it all through suicide.

But some in the medical professions still understand the ethical and truly compassionate practice of medicine and nursing. An article in Oncology Nursing News about a continuing medical education class encouraged me. From the story:

Patient and family requests for hastened death usually reflect unmet needs rather than a desire to control the circumstances of death, Boston hematologist Janet Abrahm, MD, said during an education session on pain management and palliative care at the recent annual ASH meeting. The unmet needs often relate to a desire for increased communication with care providers, better symptom control, or acknowledgment of emotional distress or crisis. Clinician responses run the gamut and in some cases can even exacerbate the unmet needs.

That is certainly what I was taught as a hospice volunteer. And here's the kicker:

Regardless of personal or professional feelings about hastened death, providers must respond to such requests, rather than ignore or deny them.

Absolutely!

Dr Abrahm suggested a multistep response that would include the following: Acknowledge the request and make sure it has been understood: Clarify the underlying causes, just as a clinician would clarify causes of physical symptoms; Evaluate the patient's decision-making capacity; Evaluate the patient for depression and risk of suicide and determine whether the patient has a plan to hasten death; Be aware that an immediate psychiatric evaluation is indicated for any patient who has a death plan.

This last part is totally ignored by the "death with dignity" crowd. In Oregon in 2007, no requesters for assisted suicide were referred for a mental health consultation--and remember treatment is not required under the law. Last year, according to the newly published virtually worthless assisted suicide annual report from Oregon, only 2 out of a reported 88 requests and 60 assisted suicides resulted in a referral to mental health professionals. This despite only 3 of the requests involving worries about pain control.

For anyone interested in the report and its details, Alex Schadenberg presents an analysis on his blog.