Frail, Elderly Patients More Opposed to Physician-Assisted Suicide Than Younger Relatives

Researchers at Duke University Medical Center have found thatthe very population most likely to be affected by legalizing physician-assistedsuicide is the group that favors it the least.

Their survey of 168 frail, elderly patients at Duke's GeriatricEvaluation and Treatment Clinic revealed that 39.9% of them favoredphysician-assisted suicide for terminally ill patients. In contrast,the survey found that 59.3% of the patients' relatives--146 spouses,children, and siblings--favored the measure under the same circumstance.

Neither group felt as disposed toward assisted suicide for patientswith chronic illness or mental disability, said Duke psychiatristDr. Harold Koenig, lead investigator of the study. And there waslittle evidence that overburdened caretaker relatives were morelikely to sanction assisted suicide.

"To the best of our knowledge, ours is the first systematicstudy in a clinical setting to examine attitudes of frail, elderlypatients and families toward physician-assisted suicide,"Koenig said. Results of the study, cowritten by Diane Wildman-Hanlonand Dr. Kenneth Schmader, are published in the October 28th issueof the Archives of Internal Medicine.

The survey, supported by the National Institute of Mental Health'sClinical Research Center for the Study of Psychopathology in theElderly, also showed that the types of patients most opposed tothe idea were those most vulnerable to external influence andthose who had the least control over their circumstances. Thesepatients generally included women, blacks, poorly educated patients,and patients with mild to moderate dementia. Those with severemental or physical handicaps were excluded from the study.

"These findings are provocative and of great concern becausethe frail elderly, poorly educated and demented members of oursociety have little power to influence public policy that maydirectly affect them," Koenig said. "If physician-assistedsuicide is made legal, then this population may warrant specialprotective measures."

Lack of Data in the Elderly

Koenig undertook this research because he felt that there wasa lack of data on how elderly people feel toward physician-assistedsuicide--a controversial issue now stirring public and professionaldebate. Considerable research has been done on attitudes towardthis measure--most of it showing that two-thirds of adults approveof it--but the respondents were generally healthy and youngerthan age 60. "This is the group least likely to be affectedeither personally or by public policy changes in this area,"Koenig said.

Koenig polled elderly patients and their relatives at Duke UniversityHospital over a 20-month period.

Besides finding that frail, elderly people favor the measure lessthan their relatives, the survey found that spouses and childrenwere only marginally able to predict their elderly relatives'attitudes toward physician-assisted suicide. Koenig said thatfinding makes the use of advanced directives or living wills moreimportant.

The survey also found that relatives of the patient had difficultyagreeing among themselves as to what course of action to takewith regard to the patient, Koenig said.

"Our data highlights a situation of concern in which relativesoften feel different from patients, they often don't know howthe patient feels, and they often can't agree among themselveson how they think the patient feels," said Koenig.

He said the survey results are important because if assisted suicideis legalized on a widescale basis, relatives may be called onto make decisions on behalf of patients who become incompetent,cognitively impaired, or otherwise unable to make a choice forthemselves.

Further Research Needed in Other Parts of the Country

However, he cautioned that additional research should be conductedin other parts of the country to rule out variables that mightbe unique to this particular population. For example, the majorityof patients in the Duke survey were white women with conservativeProtestant religious backgrounds who had significant physicaland/or mental health problems. Black patients comprised 13% ofthe sample, and the mean age of the patients was 76 years. Comparedto older adults in the United States, patients in the Duke surveywere relatively well-educated and financially secure, yet substantiallymore frail in their general health status.

"In general we feel that our findings should be applicableto similar clinical settings in the North Carolina area, the southeasternUnited States, and possibly in other parts of the country, aswell," he said.

Koenig said that patients who had more favorable feelings aboutassisted suicide tended to be male, white, better educated, andless cognitively impaired. Older female patients and those withmore conservative religious backgrounds tended to feel less favorabletoward assisted suicide, Koenig said. Factors that did not affectattitude toward assisted suicide included marital status, livingsituation, psychiatric disorders other than dementia, and physicalhealth status.

Although patients were not asked for the reasons behind theirresponses, those who were in favor often volunteered the opinionthat assisted suicide would relieve their pain and suffering.Those opposed to it often cited religious beliefs.