MIAMI, Fla--Public support of physician-assisted suicide and euthanasia
stems from multiple medical, social, and economic factors, Kathleen
Foley, MD, said at the annual meeting of the American Pain Society.
(See table for a list of some of these factors.)
However, advocacy groups that support legalization of euthanasia
for terminal patients who request it may be ignoring the possibility
that the physical and psychological factors contributing to the
patient's wish to die can be identified and treated or palliated.
Dr. Foley pointed out that much of the physician-assisted suicide/euthanasia
debate has focused on cancer patients and patients with AIDS.
Studies have shown that these patients have a high prevalence
of physical and psychological symptoms, as well as existential
distress, she said.
In this regard, Dr. Foley cited the work of Cecily Saunders, a
pioneer in palliative care, who described a model of suffering
as "total pain," which includes physical, psychological,
emotional, existential, and social factors.
She emphasized that factors that contribute to existential distress
are not being fully appreciated in this debate. Common existential
issues for patients with advanced cancer include hopelessness,
futility, meaninglessness, disappointment, remorse, death anxiety,
and disruption of personal identity.
Several vulnerability factors have been documented that may contribute
to suicide in patients with cancer or AIDS. Uncontrolled pain
is recognized as a contributing factor, and persistent pain interferes
with the patient's ability to receive support from family and
others, Dr. Foley said.