Researchers at Duke University Medical Center have found that
the very population most likely to be affected by legalizing physician-assisted
suicide is the group that favors it the least.
Their survey of 168 frail, elderly patients at Duke's Geriatric
Evaluation and Treatment Clinic revealed that 39.9% of them favored
physician-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 patients
with chronic illness or mental disability, said Duke psychiatrist
Dr. Harold Koenig, lead investigator of the study. And there was
little evidence that overburdened caretaker relatives were more
likely to sanction assisted suicide.
"To the best of our knowledge, ours is the first systematic
study in a clinical setting to examine attitudes of frail, elderly
patients and families toward physician-assisted suicide,"
Koenig said. Results of the study, cowritten by Diane Wildman-Hanlon
and Dr. Kenneth Schmader, are published in the October 28th issue
of the Archives of Internal Medicine.
The survey, supported by the National Institute of Mental Health's
Clinical Research Center for the Study of Psychopathology in the
Elderly, also showed that the types of patients most opposed to
the idea were those most vulnerable to external influence and
those who had the least control over their circumstances. These
patients generally included women, blacks, poorly educated patients,
and patients with mild to moderate dementia. Those with severe
mental or physical handicaps were excluded from the study.
"These findings are provocative and of great concern because
the frail elderly, poorly educated and demented members of our
society have little power to influence public policy that may
directly affect them," Koenig said. "If physician-assisted
suicide is made legal, then this population may warrant special
Lack of Data in the Elderly
Koenig undertook this research because he felt that there was
a lack of data on how elderly people feel toward physician-assisted
suicide--a controversial issue now stirring public and professional
debate. Considerable research has been done on attitudes toward
this measure--most of it showing that two-thirds of adults approve
of it--but the respondents were generally healthy and younger
than age 60. "This is the group least likely to be affected
either personally or by public policy changes in this area,"
Koenig polled elderly patients and their relatives at Duke University
Hospital over a 20-month period.
Besides finding that frail, elderly people favor the measure less
than their relatives, the survey found that spouses and children
were only marginally able to predict their elderly relatives'
attitudes toward physician-assisted suicide. Koenig said that
finding makes the use of advanced directives or living wills more
The survey also found that relatives of the patient had difficulty
agreeing among themselves as to what course of action to take
with regard to the patient, Koenig said.
"Our data highlights a situation of concern in which relatives
often feel different from patients, they often don't know how
the patient feels, and they often can't agree among themselves
on how they think the patient feels," said Koenig.
He said the survey results are important because if assisted suicide
is legalized on a widescale basis, relatives may be called on
to make decisions on behalf of patients who become incompetent,
cognitively impaired, or otherwise unable to make a choice for
Further Research Needed in Other Parts of the Country
However, he cautioned that additional research should be conducted
in other parts of the country to rule out variables that might
be unique to this particular population. For example, the majority
of patients in the Duke survey were white women with conservative
Protestant religious backgrounds who had significant physical
and/or mental health problems. Black patients comprised 13% of
the sample, and the mean age of the patients was 76 years. Compared
to older adults in the United States, patients in the Duke survey
were relatively well-educated and financially secure, yet substantially
more frail in their general health status.
"In general we feel that our findings should be applicable
to similar clinical settings in the North Carolina area, the southeastern
United States, and possibly in other parts of the country, as
well," he said.
Koenig said that patients who had more favorable feelings about
assisted suicide tended to be male, white, better educated, and
less cognitively impaired. Older female patients and those with
more conservative religious backgrounds tended to feel less favorable
toward assisted suicide, Koenig said. Factors that did not affect
attitude toward assisted suicide included marital status, living
situation, psychiatric disorders other than dementia, and physical
Although patients were not asked for the reasons behind their
responses, those who were in favor often volunteered the opinion
that assisted suicide would relieve their pain and suffering.
Those opposed to it often cited religious beliefs.