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.