The decision to request and proceed with euthanasia or physician-assisted dying is complex, and predictors of such decisions are heterogeneous with regard to physical health, psychological, and social factors. Local research is therefore needed.
To examine the interplay of demographic, clinical, and psychosocial factors routinely collected by a standardized clinical instrument, the interRAI Resident Assessment Instrument for Palliative Care (interRAI-PC), in people with a prognosis of less than 12 months who wanted to die.
All New Zealanders who had an interRAI-PC in 2018 were included. The outcome variable was the single item Wants to die now. Independent variables included biopsychosocial factors and health index scales generated by interRAI-PC. A binary logistic regression was used to determine the predictive factors of Wants to die now (yes vs. no).
There were 771 individuals included (mean age 76.0 years; SD 11.6; female 50.1%); 9.3% of whom reported yes to Wants to die now, 59.8% no, and for 30.9%, the assessor was unable to determine. The factors with the largest odds ratios (ORs) were awareness of terminal prognosis (OR 4.8; 95% CI 2.2–10.3), high level of depression (OR 4.6; 95% CI 1.7–12.6), not finding meaning in day-to-day life (OR 3.8; 95% CI 1.8–8.1), and pain (less than severe: OR 3.7; 95% CI 1.3–10.4 and severe to excruciating: OR 3.5; 95% CI 1.1–10.7).
Addressing the significant factors we identified should form part of a multidisciplinary assessment when terminally ill patients express a wish to die, to ensure their physical, psychological, and existential needs are adequately met.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pain and Symptom Management
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Euthanasia and assisted suicide in selected European countries and US states: systematic literature review.Med Care. 2013; 51: 938-944
- Euthanasia in Belgium: trends in reported cases between 2003 and 2013.CMAJ. 2016; 188: E407-E414
- Death on demand? An analysis of physician-administered euthanasia in The Netherlands.Br Med Bull. 2018; 125: 145-155
- Active euthanasia and physician-assisted suicide in Dutch nursing homes: patients' characteristics.Age Ageing. 1995; 24: 429-433
- Mental health and other clinical correlates of euthanasia attitudes in an Australian outpatient cancer population.Psychooncology. 2007; 16: 295-303
- Interest in physician-assisted suicide among Oregon cancer patients.J Clin Ethics. 2006; 17: 27-38
- Rational suicide in the elderly.Springer, Cham2017
- Suicide assisted by right-to-die associations: a population based cohort study.Int J Epidemiol. 2014; 43: 614-622
- The wish to die among palliative home care clients in Ontario, Canada: a cross-sectional study.BMC Palliat Care. 2016; 15: 24
- A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.Aging Ment Health. 2019; : 1-11
- Late-life suicide in terminal cancer: a rational act or underdiagnosed depression?.J Pain Symptom Manage. 2017; 54: 835-842
- Palliative care (PC).(Available from)https://www.interrai.org/palliative-care.htmlDate: 2020Date accessed: February 22, 2020
- Palliative care assessment.(Available from)https://www.interrai.co.nz/help/palliative-care/Date: 2020Date accessed: February 22, 2020
- Scaling functional status within the interRAI suite of assessment instruments.BMC Geriatr. 2013; 13: 128
- The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people.J Am Geriatr Soc. 2003; 51: 96-100
- MDS cognitive performance scale.J Gerontol. 1994; 49: M174-M182
- Pain in U.S. nursing homes: validating a pain scale for the minimum data set.Gerontologist. 2001; 41: 173-179
- Development of a minimum data set-based depression rating scale for use in nursing homes.Age Ageing. 2000; 29: 165-172
- Predictors of a new depression diagnosis among older adults admitted to complex continuing care: implications for the depression rating scale (DRS).Age Ageing. 2008; 37: 51-56
- Do Hawaii residents support physician-assisted death? A comparison of five ethnic groups.Hawaii Med J. 1998; 57: 529-534
- Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers.JAMA. 2000; 284: 2460-2468
- Desire for death in the terminally ill.Am J Psychiatry. 1995; 152: 1185-1191
- What lies behind the wish to hasten death? A systematic review and meta-ethnography from the perspective of patients.PLoS One. 2012; 7: e37117
- Why do older people oppose physician-assisted dying? A qualitative study.Palliat Med. 2014; 28: 353-359
- The desire to hasten death: using grounded theory for a better understanding “When perception of time tends to be a slippery slope”.Palliat Med. 2015; 29: 711-719
- What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care.BMC Palliat Care. 2014; 13: 38
- The meaning in life questionnaire.J Couns Psychol. 2006; 53: 80-93
- Existential depression: a nonpathological and philosophical-existential approach.J Humanist Psychol. 2019;
- The depressive dimension. From pathological depression to existential depression.Libreria Universitaria, Milan2018
- Life-Sustaining treatment and assisted death choices in depressed older patients.J Am Geriatr Soc. 2001; 49: 153-161
- Preferences for voluntary euthanasia during major depression and following improvement in an elderly population.Australas J Ageing. 1997; 16: 3-7
- Desire for hastened death: how do professionals in specialized palliative care react?.Psychooncology. 2016; 25: 536-543
- Responding to desire to die statements from patients with advanced disease: recommendations for health professionals.Palliat Med. 2006; 20: 703-710
- Responding to requests for physician-assisted suicide: “These are uncharted waters for both of us …”.JAMA. 2002; 288: 91-98
- Clinical practice guidelines for the psychosocial care of adults with cancer.Psychooncology. 2005; 14: 159-173
- Psychotherapy at the end of life.Am J Bioeth. 2019; 19: 19-28
- Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death.J Clin Oncol. 2010; 28: 445-452
- The Royal College of Nursing guidance on responding to a request to hasten death.Int J Palliat Nurs. 2011; 17: 578-579
- Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care.BMJ. 2007; 335: 184-187
- Desire to die in terminally ill people: a framework for assessment and intervention.Health Soc Work. 1999; 24: 260-268
- Trajectories of care at the end of life in New Zealand.(Available from)https://www.interrai.co.nz/news/presentations/trajectories/Date accessed: February 22, 2020
- 2018 census population and dwelling counts.(Available from)https://www.stats.govt.nz/information-releases/2018-census-population-and-dwelling-countsDate accessed: March 19, 2020
- The euthanasia debate: synthesising the evidence on New Zealander's attitudes.Kōtuitui. 2019; 14: 1-21
- Demographic and psychological correlates of New Zealanders' support for euthanasia.N Z Med J. 2017; 130: 9-17
Published online: April 16, 2020
Accepted: April 3, 2020
© 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.