Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Cohen, L. M. Articles by Fischel, S. V. Search for Related Content PubMed Citation Articles by Cohen, L. M. Articles by Fischel, S. V. Syndromes Secondary to General Medical Disorders

Psychiatric Evaluation of Death-Hastening Requests

Lessons From Dialysis Discontinuation

Received July 12, 1999; revised November 9, 1999; accepted July 12, 1999. From the Baystate Medical Center, Department of Psychiatry, Springfield, MA; the Long Island Jewish Medical Center, NY; the Albert Einstein Medical Center, PA; and the Portland VA Medical Center, OR. Address reprint requests to Dr. Cohen, Baystate Medical Center, Department of Psychiatry, Springfield, MA 01199.

The authors aim to facilitate the psychiatric evaluation of death-hastening decisions, such as cessation of life-support treatment or physician-assisted suicide, by deriving principles for evaluating patients from a literature review and a recently completed prospective study on dialysis discontinuation conducted by consultation psychiatrists. Factors are delineated and suggestions are provided for the evaluation of requests to accelerate dying. Included are the authors' method for determining major depression in the context of terminal illness and their "vector analysis" in assessing patient requests to stop dialysis. As our society heatedly examines the care provided to the terminally ill, psychiatry also needs to reconsider whether actions that foreshorten life can be normative and permissible. Familiarity with competency, psychiatric diagnosis, and ease in communication and negotiation between patient, family, and staff are resources that psychiatrists can bring to these complicated assessments. Challenging areas include diagnosing depression, establishing the adequacy of palliative care, and appreciating issues related to personality features, family dynamics, and ethnic differences.

Key Words: Death and Dying • Dialysis

This article has been cited by other articles:

				P. L Hudson, L. J Kristjanson, M. Ashby, B. Kelly, P. Schofield, R. Hudson, S. Aranda, M. O'Connor, and A. Street Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review. Palliative Medicine, October 1, 2006; 20(7): 693 - 701. [Abstract] [PDF]

				L. M. Cohen, M. J. Germain, and D. M. Poppel Practical Considerations in Dialysis Withdrawal: "To Have That Option Is a Blessing" JAMA, April 23, 2003; 289(16): 2113 - 2119. [Abstract] [Full Text] [PDF]

				L. M. Cohen, S. K. Dobscha, K. C. Hails, P. S. Pekow, and H. M. Chochinov Depression and Suicidal Ideation in Patients Who Discontinue the Life-Support Treatment of Dialysis Psychosom Med, November 1, 2002; 64(6): 889 - 896. [Abstract] [Full Text] [PDF]

Get information about faster international access.

Privacy Policy

Copyright © 2000 Academy of Psychosomatic Medicine. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us