Psychosomatics 45:311-318, August 2004
© 2004 The Academy of Psychosomatic Medicine
Association Between Clinician Factors and a Patient's Wish to Hasten Death: Terminally Ill Cancer Patients and Their Doctors
Brian J. Kelly, F.R.A.N.Z.C.P., Ph.D.,
Paul C. Burnett, Ph.D.,
Dan Pelusi, M.Clin.Psych.,
Shirlene J. Badger, B.A.,
Francis T. Varghese, F.R.A.N.Z.C.P., and
Marguerite M. Robertson, F.A.Ch.P.M.
Received April 30, 2003; revision received Oct. 21, 2003; accepted Nov. 24, 2003. From the Centre for Rural and Remote Mental Health, University of Newcastle; the Centre for Research and Graduate Training, Charles Sturt University, Wagga Wagga, N.S.W., Australia; the Department of Psychiatry, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; and the Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, St. Lucia, Queensland, Australia. Address reprint requests to Dr. Kelly, Centre for Rural and Remote Mental Health, University of Newcastle, Orange, 2800, N.S.W., Australia; brian.kelly{at}mwahs.nsw.gov.au (e-mail).
This study investigated the clinical factors associated with a wish to hasten death among patients with advanced cancer receiving palliative care, with a focus on the role of clinician-related factors. Patients were grouped into high- and low-scoring groups on the basis of their wish to hasten death; doctor-patient pairs were formed. Questionnaire data collected from patients and their treating doctors were subjected to multivariate analysis. Significant predictors of a high wish to hasten death in terminally ill patients from among treating clinicians included the clinician's perception of the patient's lower optimism and greater emotional suffering, the patient indicating a wish to hasten death, the doctor willing to assist the patient in hastening death (if requested and legal), and the doctor reporting less training in psychotherapy. When these variables were combined with patient factors identified in a previous study, the model significantly predicted a wish to hasten death with the following variables—patient factors: a higher perceived burden on others, higher depressive symptom scores, and lower family cohesion; physician factors: the doctor willing to assist the patient in hastening death (if requested and legal), the doctor's perception of lower levels of optimism and greater emotional distress in the patient, and the doctor having less training in psychotherapy; and the setting of care: recent admission to a hospice. The findings support the multifactorial influences on the wish to hasten death and suggest that the role of the clinician is a vital context within which the wish to hasten death should be considered.
Key Words: suicide • interviews • depression • other ethics issues
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