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Am J Psychiatry 1995; 152:1185-1191
Copyright © 1995 by American Psychiatric Association
Desire for death in the terminally ill
HM Chochinov, KG Wilson, M Enns, N Mowchun, S Lander, M Levitt and JJ Clinch
Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
OBJECTIVE: Euthanasia and physician-assisted suicide have become prominent
medical and social issues. This study investigated the prevalence of the
desire for death in terminally ill patients, the stability of this desire
over time, and its association with psychiatric disorders. METHOD: Two
hundred terminally ill inpatients were given semistructured interviews that
assessed their desire for death and evaluated them for major and minor
depressive episodes according to the Research Diagnostic Criteria. Each
patient also completed a short form of the Beck Depression Inventory and
provided ratings of pain and social support. When possible, patients who
expressed a desire for death received a follow-up interview after a 2- week
interval. RESULTS: Although occasional wishes that death would come soon
were common (reported by 44.5% of the patients), only 17 (8.5%) of these
individuals acknowledged a serious and pervasive desire to die. The desire
for death was correlated with ratings of pain and low family support but
most significantly with measures of depression. The prevalence of diagnosed
depressive syndromes was 58.8% among patients with a desire to die and 7.7%
among patients without such a desire. Follow-up interviews were conducted
with six patients; in four cases, the desire to die had decreased during
the 2-week interval. CONCLUSIONS: The desire for death in terminally ill
patients is closely associated with clinical depression--a potentially
treatable condition-- and can also decrease over time. Informed debate
about euthanasia should recognize the importance of psychiatric
considerations, as well as the inherent transience of many patients'
expressed desire to die.
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