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One in four Oregonians who seek to end their lives with a legally prescribed drug overdose may be clinically depressed.

The study, by researchers at Oregon Health & Science University, evaluated 58 terminally ill patients who considered ending their lives under Oregon’s unique law. Eighteen received a prescription. Nine died by taking the drug, including three who met criteria for a diagnosis of depression.

Although the number is small, the study concluded that “the current practice of the Death With Dignity Act may fail to protect some patients whose choices are influenced by depression.” The findings appear in the British Medical Journal.

Proponents and opponents of the Oregon law split predictably on the findings. Proponents said the usual measures of depression don’t work accurately in very sick people at the end of their lives. Opponents said the results point to a fundamental flaw in the law.

Depression in the very sick “has stood as one of the difficult issues to address” in the passionate debate about what some call physician-assisted suicide and others call hastened death, said Dr. Linda Ganzini, a psychiatrist at OHSU, who led the study.

Depression, as defined in the study, is not merely a feeling of sadness. It means feeling “sad or blue and unable to experience pleasure almost all of the time for two weeks,” Ganzini said. “That’s different from someone getting unfortunate news and feeling intermittent sadness.”

The line between sadness and depression — difficult to draw in physically healthy people — is doubly so in dying patients.

For example, the study asked patients whether they had been bothered by “thinking about death” during the previous two weeks.

“Give me a break,” said Steve Hopcraft, a spokesman for Compassion & Choices, an advocacy group that works with most patients who end their lives under the Oregon law. “Is that kind of depression affecting their choice of aid in dying? Duh!”

Critics of the law warned that the study might have underestimated depression.

“At best, it’s what they say — three out of 58 patients, said Dr. Charles Bentz, an internist in Beaverton and president of Physicians for Compassionate Care, a doctors group opposing the Oregon law. “At worst, this is just the tip of the iceberg.”

The finding is timely for two reasons. None of the 46 Oregonians who died last year by taking a lethal prescription was evaluated by a psychiatrist or a psychologist, according to state figures. And voters in Washington state are considering a November ballot measure modeled on Oregon’s law.

Oregon is the only state where it is legal for a doctor to prescribe a drug overdose intended to end a terminally ill patient’s life. The patient must make one written and two oral requests 15 days apart. Two doctors must affirm that the patient has unimpaired judgment, and the patient must undergo a psychological evaluation if either doctor suggests it.

A total of 341 Oregonians have ended their lives that way.

Ganzini said she hopes her study will lead doctors to improve screening for depression in such patients.

All the patients in the study had either requested a lethal prescription from a doctor or sought help in ending their lives from Compassion & Choices of Oregon between 2004 and 2006.

A psychologist interviewed each patient at home. While 15 out of the 18 patients who received a lethal prescription did not show signs of depression, researchers concluded that doctors should be more rigorous in screening for it.

Three terminally ill patients with depression is “very low,” especially given the study’s methodology, said Barbara Coombs Lee, a nurse who helped draft the law and who is president of Compassion & Choices. Lee criticized the study’s use of standardized tests designed to measure depression in otherwise healthy people.

She called on psychiatrists to develop “a better tool, designed for people dying of cancer.”

Whether a person has a “sunny outlook,” she said, is the wrong question to ask of a patient facing a terminal illness. “They’re sad, and they have a right to be sad.”

The key question, she said, is whether they have the judgment to make an informed decision.

Among the limitations of their study, researchers noted, their test for depression “carries the risk of inflating the prevalence of depressive disorder.” That’s because it attributes physical symptoms such as weight loss, fatigue and insomnia to possible depression, rather than to terminal cancer.

“If you count weight loss as a symptom of depression in a patient with terminal cancer, you’re going to end up with a skewed study,” Lee said.

Bentz, of Physicians for Compassionate Care, says the Oregon law makes it too easy for despondent patients to seek a life-ending pill — and too easy for a doctor to prescribe one. He calls that “medical killing.”

Depression is a treatable illness, Bentz said. The proper role of a doctor is not to tell a depressed patient, “Oh, you’re suicidal? Here’s your pill,” he said. It is to say, “Oh, you’re suicidal. Let’s find out why.”
[Don Colburn, The Oregonian, 7October 2008]


Study: Quarter of Oregon Assisted Suicide Victims Depressed, But Still Got Drugs
A new study shows about one-fourth of the people killed in assisted suicides in Oregon were depressed, yet they received lethal cocktails anyway.

Researchers at the Oregon Health and Science University conducted the study and skeptic say it shows the guidelines in the assisted suicide law don’t work. Psychiatrist Linda Ganzini, the lead author of the study, says the results show doctors need to do a better job of screening for depression before allowing an assisted suicide to go forward.

But Wesley J. Smith, an author and attorney who is a leading euthanasia watchdog, says the guidelines in the law only a way for assisted suicide proponents to make citizens feel safeguards are in place. “As I have repeatedly pointed out, the guidelines are not actually there to protect the vulnerable, but merely to give the appearance of control,” he said in response to the study.

“And if one doctor says no, the patient just goes doctor shopping until one is found who will prescribe–usually referred by [pro-euthanasia] Compassion and Choices,” Smith says.

“So, there is no protection of depressed patients in Oregon, and none is really intended.”

[8Oct08, Washington, DC,