Judith R. Gordon

Motivations for Physician-assisted Suicide

AbstractOBJECTIVE: To obtain detailed narrative accounts of patients’ motivations for pursuing physician-assisted suicide (PAS). DESIGN: Longitudinal case studies. PARTICIPANTS: Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individuals interested in PAS, as well as hospices and grief counselors. SETTING: Participants’ homes. MEASUREMENTS AND RESULTS: We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fatigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when planning PAS. CONCLUSIONS: Patients in this study engaged in PAS after a deliberative and thoughtful process. These motivating issues point to the importance of a broad approach in responding to a patient’s request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients’ concerns over time, and tailoring care accordingly.

The pursuit of physician-assisted suicide: role of psychiatric factors.

Physician-assisted suicide (PAS) has attracted considerable professional attention in recent years in the end-of-life care debate. The role of depression and other psychiatric illnesses on the patients pursuit of PAS is unclear. As part of a qualitative study exploring the motivations, deliberations, and complications experienced by persons with incurable diseases who were actively seeking PAS, we conducted semistructured interviews that were reviewed for psychiatric content. In total, 159 interviews were conducted with 60 participants concerning 12 prospective cases (12 patients and 20 family members) and 23 retrospective cases (28 family members), with more than 3600 pages of transcripts. Depressive symptoms, when present, were not described by the subjects and/or their family members to be an influential factor in their pursuit of PAS; no subject appeared or was described to suffer from depression-related decisional incapacity. Findings from this study, albeit from a small and self-selected sample, highlight not only the importance of avoiding a reductionistic understanding of the role of psychiatric illnesses in contributing to serious pursuit of PAS, but also the pressing need for scientifically rigorous studies of PAS in samples representative of the larger population.

Cognitive-Behavioral Group Counseling to Prevent HIV Transmission in Gay and Bisexual Men: Factors Contributing to Successful Risk Reduction

This study assessed the effectiveness of a 17-session HIV-prevention group intervention with gay and bisexual males. Participants were aged 18 years or older, had engaged in one or more instances of unprotected sex with other males during the preceding 12 months, and had responded to local publicity for a program to assist gay and bisexual men who were having difficulty being sexually safe. Following assessment, 159 individuals were matched and assigned to receive group counseling or remain in a wait-list condition. Treatment focused on skills training in coping with high-risk situations. The intervention appeared to be more effective with exclusively gay than with bisexual men. More positive outcomes were associated with safer behavioral patterns at baseline, higher self-efficacy for safer behavior, accurate personal assessment of HIV infection risk, the absence of alcohol/drug use in association with sex, and satisfaction with social support.

Preventing sexually transmitted diseases (STD) and HIV in women: Using multiple sources of data to inform intervention design

This article describes the process of developing a cognitive behavioral group intervention to help women at risk of HIV and other sexually transmitted diseases (STD) be sexually safer. Theory guided the intervention development, which integrated data on the target population from multiple sources: survey research that modeled sexual-safety decision making, a community advisory board, a needs assessment, and elicitation interviews with women at risk in our community. The article summarizes the information obtained from these sources, describes how we utilized this information to adapt a previously tested intervention for gay and bisexual men, uses case examples from pilot testing to illustrate clinical issues in implementation, and delineates major issues of concern for intervention research in this area. This paper provides a model for behavior therapists for integrating research data and community input in the design of interventions to address community problems.

Harm reduction psychotherapy comes out of the closet

Harm reduction psychotherapy gives a name to a practice many therapists have quietly been conducting for years. Some of us have been doing psychotherapy with clients who present with both psychological and addictive behavior problems, despite the ideological barriers that have promulgated total separation of these two sets of problems in terms of treatment philosophies, interventions, and providers. This article chronicles the authors evolution from viewing addictions as distinct from psychological problems to understanding and treating them as a subset of human behaviors causing suffering that can and should be integrated into a more comprehensive psychotherapeutic framework.