Melinda A. Lee

Legalizing Assisted Suicide — Views of Physicians in Oregon

BACKGROUND Since the Oregon Death with Dignity Act was passed in November 1994, physicians in Oregon have faced the prospect of legalized physician-assisted suicide. We studied the attitudes and current practices of Oregon physicians in relation to assisted suicide. METHODS From March to June 1995, we conducted a cross-sectional mailed survey of all physicians who might be eligible to prescribe a lethal dose of medication if the Oregon law is upheld. Physicians were asked to complete and return a confidential 56-item questionnaire. RESULTS Of the 3944 eligible physicians who received the questionnaire, 2761 (70 percent) responded. Sixty percent of the respondents thought physician-assisted suicide should be legal in some cases, and nearly half (46 percent) might be willing to prescribe a lethal dose of medication if it were legal to do so; 31 percent of the respondents would be unwilling to do so on moral grounds. Twenty-one percent of the respondents have previously received requests for assisted suicide, and 7 percent have complied. Half the respondents were not sure what to prescribe for this purpose, and 83 percent cited financial pressure as a possible reason for such requests. The respondents also expressed concern about complications of suicide attempts and doubts about their ability to predict survival at six months accurately. CONCLUSIONS Oregon physicians have a more favorable attitude toward legalized physician-assisted suicide, are more willing to participate, and are currently participating in greater numbers than other surveyed groups of physicians in the United States. A sizable minority of physicians in Oregon objects to legalization and participation on moral grounds. Regardless of their attitudes, physicians had a number of reservations about the practical applications of the act.

Physician Orders for Life-Sustaining Treatment (POLST): Outcomes in a PACE Program

OBJECTIVES: To evaluate whether terminal care was consistent with Physician Orders for Life‐Sustaining Treatment (POLST), a preprinted and signed doctors order specifying treatment instructions in the event of serious illness for CPR, levels of medical intervention, antibiotics, IV fluids, and feeding tubes.

Depression and Mortality in Medically Ill Older Adults

OBJECTIVE: To determine if major depressive disorder influences the survival of older, medically ill veterans.

Depression in the Elderly: Effect on Patient Attitudes toward Life-Sustaining Therapy

Objective: To determine the effect of depression on preferences for life‐sustaining therapy in older persons.

Oregon's Physician-Assisted Suicide Legislation: Troubling Issues for Families

An individual autonomy framework, rather than a family framework, has prevailed in the national debate about physician-assisted suicide for the terminally ill. However, the separation of individual andfamily is artificial in the context of life-threatening illness. This article describesfamily issues when terminally ill patients consider physician-assisted suicide. Issues includefamily roles, motives, disagreements, and grief; the problems of misuse of a lethal prescriptive; and failed suicide attempts. For multiple reasons described, thefamilyperspectiveis needed in debates about physician-assisted suicide.

The PSDA and treatment refusal by a depressed older patient committed to the state mental hospital

Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting.