Desire for Hastened Death Among Patients With Advanced AIDS (original) (raw)
Related papers
American Journal of Psychiatry, 1999
As physician-assisted suicide is debated, a need for standardized measurement of desire for death among medically ill individuals has emerged. The authors present preliminary validation data for a new self-report instrument, the Schedule of Attitudes Toward Hastened Death. Method: The participants were 195 patients with HIV/AIDS from two sites: 148 ambulatory patients and 47 patients who had been recently admitted to a facility for end-of-life care. The ambulatory participants completed the 20-item Schedule of Attitudes Toward Hastened Death and several other instruments, including the Beck Depression Inventory and Brief Symptom Inventory. The terminally ill patients also completed the Schedule of Attitudes Toward Hastened Death, along with other measures, and were assessed by clinicians with the Hamilton Depression Rating Scale and the Desire for Death Rating Scale, a global clinician rating of the patient's desire for death. Results: The Schedule of Attitudes Toward Hastened Death demonstrated high reliability. The total score significantly correlated with the clinician rating on the Desire for Death Rating Scale and with ratings of depression and psychological distress. In addition, the Schedule of Attitudes Toward Hastened Death score significantly correlated with pain intensity and physical symptom distress. Factor analysis supported a single factor structure for the instrument. Conclusions: These results indicate that the Schedule of Attitudes Toward Hastened Death is a reliable, valid measure of desire for death among patients with HIV/AIDS. Further research with this measure may help address many of the unanswered questions emerging from the ongoing debates regarding legalization of assisted suicide.
Impact of Treatment for Depression on Desire for Hastened Death in Patients With Advanced AIDS
Psychosomatics, 2010
Objective: Authors assessed the impact of treatment for depression on desire for hastened death in patients with advanced AIDS. Method: Patients with advanced AIDS (Nϭ372) were interviewed shortly after admission to a palliative-care facility, and were reinterviewed monthly for the next 2 months. Patients diagnosed with a major depressive syndrome were provided with antidepressant treatment and reinterviewed weekly. Desire for hastened death was assessed with two questionnaire measures. Results: Desire for death was highly associated with depression, and it decreased dramatically in patients who responded to antidepressant treatment. Little change in desire for hastened death was observed in patients whose depression did not improve. Although improved depression was not significantly associated with the use of antidepressant medication, those individuals prescribed antidepressant medication showed the largest decreases in desire for hastened death. Discussion: Successful treatment for depression appears to substantially decrease desire for hastened death in patients with advanced AIDS. The authors discuss implications of these findings for palliative-care treatment and the physician-assisted suicide debate.
Cancer, 2000
BACKGROUND. The authors examined the reliability and validity of the Schedule of Attitudes toward Hastened Death (SAHD), a self-report measure of desire for death previously validated in a population of individuals with the acquired immunodeficiency syndrome (AIDS), among terminally ill patients with cancer. METHODS. The authors interviewed 92 terminally ill cancer patients, all with a life expectancy of Ͻ 6 months, after admission to a palliative care hospital. Patients were administered the SAHD, a clinician-rated measure of desire for death (the Desire for Death Rating Scale [DDRS]), and several measures of physical and psychosocial well-being. RESULTS. The average number of SAHD items endorsed was 4.76 (standard deviation, 4.3); 15 patients (16.3%) endorsed Ն 10 items, indicating a high desire for death. Internal consistency was strong (coefficient ␣ ϭ 0.88, median item-total correlation ϭ 0.49), as were indices of convergent validity. Total SAHD scores were correlated significantly (correlation coefficient [r] ϭ 0.67) with the DDRS, and somewhat less so with measures of depression (r ϭ 0.49) and hopelessness (r ϭ 0.55). Lower, but substantial, correlations were observed between the SAHD and measures of spiritual well-being (r ϭ Ϫ0.42), quality of life (r ϭ Ϫ0.36), physical symptoms (r ϭ 0.38), and symptom distress (r ϭ 0.38). No significant correlation was observed between SAHD scores and social support (r ϭ Ϫ0.06) or pain intensity (r ϭ 0.16); however, pain-related functional interference and overall physical functioning were correlated significantly with SAHD scores (r ϭ 0.31 and r ϭ Ϫ0.23, respectively). CONCLUSIONS. The SAHD appears to be a reliable and valid measure of desire for death among terminally ill cancer patients. Coupled with previous research in patients with AIDS, these results support the utility of the SAHD for research addressing interest in hastened death in patients with a life-threatening medical illness.
Psychosomatics, 2004
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.
Division of Research and Commercialisation, 2004
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.
The schedule of attitudes toward hastened death
Cancer, 2000
BACKGROUND. The authors examined the reliability and validity of the Schedule of Attitudes toward Hastened Death (SAHD), a self-report measure of desire for death previously validated in a population of individuals with the acquired immunodeficiency syndrome (AIDS), among terminally ill patients with cancer. METHODS. The authors interviewed 92 terminally ill cancer patients, all with a life expectancy of Ͻ 6 months, after admission to a palliative care hospital. Patients were administered the SAHD, a clinician-rated measure of desire for death (the Desire for Death Rating Scale [DDRS]), and several measures of physical and psychosocial well-being. RESULTS. The average number of SAHD items endorsed was 4.76 (standard deviation, 4.3); 15 patients (16.3%) endorsed Ն 10 items, indicating a high desire for death. Internal consistency was strong (coefficient ␣ ϭ 0.88, median item-total correlation ϭ 0.49), as were indices of convergent validity. Total SAHD scores were correlated significantly (correlation coefficient [r] ϭ 0.67) with the DDRS, and somewhat less so with measures of depression (r ϭ 0.49) and hopelessness (r ϭ 0.55). Lower, but substantial, correlations were observed between the SAHD and measures of spiritual well-being (r ϭ Ϫ0.42), quality of life (r ϭ Ϫ0.36), physical symptoms (r ϭ 0.38), and symptom distress (r ϭ 0.38). No significant correlation was observed between SAHD scores and social support (r ϭ Ϫ0.06) or pain intensity (r ϭ 0.16); however, pain-related functional interference and overall physical functioning were correlated significantly with SAHD scores (r ϭ 0.31 and r ϭ Ϫ0.23, respectively). CONCLUSIONS. The SAHD appears to be a reliable and valid measure of desire for death among terminally ill cancer patients. Coupled with previous research in patients with AIDS, these results support the utility of the SAHD for research addressing interest in hastened death in patients with a life-threatening medical illness. Cancer 2000;88:2868 -75.
The Desire for Hastened Death in Patients with Metastatic Cancer
Journal of Pain and Symptom Management, 2007
A substantial minority of patients in palliative care settings report a high desire for hastened death (DHD), in association with physical and emotional distress, low social support, and impaired spiritual well being. To clarify to what extent DHD emerges in association with suffering prior to the end of life, we determined its prevalence and correlates in ambulatory patients with metastatic cancer, the majority of whom had an expected survival of >6 months. We hypothesized that DHD in this sample would be directly linked to physical and psychological distress, and inversely related to perceived social support, self-esteem, and spiritual well being. Three hundred twenty-six outpatients completed the Schedule of
Patient Requests for Euthanasia and Assisted Suicide in Terminal Illness
Psychosomatics, 1995
Psychosocial assessment and treatment are critical elements of care for terminally jJJ patients who desire hastened death. Most patients, in saying that they want to die, are asking for assistance in living-for help in dealing with depression, anxiety about the future, grief, lack ofcontrol, dependence, physical suffering, and spiritual despair. In this article, the authors review current understandings of the psychiatric aspects of requests by terminally jJJ patients for assisted suicide and euthanasia; describe an approach to the common problems ofphysical, psychological, social, and spiritual suffering encountered in managing dying patients; and elaborate the functions of the psychiatrist in addressing these problems.