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Attitudes of Elderly Patients and Their Families Toward Physician-Assisted Suicide

Harold G. Koenig, MD, MHSc; Diane Wildman-Hanlon, MSW; Kenneth Schmader, MD
Arch Intern Med. 1996;156(19):2240-2248. doi:10.1001/archinte.1996.00440180104013.
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Objectives:  To examine and compare attitudes of elderly outpatients and their families toward physician-assisted suicide (PAS), explore sociodemographic and health correlates of these attitudes, assess family members' ability to predict patients' attitudes toward PAS, and determine family members' ability to agree on these predictions.

Subjects and Methods:  Elderly patients with medical and psychiatric problems (n=168; mean age, 75.8 years) who were attending a geriatrics specialty clinic, along with accompanying family members (n=146), were systematically surveyed on their attitudes toward PAS in case of terminal illness, chronic illness, and mental incompetence. Relatives were also asked to predict patients' responses to items on the questionnaire. Patients and relatives were blinded to each others' responses.

Results:  Favorable attitudes toward PAS were reported by 39.9% of the patients and 59.3% of the relatives (P<.001) in case of terminal illness, 18.2% and 25.3%, respectively, in case of chronic illness, 13.5% and 15.4%, respectively, in case of mental incompetence, and 34.0% and 55.6% (P<.001), respectively, for legalization of PAS. Family members showed a marginal ability to predict patients' attitudes toward PAS with κ values of agreement that ranged from 0.09 to 0.41. Family members also had difficulty agreeing with each other on how they thought patients would respond (range of κ values, 0.18-0.47). Patients who opposed PAS were women, black individuals, and those with less education, low incomes, and dementia or cognitive impairment.

Conclusions:  While many frail elderly patients favored PAS in cases of terminal illness, the proportion that opposed it was significantly higher than that among relatives; relatives, in turn, displayed only a marginal ability either to predict patients' attitudes or to agree among themselves. Patients who oppose PAS represent a particularly vulnerable element of society (elderly persons, women, black individuals, and poor, uneducated, and demented persons), and such patients may warrant special protection.Arch Intern Med. 1996;156:2240-2248


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