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William Breitbart, MD; Barry Rosenfeld, PhD; Hayley Pessin, MA; Monique Kaim, PhD; Julie Funesti-Esch, RN; Michele Galietta, MA; Christian J. Nelson, MA; Robert Brescia, MD

JAMA. 2000;284:2907-2911.

Context  Understanding why some terminally ill patients desire a hastened death has become an important issue in palliative care and the debate regarding legalization of assisted suicide.

Objectives  To assess the prevalence of desire for hastened death among terminally ill cancer patients and to identify factors corresponding to desire for hastened death.

Design  Prospective survey conducted in a 200-bed palliative care hospital in New York, NY.

Patients  Ninety-two terminally ill cancer patients (60% female; 70% white; mean age, 65.9 years) admitted between June 1998 and January 1999 for end-of-life care who passed a cognitive screening test and provided sufficient data to permit analysis.

Main Outcome Measure  Scores on the Schedule of Attitudes Toward Hastened Death (SAHD), a self-report measure assessing desire for hastened death among individuals with life-threatening medical illness.

Results  Sixteen patients (17%) were classified as having a high desire for hastened death based on the SAHD and 15 (16%) of 89 patients met criteria for a current major depressive episode. Desire for hastened death was significantly associated with a clinical diagnosis of depression (P = .001) as well as with measures of depressive symptom severity (P<.001) and hopelessness (P<.001). In multivariate analyses, depression (P = .003) and hopelessness (P<.001) provided independent and unique contributions to the prediction of desire for hastened death, while social support (P = .05) and physical functioning (P = .02) added significant but smaller contributions.

Conclusions  Desire for hastened death among terminally ill cancer patients is not uncommon. Depression and hopelessness are the strongest predictors of desire for hastened death in this population and provide independent and unique contributions. Interventions addressing depression, hopelessness, and social support appear to be important aspects of adequate palliative care, particularly as it relates to desire for hastened death.

Author Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY (Drs Breitbart and Kaim, Mss Pessin and Funesti-Esch, and Mr Nelson); Department of Psychology, Fordham University, Bronx, NY (Dr Rosenfeld and Ms Galietta); and the Palliative Care Institute, Calvary Hospital, Bronx, NY (Dr Brescia).

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