Journal of Clinical Oncology, Vol 20, Issue 8
(April), 2002: 2134-2141
© 2002 American Society for Clinical Oncology
Attitudes of Terminally Ill Cancer Patients About Euthanasia and Assisted Suicide: Predominance of Psychosocial Determinants and Beliefs Over Symptom Distress and Subsequent Survival
By Maria E. Suarez-Almazor,
Catherine Newman,
John Hanson,
Eduardo Bruera
From the Department of Medicine, Baylor College of Medicine, Houston Center for Utilization Studies and Quality of Care, Veterans Affairs Medical Center, and Department of Symptom Control and Palliative Care, M.D. Anderson Cancer Center, Houston, TX; and Palliative Care Unit, Grey Nuns Hospital, Edmonton, Alberta, Canada.
Address reprint requests to Maria E. Suarez-Almazor, MD, PhD, Health Services Research, Baylor College of Medicine, Veterans Affairs Medical Center (Station 152), 2002 Holcombe Blvd, Houston, TX 77030; email: mes{at}bcm.tmc.edu
PURPOSE: Although euthanasia and physician-assisted suicide (PAS) are controversial issues, the views of those most affected, terminal patients, are seldom explored. Our objective was to assess whether the attitudes about euthanasia/PAS of terminally ill cancer patients were determined by their symptomatic distress.
PATIENTS AND METHODS: We conducted a survey of 100 patients with terminal cancer. Statements related to the legalization of euthanasia/PAS were scored using Likert scales. We also asked patients how often they had considered ending their lives. Their responses were analyzed in relation to disease characteristics, including an assessment of symptomatic severity, sociodemographic features, general beliefs about the suffering of cancer patients, and survival.
RESULTS: Most patients (69%) supported euthanasia or PAS for one or more situations. The association between these attitudes and symptoms was weak, consistent in univariate analysis only for shortness of breath. No significant associations were observed with pain, nausea, well-being, loss of appetite, depression, or subsequent survival. Agreement with euthanasia was significantly related to male sex, lack of religious beliefs, and general beliefs about the suffering of cancer patients and their families. In multivariate analysis, the only characteristics that remained statistically associated with support were the strength of religious beliefs and the perception that patients with cancer are a heavy burden on their families. Frequency of suicidal ideation was associated with poor well-being, depression, anxiety, and shortness of breath, but not with other somatic symptoms such as pain, nausea, and loss of appetite.
CONCLUSION: Symptom intensity had limited impact on the attitudes about euthanasia of terminally ill cancer patients. Our findings suggest that patient views are primarily determined by psychosocial traits and beliefs, as opposed to disease severity or symptomatic distress.
The views expressed herein do not necessarily reflect those of the Department of Veterans Affairs.
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