Originally published as JCO Early Release 10.1200/JCO.2005.14.308 on August 22 2005

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Euthanasia and Depression: A Prospective Cohort Study Among Terminally Ill Cancer Patients

From the Department of Clinical Psychology, Utrecht University; Departments of Gynecology and Medical Oncology, University Medical Center Utrecht, Utrecht; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

Address reprint requests to M.L. van der Lee, Clinical Psychology, Faculty Social Sciences, University Utrecht, PO Box 80140, 3508 TC Utrecht, the Netherlands; e-mail: m.l.vanderlee{at}erasmusmc.nl

PURPOSE: To study the association between depression and the incidence of explicit requests for euthanasia in terminally ill cancer patients.

PATIENTS AND METHODS: A prospective cohort study was conducted on 138 consecutive cancer patients with an estimated life expectancy of 3 months or less, in the period between September 1999 and August 2003. At inclusion, participants completed the Hospital Anxiety and Depression Scale. To identify "depressed mood" we used a cutoff score of 20. Kaplan-Meier curves and Cox regression analyses were used to assess the association between depressed mood and the risk of a request for euthanasia.

RESULTS: Of 138 patients, 32 patients had depressed mood at inclusion. Thirty patients (22%) made an explicit request for euthanasia. The risk to request euthanasia for patients with depressed mood was 4.1 times higher than that of patients without depressed mood at inclusion (95% CI, 2.0 to 8.5).

CONCLUSION: Depression in cancer patients with an estimated life expectancy of less than 3 months is associated with a higher likelihood to request for euthanasia. The question of whether depressed mood can adequately be treated in this terminally ill population, and if so, whether it would lower the incidence of requests for euthanasia needs further investigation.

Supported by the Research Institute for Psychology and Health, and by the Department of Gynecology, University Medical Center Utrecht. The funding sources had no involvement in the study design and conduct, collection, management, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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