Quality of life and depression: Attitudes toward physician -assisted suicide in patients with AIDS

Physician-assisted suicide is an important issue for contemporary medical and mental health professionals. The right to decide the time and manner of one's own death has become an important moral, legal and medical dilemma. Of pressing concern is the question of who is qualified to make end-of-life decisions and on what basis is such a decision made. Surveys of physicians, patients and the general public have supported right-to-die lobbying for individuals who are terminally ill. However, research suggests individuals with a terminal illness may be unlikely to request physician-assisted suicide. Quality of life considerations may vary across individuals and the relationship between medical illness, quality of life, and depression is unclear. The present study investigated the predictive value of quality of life on attitudes toward physician-assisted suicide above and beyond depression in patients with AIDS. Sixty outpatient men and women with a diagnosis of AIDS completed self-administered questionnaires regarding depression, health-related quality of life, life satisfaction, reasons for living and physician-assisted suicide. Attitudes toward physician-assisted suicide were significantly correlated with non-health-related quality of life factors and reasons for living. In predicting attitudes toward physician-assisted suicide, life satisfaction accounted for a significant amount of the variance independent of depression. Subjects who reported less satisfaction with their quality of life were more likely to approve of physician-assisted suicide. Reasons for living such as moral objections and responsibility to family also contributed significantly to subjects' attitudes toward physician-assisted suicide. Surprisingly, depression and health status did not account for any of the variance in subjects' attitudes toward physician-assisted suicide. The debate over legalization of physician-assisted suicide in recent years has lead to an increase in research focusing on factors that influence a person's decision to consider physician-assisted suicide. In end-of-life decision-making, quality of life considerations are a common practice for evaluating termination of life decisions. When discussing end-of-life decisions with patients, results of the present study suggest it is important to consider the patient's quality of life issues and personal reasons for living. The role mental health providers may play in end-of-life care and decision-making for patients with a terminally illness is also emphasized.