Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer | Depressive Disorders | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Ganzini L, Nelson HD, Schmidt TA.  et al.  Physician's experiences with the Oregon Death With Dignity Act.  N Engl J Med.2000;342:557-563.Google Scholar
Sullivan AD, Hedberg K, Fleming DA. Legalized physician-assisted suicide in Oregon—the second year.  N Engl J Med.2000;342:598-604.Google Scholar
Meier DE, Emmons C-A, Wallenstein S.  et al.  A national survey of physician-assisted suicide and euthanasia in the United States.  N Engl J Med.1998;338:1193-1201.Google Scholar
Foley KM. Competent care for the dying instead of physician-assisted suicide.  N Engl J Med.1997;336:54-58.Google Scholar
Hendin H, Klerman G. Physician-assisted suicide: the dangers of legalization.  Am J Psychiatry.1993;150:143-145.Google Scholar
Rosenfeld B. Depression, assisted suicide and the right to die.  Psychol Public Policy Law.In press.Google Scholar
Brown JH, Henteleff P, Barakat S, Rowe CJ. Is it normal for terminally ill patients to desire death?  Am J Psychiatry.1986;143:208-211.Google Scholar
Chochinov HM, Wilson KG, Enns M.  et al.  Desire for death in the terminally ill.  Am J Psychiatry.1995;152:1185-1191.Google Scholar
Rosenfeld B, Breitbart W, Stein K.  et al.  Measuring desire for death among patients with HIV/AIDS: the Schedule of Attitudes Toward Hastened Death.  Am J Psychiatry.1999;156:94-100.Google Scholar
Rosenfeld B, Breitbart W, Galietta M.  et al.  The Schedule of Attitudes Toward Hastened Death: measuring desire for death in terminally ill cancer patients.  Cancer.2000;88:2868-2875.Google Scholar
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method of grading the cognitive state of patients for the clinician.  J Psychiatr Res.1975;12:189-198.Google Scholar
Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders-Nonpatient Edition (SCID-NP) Version 2.0New York, NY: Biometrics Research Department, New York State Psychiatric Institute; 1996.
Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry.1960;23:56-61.Google Scholar
Beck AT, Weissman A, Lester D.  et al.  The measurement of pessimism: the Beck Hopelessness Scale.  J Consult Clin Psychol.1974;42:861-865.Google Scholar
Broadhead WE, Gehlbach SH, De Gruy FV.  et al.  The Duke-UNC Functional Social Support Questionnaire: measurement of social support in family medicine patients.  Med Care.1988;26:709-723.Google Scholar
Brady MJ, Peterman AH, Fitchett G.  et al.  A case for including spirituality in quality of life measurement in oncology.  Psychooncology.1999;8:417-428.Google Scholar
Cleeland CS. Measurement of pain by subjective report. In: Chapman CR, Loeser JD, eds. Advances in Pain Research and Therapy, XXII: Issues of Pain Measurement. New York, NY: Raven Press; 1989:391-403.
Portenoy R, Thaler HT, Kornblith AB.  et al.  The Memorial Symptom Assessment Scale: an instrument for evaluation of symptom prevalence, characteristics and distress.  Eur J Cancer.1994;30A:1326-1336.Google Scholar
Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM, ed. Evaluation of Chemotherapeutic Agents. New York, NY: Columbia University Press; 1949:191-205.
Cohen SR, Mount BF, Strobel MG.  et al.  The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease.  Palliat Med.1995;9:207-219.Google Scholar
Serlin RC, Mendoza TR, Nakamura Y.  et al.  When is cancer pain mild, moderate or severe? grading pain severity by its interference with function.  Pain.1995;61:277-284.Google Scholar
Breitbart W, Rosenfeld B, Passik S. Interest in physician assisted suicide among ambulatory HIV-infected patients.  Am J Psychiatry.1996;153:238-242.Google Scholar
Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR. Euthanasia and physician assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public.  Lancet.1996;347:1805-1810.Google Scholar
Chochinov HM, Wilson KG, Enns M, Lander S. Depression, hopelessness, and suicidal ideation.  Psychosomatics.1998;39:366-370.Google Scholar
Ganzini L, Johnston WS, McFarland BH.  et al.  Attitudes of patients with amyotrophic lateral sclerosis and their care givers toward assisted suicide.  N Engl J Med.1998;339:967-973.Google Scholar
Block SD. Assessing and managing depression in the terminally ill patient.  Ann Intern Med.2000;132:209-218.Google Scholar
Moorey S, Greer S, Bliss J, Law M. A comparison of adjuvant psychosocial therapy and supporting counseling in patients with cancer.  Psychooncology.1998;7:218-228.Google Scholar
Spiegel D. Essentials of psychotherapy intervention for cancer patients.  Support Care Cancer.1995;3:252-256.Google Scholar
Rousseau P. Spirituality and the dying patient.  J Clin Oncol.2000;18:2000-2002.Google Scholar
Original Contribution
December 13, 2000

Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer

Author Affiliations

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).

JAMA. 2000;284(22):2907-2911. doi:10.1001/jama.284.22.2907

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.