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Keith G. Wilson, PhD; John F. Scott, MD, MDiv; Ian D. Graham, PhD; Jean F. Kozak, PhD; Susan Chater, MB; Raymond A. Viola, MD, MSc; Barbara J. de Faye, MA; Lynda A. Weaver, MHA; Dorothyann Curran, BA

Arch Intern Med. 2000;160:2454-2460.

Background  In jurisdictions that permit euthanasia or physician-assisted suicide, patients with cancer comprise the largest group to die by these methods. We investigated the personal attitudes toward these practices of patients receiving palliative care for advanced cancer.

Methods  Seventy patients (32 men and 38 women; median survival, 44.5 days) took part in a survey using in-depth semistructured interviews. The interviews were audiotaped for transcription and content analysis of themes.

Results  Most participants (73%) believed that euthanasia or physician-assisted suicide should be legalized, citing pain and the individual's right to choose as their major reasons. Participants who were opposed to legalization cited religious and moral objections as their central concerns. Forty (58%) of the 69 participants who completed the entire interview also believed that, if legal, they might personally make a future request for a hastened death, particularly if pain or physical symptoms became intolerable. Eight of these individuals (12%) would have made such a request at the time of the interview. These 8 participants differed from all others on ratings of loss of interest or pleasure in activities, hopelessness, and the desire to die (Ps<.02). They also had a higher prevalence of depressive disorders (P<.05). However, they did not differ on ratings of pain severity.

Conclusions  Many patients with advanced cancer favor policies that would allow them access to both euthanasia and physician-assisted suicide if pain and physical symptoms became intolerable. For patients who would actually make requests for a physician-hastened death, however, psychological considerations may be at least as salient as physical symptoms.

From the Institute for Rehabilitation Research and Development, The Rehabilitation Centre, Ottawa, Ontario (Dr Wilson and Ms Curran); University of Ottawa Institute of Palliative Care (Drs Wilson, Scott, Kozak, Chater, and Viola and Ms Weaver); Department of Medicine (Drs Wilson, Scott, Graham, Chater, and Viola), School of Psychology (Dr Wilson and Ms de Faye), and Department of Epidemiology and Community Medicine (Dr Graham), University of Ottawa; SCO Hospital, Ottawa (Drs Scott, Kozak, and Ms Weaver); Clinical Epidemiology Unit, Loeb Health Research Institute, The Ottawa Hospital (Dr Graham); Palliative Care Service, The Ottawa Hospital, Civic Campus (Dr Chater); and Palliative Care Service, The Ottawa Hospital, General Campus (Dr Viola).

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