On the basis of reports by nurses, patients in hospice care who voluntarily choose to refuse food and fluids are elderly, no longer find meaning in living, and usually die a "good" death within two weeks after stopping food and fluids.

Oregon legalized physician aid in dying over 10 years ago but little is known about the effects of this choice on family members' mental health. We surveyed 95 family members of decedent Oregonians who had explicitly requested aid in dying, including 59 whose loved one received a lethal prescription and 36 whose loved one died by lethal ingestion. For comparison purposes, family members of Oregonians who died of cancer or amyotrophic lateral sclerosis also were surveyed. A mean of 14 months after death, 11% of family members whose loved one requested aid in dying had major depressive disorder, 2% had prolonged grief, and 38% had received mental health care. Among those whose family member requested aid in dying, whether or not the patient accessed a lethal prescription had no influence on subsequent depression, grief, or mental health services use; however, family members of Oregonians who received a lethal prescription were more likely to believe that their loved one's choices were honored and less likely to have regrets about how the loved one died. Comparing family members of those who requested aid in dying to those who did not revealed no differences in primary mental health outcomes of depression, grief, or mental health services use. Family members of Oregonians who requested aid in dying felt more prepared and accepting of the death than comparison family members. In summary, pursuit of aid in dying does not have negative effects on surviving family members and may be associated with greater preparation and acceptance of death.

Objective This study’s objective was to evaluate the effect of two common components of meditation (mindfulness and slow breathing) on potential mechanistic pathways. Methods 102 combat veterans with posttraumatic stress disorder (PTSD) were randomized to: 1) the body scan mindfulness meditation (MM), 2) slow breathing (SB) with a biofeedback device, 3) mindful awareness of the breath with an intention to slow the breath (MM+SB), or 4) sitting quietly (SQ). Participants had six weekly one-on-one sessions with 20 minutes of daily home practice. The mechanistic pathways and measures were: 1) Autonomic Nervous System: hyperarousal symptoms, heart-rate (HR), heart-rate variability (HRV); 2) Frontal Cortex Activity: Attentional Network Task (ANT) conflict effect and event-related negativity, and intrusive thoughts; and 3) Hypothalamic-pituitary-adrenal axis: awakening cortisol. PTSD measures were also evaluated. Results Meditation participants had significant but modest within-group improvement in PTSD and related symptoms although there were no between-group effects. Perceived impression of PTSD symptom improvement was greater in the meditation arms compared to controls. Resting respiration decreased in the meditation arms compared to SQ. For the mechanistic pathways 1) Subjective hyperarousal symptoms improved within-group (but not between-group) for MM, MM+SB, and SQ while HR and HRV did not; 2) Intrusive thoughts decreased in MM compared to MM+SB and SB while the ANT measures did not change; and 3) MM had lower awakening cortisol within-group but not between-group. Conclusion Treatment effects were mostly specific to self-report rather than physiological measures. Continued research is needed to further evaluate mindfulness meditation’s mechanism in people with PTSD.