Attitudes toward Physician-Assisted Suicide among Persons with Multiple Sclerosis

Berkman, Cathy S.; Cavallo, Pamela F.; Chesnut, Walda C.; Holland, Nancy J.

doi:10.1089/jpm.1999.2.51

Cited by 17 publications

(10 citation statements)

References 56 publications

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“…3,14 One study showed that close to one-third of MS patients who participated in a mail questionnaire in Oregon through the National Multiple Sclerosis Society (NMSS), had thought about assisted suicide as an option for themselves, and would consider it under specific circumstances. 21 In the Netherlands, the reported cases of euthanasia have increased from 1984 to 1993, and it can be shown that the percentage of euthanasia was higher for patients with MS (5%) than for patients with malignant neoplasms (2%). 13 There is, so far, little literature about palliative care in MS. Ben-Zacharia and Lublin in 2001, summarised the need for comprehensive care, which includes medical treatment with disease modifying agents, symptomatic treatment and palliative care.…”

Section: Discussionmentioning

confidence: 99%

Palliative care in patients with severe multiple sclerosis: two case reports and a survey among German MS neurologists

Kümpfel

Hoffmann

Pöllmann³

et al. 2007

Palliat Med

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Due to its chronic and fluctuating time course, multiple sclerosis (MS), thus far, has not been regarded as a focus of palliative care. However, sometimes we are confronted with severely affected MS patients, who suffer from complex medical, physical and psychosocial problems, which are not fully covered by the current health care services. We present two cases of severely affected MS patients we saw in our outpatient MS clinic, and who, we believe, are candidates for palliative care. The first patient, with primary chronic progressive (pcP) MS for many years (Expanded Disability Status Scale (EDSS): 8.0) presented with complex painful dysaesthesias and a depressive syndrome. He refused any treatment, and finally committed suicide with the help of a euthanasia group in Switzerland. The second patient was also severely affected by a secondary chronic progressive (scP) MS (EDSS: 9.0) and was finally admitted to our palliative care unit due to a complex pain syndrome associated with panic attacks and anxiety. She spent three weeks on the palliative care unit and her symptoms improved gradually after changing and optimising her pain medication. The patient was discharged with home care and is seen regularly on the palliative care unit. Additionally, as a first step, a questionnaire was sent to 53 German MS specialists regarding their general view on the needs for palliative care in MS. Our two cases and the results of the questionnaire demonstrated that MS patients and their caregivers are confronted with a variety of symptoms which are difficult to treat, and are a cause of great suffering for the patients, including ataxia, depression and fatigue. The data of the questionnaire also showed that neurologists usually do not deal with end-of-life care issues in MS.More research is needed to define the role of palliative care in MS and establish appropriate interventions to improve the quality of life in advanced stage MS patients and their relatives.

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Section: Discussionmentioning

confidence: 99%

Palliative care in patients with severe multiple sclerosis: two case reports and a survey among German MS neurologists

Kümpfel

Hoffmann

Pöllmann³

et al. 2007

Palliat Med

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“…This finding helps shed light on the association between the wish to die and depression in end-stage disease. An association between the desire to hasten death and depression has been reported for people with end-stage cancer, [25][26][27] cancer pain, 28 HIV infection, 29 multiple sclerosis, 30 and in patients who request assistance in dying. 2 Our findings suggest caution in concluding that the desire to hasten dying is simply a feature of depression.…”

Section: Methodsmentioning

confidence: 99%

Wish to die in end-stage ALS

et al. 2005

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“…An association between the desire to hasten death and depression has been reported for people with end-stage cancer, [25][26][27] cancer pain, 28 HIV infection, 29 multiple sclerosis, 30 and in patients who request assistance in dying. 2 Our findings suggest caution in concluding that the desire to hasten dying is simply a feature of depression.…”

Section: Comparisons Between Patients Who Expressed a Wish To Die Butmentioning

confidence: 99%

Bilateral extraocular muscle metastasis from primary breast cancer

Peckham¹,

Giblen²,

Kim³

et al. 2005

Neurology

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Abstract-Background:In retrospective studies, estimates of hastened dying among seriously ill patients range from Ͻ2% in one national survey to as much as 20% in end-stage disease cohorts. Objective: To examine, in prospective studies, dying patients in the months before death, in order to understand the wish to die. Methods: Patients with advanced ALS with a high likelihood of death or need for tracheostomy within 6 months were identified. Patients were assessed monthly with an extensive psychosocial interview, including a diagnostic interview for depression. Family caregivers were interviewed on the same schedule and also after patient deaths. Results: Eighty patients with ALS were enrolled, 63% of eligible patients; 53 died over follow-up. Ten (18.9%) of the 53 expressed the wish to die, and 3 (5.7%) hastened dying. Patients expressing the wish to die did not differ in sociodemographic features, ALS severity, or perceived burden of family caregivers. They were more likely to meet criteria for depression, but differences were smaller when suicidality was excluded from the depression interview. Patients who expressed the wish to die reported less optimism, less comfort in religion, and greater hopelessness. Compared with patients unable to act on the wish to die, patients who hastened dying reported reduction in suffering and increased perception of control over the disease in the final weeks of life. Conclusion: These findings suggest caution in concluding that the desire to hasten dying in end-stage disease is simply a feature of depression.

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Attitudes toward Physician-Assisted Suicide among Persons with Multiple Sclerosis

Cited by 17 publications

References 56 publications

Palliative care in patients with severe multiple sclerosis: two case reports and a survey among German MS neurologists

Palliative care in patients with severe multiple sclerosis: two case reports and a survey among German MS neurologists

Wish to die in end-stage ALS

Bilateral extraocular muscle metastasis from primary breast cancer

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