The relationships among clinical depression, suicide, and other actions that may hasten death

Abstract

Clinical depression and other psychological disorders have been associated with suicidal ideation, attempts, and deaths. Because of the link between suicide and mental illness, whenever discussion of "assisted suicide" arises, the possibility that major depression is affecting the decision arises. This article examines the literature on clinical depression as it relates to suicide, "assisted suicide," and other decisions that will hasten death (i.e. withholding and withdrawing treatment, terminal sedation, and voluntarily stopping eating and drinking). Ethical and legal considerations when working with individuals who are considering taking an action that would hasten death are also briefly reviewed. The article ends with practice and policy recommendations.

Psychological Risk Factors of Suicide Attempts in Patients Admitted to Emergency Departments

“…Menon suggested hostility scores as a predictor for suicide intention [52]. Werth found associations between clinical depression and suicidal ideation, attempts, and deaths [53]. These associations should be considered in the surveillance of patients with depressed mood or hostility trait.…”

End‐of‐Life Care: An Overview for Professional Counselors

“…For example, major depression is only present in approximately 25% of terminally ill individuals (Block, 2000;Werth, 2004) and clinical anxiety disorders are problems only for some people (Gibson, Breitbart, Tomarken, Kosinski, & Nelson, 2006;Pessin, Rosenfeld, & Breitbart, 2002). Although individuals facing the end of life may be sad or have fears, these situations are very different from being debilitated by a diagnosable condition that appears in the current version of the DSM.…”

“…The distinctions can be subtle, but the implications of an incorrect diagnosis can be the difference between life and death or maintaining/losing the capacity to make decisions. A person who is clinically depressed and is making EOL decisions may opt for less treatment than she or he would do if the depression were not present; although this is not always the case, the potential is that a different decision would be made if the person were not depressed (Ganzini, Lee, Heintz, Bloom, & Fenn, 1994;Rosenblatt & Block, 2001;Werth, 2004).…”

Characteristics of Persons Approving of Physician-Assisted Death

“…This has led to significant concern about whether individuals asking to die under the Death with Dignity Act, or requesting assisted death outside of Oregon, are doing so as a result of a psychological condition that, if alleviated, would eliminate their desire for a hastened death (see Rosenfeld, 2000;Werth, 1999). Although there appear to be reasons to justify such concern, a review of the evidence suggests that appropriate screening can screen out people with ameliorable conditions such as some forms of clinical depression (see Werth, 2004). One series of studies examined the extent to which reduction in depressive symptoms would influence treatment decisions that could affect the manner and timing of death.…”