Some hospice patients and families talk of hastening death

May 28, 2004

WINSTON-SALEM, N.C. - More that half of social workers who treat hospice patients report that they had been told by one or more patients that they were considering hastening their deaths, according to a survey of hospice social workers in the Carolinas.

Additionally, more than one-fourth of the social workers reported similar comments from a patient's family member. Reporting in the June issue of the Journal of Pain and Symptom Management, available on-line, Elizabeth Mayfield Arnold, Ph.D., M.S.W., of Wake Forest University Baptist Medical Center, said, "Poor quality of life and concern for suffering were the most common reasons reported for the request to hasten death."

The survey, based on responses from 73 social workers in the Carolinas, reported on 54 cases in which the patient or a family member considered hastening the patient's death.

"Despite ongoing efforts to improve end-of-life care, many individuals in hospice still experience unmet needs that may play a role in consideration of hastening death," said Arnold, assistant professor of psychiatry and behavioral health. "Many of these needs, such as depression, physical symptoms and anxiety, are potentially treatable problems."

But, she said, the data suggest that the 54 patients who were considering hastening death may differ from the typical hospice patient. For example, 70 percent of the patients in the study had cancer, which was far higher than the overall rate of 56 percent of North Carolina hospice patients and 54.5 percent of South Carolina hospice patients.

Of the 54 patients, 36 were men, 51 were white, 38 had cancer, and 36 were married or had a partner. Most patients were being treated by hospice workers in their homes rather than in an inpatient hospice facility.

Despite the talk about hastening death, in 40 of the 54 cases death in fact was not hastened; in five cases, death was hastened and it was unknown or unclear what happened to the other nine patients. "Consideration of hastening death among hospice patients does not appear to be a rare event, as most social workers had experienced one or more cases in the past year."

Arnold said that overall, "these do not appear to be individuals who have histories of psychiatric problems that might have contributed to their desire to hasten their death. These appear to be individuals whose consideration of this option was influenced by their current medical condition and related factors."

In these cases, social workers can provide assessment and intervention for depression, lack of social support or financial stressors. But they may need to initiate discussions with patients about hastening death to find out where they stand and what options they are considering.

"However, in many instances, health care providers, even those with years of experience, tend to feel uncomfortable discussing issues related to hastening death with patients, even though it is a necessary part of understanding the patient and can be therapeutic by allowing the patient to openly communicate his or her thoughts and feelings," Arnold said.

"The National Hospice and Palliative Care Association clearly denounces use of assistance in dying in hospice care," Arnold said. "Despite the many benefits of hospice care, it is still important to consider the issues that contribute to consideration of hastening death among some hospice patients and their families."

Besides Arnold, other authors included Katherine Abbott Artin of Hospice of Alamance-Caswell in Burlington, N.C., Judi Lund Person of the National Hospice and Palliative Care Organization and Devin L. Griffith of Community Health services at Randolph Hospital in Asheboro.
Media Contacts: Name and email address of author; Shannon Koontz,, or Karen Richardson,, at 336-716-4587.

About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University School of Medicine. It is licensed to operate 1,282 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report.

Wake Forest Baptist Medical Center

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