Can a terminally ill person want to hasten death and be mentally competent?

June 13, 1999

New Research Raises Questions About Assessing the Mental State of the Terminally Ill

(WASHINGTON) --- In 1994, Oregon passed a referendum (the Oregon Death With Dignity Act) which specified that a physician may prescribe lethal medication for the purpose of hastening the death of a terminally ill person. The Act survived numerous legal challenges and became state law in October of 1997. To address concerns that many terminally ill people may also suffer from a psychiatric disorder, such as depression, the Act bars suicide assistance to any person who, in the judgement of the attending physician, may be suffering from a psychiatric or psychological disorder which may impair judgement.

With this legislation, psychologists and psychiatrists were called upon to determine a physically ill person's mental state, and in doing so were asked to judge their competency to request a hastened death. To ascertain how psychologists felt about this role and to study the practical problems in making such judgements, psychologist Darien S. Fenn, Ph.D., of the Oregon Health Sciences University, and psychiatrist Linda Ganzini, M.D., of the Portland Area Veterans Affairs Medical Center and the Oregon Health Sciences University, surveyed 625 licensed psychologists in the state. The survey findings are published in the June issue of Professional Psychology: Research and Practice, published by the American Psychological Association.

According to the research, Oregon psychologists have varying degrees of comfort with suicide and assisted suicide, which the survey data suggest, may be influencing their choice to work or not to work in the area of hasten death requests. While a surprising large percentage of respondents (82%) said they would consider assisted suicide for themselves under certain circumstances, for other respondents, opposition to assisted suicide was strongly a function of their opposition to suicide per se.

One third of the respondents indicated that performing such evaluations was outside of their practice area. Of the remaining 275 psychologists, 60 percent said that they would perform a competency evaluation if asked to do so by an attending physician. Seven percent said they would refuse to perform such evaluations, and 33 percent would refuse to perform the evaluation but would make a referral to a colleague who did such assessments.

Opinions on the proper role for the psychologist after the assessment was completed varied widely. The majority (62 %) of those who said they would perform the evaluation also reported that they would provide the assessment to the referring physician and then take no further action. Twenty-eight percent said they would support the patient in obtaining a lethal medication, while the remaining 10% reported that they would work with the patient or others involved in the case to try to prevent the suicide.

While the Oregon law calls for a mental health assessment before assistance in hastening death can be given, it did not specify the nature of such an assessment. Likewise, there are not yet agreed upon standards for such an assessment within the mental health community. However, psychologists' level of confidence in the accuracy of an assessment to determine whether a psychiatric disorder is impairing judgement varied with the nature of the evaluation. When placed in the context of a single evaluation, only seven percent of the respondents were 'very confident' in the results. But, when the assessment was done in the context of a long-term relationship with the patient, 64 percent of the respondents felt 'very confident' about the assessment.

On the question of a two week waiting period before any assistance in hastening death would be given, respondents were nearly split, with 52 percent agreeing that such a waiting period would be adequate to prevent transitory desire to end life, and 48 percent disagreeing that such a waiting period would prevent such transitory desire.

Other issues raised by the survey respondents include the need for assessments at multiple points in time and mandatory psychotherapy or trials with antidepressants. However, Oregon's experience to date shows that a substantial fraction of the people who have made requests for hastened death have not lived through the required 15-day waiting period.

A final concern raised by the survey results is whether an evaluator's personal views on the acceptability of assisted suicide will influence their assessment of a patient's mental competency. "If an evaluator judges the rationality of a patient by the degree to which the reasons underlying a patient's request for assisted suicide match his or her own, it is possible that the evaluator's personal views could sway the outcome of the evaluation," the authors write.
Article: "Attitudes of Oregon Psychologists Toward Physician-Assisted Suicide and the Oregon Death With Dignity Act," Darien S. Fenn, Ph.D., Oregon Health Sciences University, and Linda Ganzini, M.D., Portland Veterans Affairs Medical Center, Professional Psychology: Research and Practice, Vol. 30, No. 3.

Full text available from the APA Public Affairs Office.

Dr. Fenn can be reached at: 503 685-9357 (W),

The American Psychological Association (APA), in Washington, DC, is the largest scientific professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 159,000 researchers, educators, clinicians, consultants and students. Through its divisions in 50 subfields of psychology and affiliations with 58 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

American Psychological Association

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