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Be cautious with patient suicide query

A report in JAMA says most Oregon patients who ask about doctor-assisted suicide do not follow through.

By Andis Robeznieks, amednews staff. July 29, 2002.

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Susan W. Tolle, MD, believes it's proper for physicians to answer a patient's question with another question -- particularly if that question pertains to physician-assisted suicide.

"Before revealing one's own views, the first response from a physician should be: 'Why do you ask?' '' said Dr. Tolle, director of the Center for Ethics on Health Care at the Oregon Health & Science University, Portland.

With OHSU Assistant Professor of Medicine Paul B. Bascom, MD, Dr. Tolle wrote a report for the July 3 issue of the Journal of the American Medical Association about why patients request physician-assisted suicide.

In the report, Drs. Bascom and Tolle say that a tiny fraction of those patients that ask about assisted suicide actually use that method to end their lives.

"If we had 1,000 people known to have terminal illness, 100 would talk to their family about it," she said. "Only 10 of those would actually ask their doctor for physician-assisted suicide, and one of them would take a [lethal] prescription and end their life."

Taking this into account, Dr. Tolle believes a patient's questions about assisted suicide actually may be something other than a request to help end his or her life.

"It may be a signal," she said. "It really isn't to be taken at face value, but as a call for exploration of the patient's motivations for asking."

These motivations, Drs. Bascom and Tolle write, include being a burden to others and loss of autonomy or dignity.

"Some patients have an existential crisis and have questions about the meaning of their life," Dr. Tolle said, adding that by addressing these motivations the number of assisted suicides might be reduced even more. "Ninety percent of those who ask about physician-assisted suicide wind up satisfied with other alternatives when options are fully explained." [...]