This article appears in the November 1999 edition of the Catholic Medical Quarterly

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Letter From America

Federal Pain Relief Act Advances.

A federal Pain Relief Promotion Act (HR 2260, S 1272) has begun to advance in Congress. The Bill promotes use of federally regulated drugs for pain relief, while affirming they are not authorised for use in assisted suicide. By August it had collected 154 sponsors: its Senate counterpart had 26 sponsors. The Bill also continues to collect organisational support. The Catholic Health Association, The American College of Osteopathic Family Physicians, and the disability rights group Not Yet Dead endorsed the regulation in July, joining the American Medical Association, National Hospice Organisation and other. supporters. Opposition to the Bill has also become more visible. The Oregon Hospice Association and Oregon Medical Association have broken ranks with their national organisations to defend Oregon’s authority to decide whether assisted suicide is 'good medical care . However, Oregon’s own policy has collected more visible opposition within the state.

Full House Judiciary Committee consideration of the Bill was expected on September 9th. It still faces a number of hurdles before it can be approved by Congress in the final weeks of this session. It requires to be marked up by various other committees but has receive sponsorship by many of their key members.

Terminally Ill Patients Will to Live

Canadian researchers report on how dying patients 'will to live’ is likely to show substantial fluctuation 'due to changes in both physical and mental factors . Dr. Harvey Chochinov and his colleagues of the University of Manitoba assessed the 'will to live’ twice daily in 168 mentally competent cancer patients admitted to palliative care, and correlated this with a variety of other factors. They ranged in age from 31 to 89 years old; they survived an average of 18 days, though one woman lived for more than 150 days.

The factors with the greatest impact on the will to live were 'depression, anxiety, shortness of breath, as against a sense of well being’. The most important factor varied with the stage of the disease. During the earlier course of the illness, anxiety was the dominant factor; depression became more important later, and shortness of breath became the chief factor suppressing the will to live when death became imminent. The study confirmed that, at least during much of the course of a terminal illness, psychological factors weigh more heavily in a desire for death than such factors as physical pain.

The study's finding that the will to live is 'highly unstable' among terminally ill patients should not be surprising, say the researchers. After all, 'only 10-14% of individuals who survive a suicide intent commit suicide during the next 10 years, which suggests that desire to die is inherently changeable’.

Dr. Chochhinov added in an interview with the New York Times that physicians who want to be responsive to their patients should be knowledgeable in 'how to go about managing reversible distress at the end of life’ which can greatly affect a patient s interest in living.

Also interviewed by the Times was Dr. Gregory Hamilton of Physicians for Compassionate Care, which promotes improved care of the dying and opposes assisted suicide. 'This study’ he said 'demonstrates numerically that feelings of suicide ideation or suicidal despair can be influenced through treatment and should not be taken at face value as some kind of ideological right’.

But Gorge Eighmey of Compassion in Dying, which supports assisted suicide, also claims that the study 'in a sense confirms what we have found to be the case ... the overwhelming majority of our patients who have sustained desire and will to end their life do so because of a fear of loss of autonomy, and of the indignities associated with losing control over bodily function’.

On this point The Lancet paper itself, republished in our own journal, observes 'For jurisdictions considering legislation enabling physician assisted suicide or euthanasia, the likely transience of a request to die is one of the most important considerations’.

  1. Chochhinov H. et al. "Will to live in the terminally ill" 354, The Lancet 816-19 (4 September 1999), New York Times 9/4/99, p. A8.

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