In Brief

A new study adds to earlier evidence that when terminally ill people want to die before they have to, their feelings may be related to depression or hopelessness, rather than pain or other factors.

In the study, only 16 of 92 terminally ill patients at the Sloan-Kettering Cancer Center indicated a "high desire for hastened death." However, those diagnosed with depression were four times as likely to have such a desire.

The study in the Journal of the American Medical Association (JAMA) Vol. 284, No. 22) rated patients with several questionnaires, measuring elements such as depression, hopelessness, social support, pain and spiritual well-being. And, in what the authors say is perhaps the study's most novel contribution, it found an independent effect for hopelessness, "characterized as a pessimistic cognitive style, rather than an assessment of one's poor prognosis." Twenty-seven percent of patients who rated high on a hopelessness scale had an increased desire for death even if they were not diagnosed as depressed.

Two-thirds of patients who were both depressed and rated high on the hopelessness scale had an increased desire for death. On the other hand, those with neither depression nor a high level of hopelessness had no such desire.

In addition to the study's implications for the need for psychological care for the terminally ill, the researchers, led by William Breitbart, MD, say their findings also indicate that because depression and hopelessness are not identical, "clinical interventions may need to target these issues selectively."

The study echoes in part a larger one in the November JAMA, which focused on end-of-life issues. Research on 988 terminally ill patients found that 60 percent of them supported euthanasia or physician-assisted suicide in hypothetical situations, but only 11 percent seriously considered such action for themselves.

That study also found that for those who did consider suicide, the biggest factors were depression and feeling burdensome to their families and pain.