Community attitudes toward physician assisted suicide

Attitudes toward physician-assisted suicide (PAS) were assessed in a sample of 400 community adults, stratified as to gender and socioeconomic class, using a 12-item psychometric scale rather than the more typical survey question. The results indicate that the Domino scale, currently the only psychometric instrument of attitudes toward PAS, is factorially homogeneous and shows considerable internal stability. There were no gender differences, but significant socioeconomic class differences were obtained with better educated, upper class individuals more favorable in attitude than semi-skilled and unskilled poorly educated lower social class individuals. The majority of respondents support physician assisted suicide, but such support is inversely related to age.     

The attitudes of socially marginalized men toward physician-assisted suicide

Bioethics and public policy literature suggests that socially marginalized populations may be at increased risk for overuse of physician-assisted suicide (PAS) were it to become more accepted. Yet the attitudes of socially marginalized populations toward PAS have not been widely studied. The present study surveyed a sample of men in a substance abuse recovery program. Participants completed a PAS attitude questionnaire and a religiosity measure. Support for PAS was fairly evenly split, with 52.2% indicating general opposition to PAS and 46.9% indicating general support. Greater religiosity was associated with more negative attitudes toward PAS. Higher educational level was associated with more acceptance. Overall attitudes toward PAS were considerably more negative than those of Dr. George Domino's (2003) general population sample.     

Attitudes toward and desire for assisted suicide among persons with amyotrophic lateral sclerosis

This study aimed at investigating attitudes toward assisted suicide among individuals with amyotrophic lateral sclerosis, and the differences in health status (illness severity and functional disability) and psychosocial adjustment (depression, perceived stress, social support, and coping) between those in favor of and those against assisted suicide. This study also aimed at describing the characteristics of terminally-ill individuals who acknowledge contemplating assisted suicide. Forty-four individuals diagnosed with amyotrophic lateral sclerosis were surveyed about their attitudes and the circumstances that would make them contemplate assisted suicide and filled out standardized measures of mood, stress, social support, coping, and illness status. Seventy percent of the sample found assisted suicide morally acceptable and 60% thought it should be legalized. In addition, 60% of patients agreed they could foresee circumstances that would make them contemplate assisted suicide, but only three (7%) indicated they would have requested it already if it had been legal. Willingness to contemplate assisted suicide was associated with reports of elevated levels of depressive symptoms and reports of hopelessness. Results highlight the need to assess psychological status carefully when terminally ill individuals begin contemplating assisted suicide or voice a request for it.     

Gender,pain, and doctor involvement: high school student attitudes toward doctor-assisted suicide

The present study concentrates on the attitudes of high school students toward active doctor-assisted suicide as described in hypothetical doctor-patient scenarios, orthogonally manipulating doctor's reaction to patient's wishes to end his/her life (whether discussed, accepted or encouraged), presence of patient's physical pain, presence of patient's emotional pain, and the gender of the hypothetical patient. Doctor-assisted suicides thoroughly discussed with the patient are judged to be more moral, acceptable, and "legal" than assisted suicides that are simply accepted by the doctor or actively encouraged by him. Significantly, this is not a distinction that is relevant in the eyes of the law. Further, the presence of both physical and emotional pain on the part of the patient make the patient death more acceptable in the eyes of high school students. This latter effect is striking, given the result of the Wooddell and Kaplan (1999-2000) study showing that patient depression tends to weaken acceptability of death. Finally, respondents, both male and female, tend to view deaths of patients of the opposite gender as more acceptable than patients of the same gender.     

Predictors of attitudes towards physician-assisted suicide

Psychological factors may influence an individual's acceptance of euthanasia and physician-assisted suicide (PAS). The purpose of the present investigation was to evaluate predictors of attitudes towards PAS. Data were collected from 136 college students at a private Midwestern university. In addition to demographic and family history information, respondents completed measures of attitudes toward seeking mental health services, depression, hopelessness, and PAS attitudes. Respondent age, race, and hopelessness scores emerged as the only significant predictors (R2=.20) in a multiple regression model used to identify potential predictors of PAS attitudes. Younger, non-minority respondents, and those enduring more hopelessness reported more accepting attitudes towards PAS. Data from a three month follow-up assessment supported the stability of this pattern. The findings highlight the important role that mental health professionals should play in PAS decision making. Implications for the evaluation of medically ill considering PAS and their caregivers are discussed.     

Attitudes toward physician assisted suicide: Poland and the United States

A scale to measure attitudes toward physician assisted suicide was administered to a sample (N=246) of Polish citizens and a sample (N=246) of U.S. citizens equated on gender, marital status, religion, and socioeconomic level. In both samples the reliability was substantial (Cronbach's alphas of .93 and .89), and the factor structure identical (one major factor). Significant ethnic differences were found for 10 of the 12 scale items, but no differences related to demographic variables. The obtained differences appear to parallel a conservative-liberal dimension, though this will need to be assessed in future studies.     

Psychosocial versus biomedical risk factors in Kevorkian's first forty-seven physician-assisted deaths

This article examines biomedical and psychosocial data on the first forty-seven cases of physician-assisted suicide (PAS) of Kevorkian as collected by means of both a physical autopsy and a preliminary psychological autopsy. The following patterns emerge: 1) The physical condition of these PAS patients was not typical of the conditions that lead to death in the United States. 2) Consistent with the above findings, our pilot data indicate that only 31.1 percent of these patients were terminal. While 73.9 percent were described as reporting pain, only 42.6 percent were revealed at autopsy to have a specific anatomical basis for their pain. However 36 percent were described as depressed, 66 percent as having some disability, and perhaps of key importance, 90 percent expressed a fear of dependency. Most important, our pilot data suggest the possibility of large gender differences, since 3) 68.1 percent of these forty-seven PAS's are women and only 31.9 percent are men. This represents the reverse of the gender pattern for completed suicides in the United States in 1995, resembling instead the approximate pattern for unsuccessful suicide attempts. 4) Approximately 75 percent of both men and women in the above sample were described as reporting pain. Men were almost twice as likely to have had an anatomical basis for the pain and three times as likely to be terminal. Our pilot data indicate PAS women are more likely to be described as depressed and twice as likely to have had a history of previous unsuccessful suicide attempts. 5) Kevorkian's patients were older than the typical unaided suicides in America. Reported pain decreases with age as does depression; however anatomical basis for pain increases slightly with age, and no age effect emerges for terminality. 6) Approximately two-thirds of those physician-assisted suicides were at middle SES levels. History of disability was the biggest risk factor for the low SES patients and fear of dependency for the high SES patients.     

Older adults' attitudes toward death: links to perceptions of health and concerns about end-of-life issues

The current study had two primary goals, to determine whether: 1) self-rated mental and physical health, pain, and experience with health problems were predictors of elderly adults' attitudes toward death; and 2) death attitudes predict end-of-life medical treatment concerns. Participants were 109 adults, 65 years of age or older (M=78.74 years), recruited from the local community. Regression analysis indicated that poorer perceived physical health predicted a greater likelihood of viewing death as an escape, and poorer perceived mental health predicted a greater fear of death. Viewing death as an escape and fearing death predicted end-of-life medical treatment concerns; a greater endorsement of either attitude predicted more concern. Possible explanations for the links between perceived health, attitudes toward death, and concern about end-of-life issues are suggested.     

Gender and physician-assisted suicide: an analysis of the Kevorkian cases, 1990-1997

This study examines the seventy-five suicide cases Dr. Jack Kevorkian acknowledged assisting during the period between 1990-1997. Although these cases represent a range of regional and occupational backgrounds, a significant majority are women. Most of these individuals had a disabling, chronic, nonterminal-stage illness. In five female cases, the medical examiner found no evidence of disease whatsoever. About half of the women were between the ages of forty-one and sixty, and another third were older adults. Men's conditions were somewhat less likely than women's to be chronic and nonterminal-stage. The main reasons for the hastened death mentioned by both the person and their significant others were having disabilities, being in pain, and fear of being a burden. The predominance of women among Kevorkian's assisted suicides contrasts with national trends in suicide mortality, where men are a clear majority. It is possible that individuals whose death was hastened by Kevorkian are not representative of physician-assisted suicide cases around the country, because of Kevorkian's unique approach. Alternatively, the preponderance of women among Kevorkian's assisted suicides may represent a real phenomenon. One possibility is that, in the United States, assisted suicide is particularly acceptable for women. Individual, interpersonal, social, economic, and cultural factors encouraging assisted suicide in women are examined.     

An update on the Kevorkian-Reding 93 physician-assisted deaths in Michigan: is Kevorkian a savior,serial-killer or suicidal martyr?

This report presents an update of the Kevorkian-Reding physician-assisted (or physician-aided) deaths to include the ninety-three publicly acknowledged cases as of November 25, 1998. These deaths are divided into ten distinct time phases. The following trends emerge. Over two-thirds of the decedents are women, the ratio of females to males varying widely with phase. The proportion of women seems to be the highest when Kevorkian is free to act as he wants and lowest when he seems to be acting under legal or political restraints. Based on autopsy results, only 29.0 percent of the cases are terminal, this percentage being higher among men (37.9%) than among women (25.4%). However, 66.7% of the decedents were disabled, no significant difference emerging between men and women. Further, five out of the six decedents showing no apparent anatomical sign of disease at autopsy were women. Over 80 percent of the physician-assisted deaths are cremated, approximately twice as high a proportion as that emerging for suicides in Michigan and four times as high as cremations occurring with regard to overall deaths. Finally, death by carbon monoxide decreases dramatically with time phase while the use of the contraption dubbed the "suicide machine" increases, suggesting an increasing routinization over time. Finally, during the ninth and tenth phases, Kevorkian's aims and his own suicidality emerge more clearly involving 1) harvesting organs and 2) threat of starving himself in prison if he is convicted. Phase 10 can be seen as an escalation from assisted death to overt euthanasia, repeating the same need for a demonstration (Thomas Youk) that was first exhibited in Phase I (Janet Adkins).     

Why does zeno the stoic hold his breath? "Zenoism" as a new variable for studying suicide

A single misfortune may be seen as just that, or may be interpreted as Zeno the Stoic did, as a "sign" of cosmic proportion (zenoizing), which paradoxically provides a missing meaning structure. This article presents two studies testing out this new variable (zenoism): in Study One (n = 233), we explore the moderating effects of religiosity and gender on zenoism, depression, demoralization, and suicidality. In Study Two (n = 137), we explore these same moderating effects on zenoism, fear of dependency, value of life, and favorability toward physician-assisted suicide (PAS). Results indicate: 1) men and non-religious respondents (especially men) zenoize more than women and religious respondents; 2) non-religious respondents, (especially men) are more generally favorable to PAS and more suicidal; 3) Zenoism is negatively related to depression, demoralization, and value of life for non-religious respondents, and for men; 4) Zenoism is positively related to favorability toward PAS toward one's self and overall suicidality; and finally 5) general and self-specific favorability toward PAS are distinct, but both relate to overall suicidality.     

A qualitative study of attitudes toward suicide and suicide prevention among psychology students in Ghana

The purpose of the present study was to investigate attitudes toward suicide and suicide prevention among psychology students in Ghana by means of a qualitative analysis of open-ended questions about causes of suicide and how suicide best can be prevented. The students mainly saw the causes as intra-personal and almost all of them believed that suicide can be prevented. The results indicated a huge impact of religion on the attitudes toward suicide as well as some lack of distinction between their religious and professional roles and responsibilities.     

Potential psychodynamic factors in physician-assisted suicide

A number of assumptions underlying the debate over physician-assisted suicide (PAS) deserve closer scrutiny. It is often implicitly assumed that decisions as to the competency of the patient to request PAS can be accurately made, and that the treating physician's values and intrapsychic conflicts can be successfully separated from the decision to accede to or reject the patient's request. This article argues that in such an emotionally-laden decision, such factors may play a significant role, and that even were PAS to gain widespread acceptance, ignoring them may lead to errors in classifying patients either as appropriate or inappropriate for PAS.     

Facts and myths about suicide: a study of Jewish and Arab students in Israel

This research investigates the knowledge and myths regarding suicide among students in Israel, and examines whether they are affected by ethnic origin, gender, and religiosity. A random sample of 450 undergraduate students from two colleges was asked to fill out the Suicide Opinion Questionnaire (SOQ). Knowledge was measured by five SOQ items (alpha = 0.57) and myths of suicide by 20 SOQ items (alpha = 0.67). The level of Israeli students' knowledge about suicide is generally good (X = 3.21; SD = 0.58). There are significant differences, however, between the Jewish (n = 266) and Arab (n = 154) students in knowledge about basic facts of suicide in Israel [(X Arabs = 3.04; X Jews = 3.32; t (419, 0.95) = 4.63, p < .001)]. Although both groups share the same educational milieu, the Arab students tend more to believe that suicide rates are higher in Israel, and even more so among people of Asian African origin and minorities. They also perceive suicide by shooting to be the most popular suicide method. There are also significant differences between those groups with respect to their belief in suicide myths [(X Arabs = 2.91; SD = 0.40; X Jews = 3.17, SD = 0.41; t (419, 0.95)= 6.31, p < 0.01)]. Arabs tend more to relate suicide to lower religious affiliation, mental illness and chronic tendency, and to believe that the victim's relatives know nothing about the coming suicide. No significant differences were found based on religiosity or gender. Discussion focuses on the influence of the different cultural characteristics of lifestyle and the social control systems among Jews and Arabs in Israel on perceptions toward suicide.     

Perception of Earthquake Risk in Taiwan: Effects of Gender and Past Earthquake Experience

This study explored how individuals in Taiwan perceive the risk of earthquake and the relationship of past earthquake experience and gender to risk perception. Participants (n= 1,405), including earthquake survivors and those in the general population without prior direct earthquake exposure, were selected and interviewed through a computer‐assisted telephone interviewing procedure using a random sampling and stratification method covering all 24 regions of Taiwan. A factor analysis of the interview data yielded a two‐factor structure of risk perception in regard to earthquake. The first factor, “personal impact,” encompassed perception of threat and fear related to earthquakes. The second factor, “controllability,” encompassed a sense of efficacy of self‐protection in regard to earthquakes. The findings indicated prior earthquake survivors and females reported higher scores on the personal impact factor than males and those with no prior direct earthquake experience, although there were no group differences on the controllability factor. The findings support that risk perception has multiple components, and suggest that past experience (survivor status) and gender (female) affect the perception of risk. Exploration of potential contributions of other demographic factors such as age, education, and marital status to personal impact, especially for females and survivors, is discussed. Future research on and intervention program with regard to risk perception are suggested accordingly.     

Internet support groups for suicide survivors: a new mode for gaining bereavement assistance

Taken among parents who sustained the loss of a child to suicide this study explores the participation of parents in Internet support groups, comparing their demographic and loss-related characteristics (N = 104) to other parent survivors participating in face-to-face support groups (N = 297). Contrary to expectations that Internet affiliates would be concentrated in under-served rural areas, we found similar levels of urban, suburban, small city and rural residents in both Internet and face-to-face subsamples. Bivariate and multivariate analyses suggested several important factors contributing to interest in Internet grief support including: 24/7 availability and opportunities to invest more time into this type of support group experience. Compared to their face-to-face group counterparts, Internet affiliates experienced greater suicide stigmatization from their families and other associates. Unable to find ready comfort and support from their personal communities, Internet users-and especially highly depressed survivors-sought and obtained valuable help from the Internet support resource.     

Validating a short version of the Suicide Intent Scale in China

As Beck's Suicide Intent Scale (SIS) gains popularity in various areas in the world, we are not sure whether the scale is an optimal measure of suicide intent in the Chinese culture. This study is to provide evidence to support the use of the Chinese shortened version of SIS (C-SIS) in Chinese societies. The data were from applying the C-SIS in a psychological autopsy (PA) study of 66 suicides in Dalian, China. Reliability and validity tests were performed on the C-SIS data. Internal consistency analysis showed excellent correlation coefficients for all items but one. Inter-rater reliability tests showed statistically significant correlations between each pair of informants for each item and for the total scores. Criterion validity analysis demonstrated a relatively high correlation between the scores on the Hamilton Depression Rating Scale (HAM-D) and C-SIS. Factor analysis produced three factors accounting for 66.77% of the total variance. The study suggested that C-SIS should be an appropriate instrument for detecting and measuring suicide intent in Chinese societies.     

Turkey's physicians' attitudes toward euthanasia: a brief research report

Euthanasia and assisted suicide are subject to an ongoing debate and discussed with various aspects. Because physicians are in a profession closely related to euthanasia, their attitudes toward this subject are significant. Thus, research intending to explore their opinions is carried out in many countries. In this study, opinions of the physicians regarding euthanasia's definition, contents, legal aspects, and acceptable conditions for its application are addressed. The questionnaire was given to 949 physicians, more than 1% of the total working in Turkey. Of the physicians who participated in the study, 49.9% agreed with the opinion that euthanasia should be legal in certain circumstances. In addition, 19% had come across a euthanasia request and the majority of physicians (55.9%) believed that euthanasia is applied secretly in the country despite the prohibitory legislation. In conclusion, the authors infer from the study itself and believe that euthanasia should be legal in certain circumstances and that the subject, which is not in the agenda of the Turkish population, should continue to be examined.     

Michigan versus Kevorkian

Our personal reflections on the Michigan versus Kevorkian trial highlight the following issues: 1) the switch from physician-assisted suicide to euthanasia, 2) the television showing of the death, 3) the dropping of the prosecution of the charge of physician-assisted suicide, 4) Kevorkian serving as his own defense attorney, trying to argue that ALS was a secondary cause of Thomas Youk's death, 5) Kevorkian's attempt to employ a logical syllogism to demonstrate that euthanasia need not be murder, 6) Kevorkian's initial reference to the civil rights tradition but sudden change to the medical analogy of Nazi medicine: a final solution, 7) the insistence of Kevorkian on "all or nothing" sentencing, 8) the irony of Kevorkian being finally convicted by a prosecutor who was elected on a platform of not prosecuting Kevorkian, 9) Kevorkian hiring a lawyer after the verdict is in, and 10) Kevorkian's threat to starve himself to death if sent to prison.