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Letters |

Responding to Patient Requests for Physician-Assisted Suicide

Linda Ganzini, MD; Mark Sullivan, MD, PhD
JAMA. 1999;281(3):227-229. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-3-jbk0120.
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To the Editor: As consultation psychiatrists we are disturbed by Dr Emanuel's1 8-step approach to dying patients who persistently request assisted suicide. The approach is burdensome, and some steps offer no benefit to the patient. Emanuel states that decision-making capacity should be assessed first to determine if the request is valid. We know of no circumstance in medicine in which it is recommended that informed consent be obtained for a procedure that will, under no conditions, be offered. Evaluating whether the patient has depression is important because the patient may have an illness for which successful treatment may improve his or her final days. However, Emanuel states that depression should be evaluated to determine whether the request is rational. Again, if assisted suicide is not an option, why take up the patient's time in making this distinction? Moreover, Emanuel assumes that the presence of depression, by itself, makes the request for assisted suicide irrational and therefore makes the patient incompetent. In fact, available data indicate a weak and variable effect of depression on end-of-life decisions, including assisted suicide.2,3

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