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Letters |

Dignity-Conserving Care at the End of Life—Reply

Harvey Max Chochinov, MD, PhD, FRCPC
JAMA. 2002;288(2):162. doi:10.1001/jama.288.2.162.
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In Reply: I am delighted by the Hemlock Society's endorsement of the dignity-conserving model of care. I was particularly taken by Dr Girsh's unequivocal statement that, "if most individuals with a terminal illness were treated this way [according to the dignity-conserving model of care], the incentive to end their lives would be greatly reduced."

If she is correct, one cannot help but wonder how many fewer patients, in anticipation of dying, would feel compelled to consider or seek the option of a hastened death. It is known that patients who are free of pain, clinical depression, and social isolation are less vulnerable to considerations of euthanasia or assisted suicide.13 Similarly, patients who do not feel abandoned by their health care providers are less likely to consider or commit suicide.4 Data from Oregon suggest that the number of patients who died of physician-assisted suicide is relatively small, about 9 per 10 000 deaths annually.5 In the context of a dignity-conserving care model, would the correspondent's predication of substantial, further reductions in the incentive to die be realized?


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