A 75-year-old man with a recent diagnosis of metastatic pancreatic cancer is admitted to the hospital due to dehydration. The patient admits that he was trying to hasten his death by refusing food and water despite his family's disagreement with this plan. He is a documentary filmmaker who has made multiple films on the subject of bravery, frequently interviewing firemen and wartime pilots. He says that "being brave means not being afraid of death and leaving this suffering behind." The patient's wife recently filed for divorce. She says that she is an observant Buddhist and has been "fed up with his atheism for a long time; it's just so negative. He doesn't believe that anything has a point, when really everything is purposeful if he would only just look. He can't even see the people around him who love and support him." The patient occasionally has pain despite taking morphine regularly. He has experienced severe constipation as a result of the pain medication and has received minimal relief from stool softeners. His wife says that prior to his hunger strike his appetite was poor and that he frequently spends much of the day doing nothing other than lying on the couch watching television due to fatigue. After his wife leaves the room, the patient pleads with the physician to "give me something to end my life in peace with dignity."
Which of the following factors is most closely associated with this type of request?

Question

A 75-year-old man with a recent diagnosis of metastatic pancreatic cancer is admitted to the hospital due to dehydration.  The patient admits that he was trying to hasten his death by refusing food and water despite his family's disagreement with this plan.  He is a documentary filmmaker who has made multiple films on the subject of bravery, frequently interviewing firemen and wartime pilots.  He says that "being brave means not being afraid of death and leaving this suffering behind."  The patient's wife recently filed for divorce.  She says that she is an observant Buddhist and has been "fed up with his atheism for a long time; it's just so negative.  He doesn't believe that anything has a point, when really everything is purposeful if he would only just look.  He can't even see the people around him who love and support him."  The patient occasionally has pain despite taking morphine regularly.  He has experienced severe constipation as a result of the pain medication and has received minimal relief from stool softeners.  His wife says that prior to his hunger strike his appetite was poor and that he frequently spends much of the day doing nothing other than lying on the couch watching television due to fatigue.  After his wife leaves the room, the patient pleads with the physician to "give me something to end my life in peace with dignity." 
Which of the following factors is most closely associated with this type of request?

Quizplus · Accepted Answer

Explanation: Requests for euthanasia (in which a physician ends a patient's life through the administration of a lethal substance) or physician-assisted suicide (in which the physician provides only the prescription for the lethal medication) are common in patients with terminal illnesses, most frequently cancer. The factors most often associated with requests for euthanasia include a loss of autonomy and control of the dying process, loss of dignity, and loss of ability to engage in pleasurable activities. Although pain should be routinely assessed as a potential factor, it is not as consistently correlated with requests for euthanasia (Choice E). Requests for euthanasia are more closely associated with fears of future suffering rather than actual pain in the moment. Psychological factors (eg, significant depressive symptoms) should also be considered; psychiatric consultation may be indicated to assess for the presence of clinical depression as well as the potential for treatment. (Choice A) Absence of religious beliefs has not been shown to be consistently associated with requests for euthanasia or assisted suicide. (Choice B) Divorced or separated marital status is a risk factor for suicide, but it is not consistently associated with requests for euthanasia or assisted suicide among the terminally ill. (Choice C) Fear of becoming a burden is less commonly identified with requesting euthanasia or assisted suicide than loss of autonomy. Educational objective: Requests for euthanasia and physician-assisted suicide are most common in patients with terminal cancer. A loss of sense of autonomy and dignity and the fear of future suffering are the factors most consistently associated with these requests. References: Implementing a Death with Dignity program at a comprehensive cancer center. (http://www.ncbi.nlm.nih.gov/pubmed/23574120) Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups. (http://www.ncbi.nlm.nih.gov/pubmed/17906058)

A 75-Year-Old Man with a Recent Diagnosis of Metastatic Pancreatic