Family members of Oregonians who died with a physician's assistance experience no worse feelings of grief than those whose loved ones died naturally, according to a new study.
The study, by researchers at OHSU and the Portland VA Medical Center, is the first effort to measure the impact of physician-assisted death on loved ones. And advocates of doctor-assisted death say the study is significant because it shows family members experience no greater risk of additional anguish from their loved one choosing to have a doctor hasten death.
"Their families feel sadness but know of the approaching death," says Barbara Lee, president of Compassion Choices.
The study, published online this fall in the Journal of Pain and Symptom Management, was funded by the Greenwall Foundation, which works with physicians and others who deal with "decision making at the bedside."
Researchers sent surveys to 180 people who had a family member request physician-assisted death or asked for counseling by Compassion Choices in 2007 or 2008. Out of 95 surveys returned, 36 came from family members of those who died by lethal prescription and 59 from family of those who died before they completed the process.
For a comparison group, researchers queried 63 family members of patients who died naturally within the same time period from cancer or amyotrophic lateral sclerosis, better known as Lou Gehrig's disease. Researchers chose cancer and ALS because they are the leading diagnoses of patients who request physician-assisted death.
The study aimed to determine how a patient's decision to die affected family caregivers and to measure "the severity of grief symptoms, use of mental services, and depression."
Fourteen months after a patient's physician-assisted death, 11 percent of family members whose loved one died by physician assistance had a major depressive disorder, 15 percent used hospice bereavement services, and 38 percent got mental care. The numbers for each category in the comparison group of people whose loved one died naturally of cancer or ALS was slightly higher—14 percent had a major depressive disorder, 17 percent used hospice bereavement services, and 41 percent sought mental care.
"In summary, pursuit of aid in dying does not have negative effects on surviving family members and may be associated with greater preparation and acceptance of death," the study concludes.
Eileen Geller, president of True Compassion Advocates, an organization whose mission is to offer "life-affirming care, hope and support to people at risk for assisted suicide," says the study was skewed because it could "cherry-pick" participants to elicit a preferred response.
"The researchers went to a pro-assisted-suicide group and asked them to refer families to this study," she says. "Of course they'd get responses from people that support physician-assisted suicide."
Geller adds that family members in extreme grief lack the ability to send back a volunteer survey, saying the research "doesn't even include the people who are too catatonic with grief at home to answer the phone or much less send back a survey."
George Eighmey, executive director at the local Compassion Choices affiliate, counters, "Even if family members who 'weren't depressed' answered the surveys, it would have also affected the comparison group, too."
The study's lead researcher, Dr. Linda Ganzini acknowledges the response rate wasn't as high as her research team wanted. But she notes that collecting responses for this type of study is extremely difficult because of patient privacy regulations.
"The [Institutional Review Board] says we get one chance to ask people to participate, and that's it," Ganzini says. "We took what we could get."
In 1997, Oregon became the first state to let terminally ill patients end their lives by taking a lethal prescription of drugs from a licensed physician. About 400 Oregonians have now died this way. Washington legalized the practice last year.