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Patient Requests to Hasten Death: Evaluation and Management in Terminal Care

Patient Requests to Hasten Death: Evaluation and Management in Terminal Care Abstract Terminally ill patients often hope that death will come quickly. They may broach this wish with their physicians, and even request assistance in hastening death. Thoughts about accelerating death usually do not reflect a sustained desire for suicide or euthanasia, but have other important meanings that require exploration. When patients ask for death to be hastened, the following areas should be explored: the adequacy of symptom control; difficulties in the patient's relationships with family, friends, and health workers; psychological disturbances, especially grief, depression, anxiety, organic mental disorders, and personality disorders; and the patient's personal orientation to the meaning of life and suffering. Appreciation of the clinical determinants and meanings of requests to hasten death can broaden therapeutic options. In all cases, patient requests for accelerated death require ongoing discussion and active efforts to palliate physical and psychological distress. In those infrequent instances when a patient with persistent, irremediable suffering seeks a prompt and comfortable death, the physician must confront the moral, legal, and professional ramifications of his or her response. Rarely, acceding to the patient's request for hastening death may be the least terrible therapeutic alternative. (Arch Intern Med. 1994;154:2039-2047) References 1. van der Maas PJ, van Delden, JJM, Pijnenborg L. Euthanasia and other medical decisions concerning the end of life . Health Policy . 1992;22 (special issue[pts (1) and 2]):193-195.Crossref 2. van der Maas PJ, van Delden JJM, Pijnenborg L, Looman CWN. Euthanasia and other medical decisions concerning the end of life . Lancet . 1991; 338:669-674.Crossref 3. Breitbart W. Suicide . In: Holland JC, Rowland JH, eds. Handbook of Psychooncology . New York, NY: Oxford University Press; 1989:291-299. 4. Whitlock FA. Suicide, cancer and depression . Br J Psychiatry . 1978;132:268-274. 5. Breitbart W. Suicide in cancer patients . Oncology . 1987;1:49-54. 6. Brown JH, Henteleff P, Barakat S, Rowe CJ. Is it normal for terminally ill patients to desire death? Am J Psychiatry . 1986;143:208-211. 7. Owen C, Tennant C, Levi J, Jones M. Suicide and euthanasia: patient attitudes in the context of cancer . Psychooncology . 1992;1:79-88.Crossref 8. Bolund C. Suicide and cancer, I: demographic and social characteristics of cancer patients who committed suicide in Sweden, 1973-76 . J Psychosoc Oncol . 1985;3:17-30.Crossref 9. Bolund C. Suicide and cancer, II: medical and care factors in suicides by cancer patients in Sweden, 1973-76 . J Psychosoc Oncol . 1985;3:31-52.Crossref 10. Louhivuori KA, Hakama M. Risk of suicide among cancer patients . Am J Epidemiol . 1979;109:59-65. 11. Storm HH, Christensen N, Jensen OM. Suicides among Danish patients with cancer: 1971 to 1986 . Cancer . 1992;69:1507-1512.Crossref 12. Marzuk PM, Tierney H, Tardiff K, Gross EM, Morgan EB, Hsu M. Increased risk of suicide in persons with AIDS . JAMA . 1988;259:1333-1337.Crossref 13. Cote TR, Biggar RJ, Dannenberg AL. Risk of suicide among persons with AIDS . JAMA . 1992; 268:2066-2068.Crossref 14. Snyder S, Reyner A, Schmeidler J, Bogursky E, Gomez H, Strain JJ. Prevalence of mental disorders in newly admitted medical inpatients with AIDS . Psychosomatics . 1992;33:166-170.Crossref 15. Humphry D. Final Exit . Eugene, Ore: Hemlock Society; 1991. 16. Twycross RG, Lack SA. Symptom Control in Far Advanced Cancer: Pain Relief . London, England: Pitman Publishing; 1984. 17. Cleeland CS. The impact of pain on patients with cancer . Cancer . 1984;54:235-241.Crossref 18. Portenoy RK. Cancer pain: pathophysiology and syndromes . Lancet . 1992;339:1026-1031.Crossref 19. Levin DN, Cleeland CS, Dar R. Public attitudes toward cancer pain . Cancer . 1985;42:1385-1391.Crossref 20. Owens C, Tennant C, Levi J, Jones M. Suicide and euthanasia: patient attitudes in the context of cancer . Psychooncology . 1992;1:79-88.Crossref 21. Breitbart W. Cancer pain and suicide . In: Foley KM, Bonica JJ, Ventafridda V, eds. Advances in Pain Research and Therapy . New York, NY: Raven Press; 1990;16:399-412. 22. Helig S. The San Francisco Medical Society euthanasia survey: results and analysis . San Francisco Med . 1988;61:24-34. 23. Ventafridda V, Tamburini M, Caraceni A, DeConno F, Naldi F. A validation study of the WHO method for cancer pain relief . Cancer . 1987;59: 350-356.Crossref 24. Grond S, Zech D, Schug SA, Lynch J, Lehmann KA. Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life . J Pain Sympt Manage . 1991; 6:411-422.Crossref 25. Foley KM. The relationship of pain and symptom management to patient requests for physician-assisted suicide . J Pain Sympt Manage . 1991; 6:289-297.Crossref 26. Marks RM, Sachar ES. Undertreatment of medical inpatients with analgesics . Ann Intern Med . 1973;78:173-181.Crossref 27. Hanks GW, Justin DM. Cancer pain: management . Lancet . 1992;339:1031-1036.Crossref 28. Cleeland C. Barriers to the management of cancer pain . Oncology . April 1987( (suppl) ):19-26. 29. Max MB. Improving outcomes of analgesic treatment: is education enough? Ann Intern Med . 1990; 113:885-889.Crossref 30. Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer . J Palliat Care . 1991;7( (2) ):25-29. 31. Lichter I, Hunt E. The last 48 hours of life . J Palliat Care . 1990;6( (4) ):7-15. 32. Ventafridda V, Ripamonti C, DeConno F, Tamburini M, Cassileth BR. Symptom prevalence and control during cancer patients' last days of life . J Palliat Care . 1990;6( (3) ):7-11. 33. Billings JA. Outpatient Management of Advanced Cancer . Philadelphia, Pa: JB Lippincott; 1985. 34. Twycross RG, Lack SA. Therapeutics in Terminal Cancer . 2nd ed. New York, NY: Churchill Livingstone Inc; 1984. 35. Walsh TD. Symptom Control . Boston, Mass: Blackwell Scientific Publications Inc; 1989. 36. Patt RB. Cancer Pain . Philadelphia, Pa: JB Lippincott; 1993. 37. Admiraal P. Cited by: Lo B. Euthanasia: the continuing debate . West J Med . 1988;149:211-212. 38. Truog RD, Berde CB, Mitchell C, Grier HE. Barbiturates in the care of the terminally ill . N Engl J Med . 1992;327:1678-1681.Crossref 39. Wanzer SH, Federman DD, Adelstein SJ, et al. The physician's responsibility toward hopelessly ill patients: a second look . N Engl J Med . 1989;320:844-849.Crossref 40. Greene WR, David WH. Titrated intravenous barbiturates in the control of symptoms in patients with terminal cancer . South Med J . 1991;84: 332-337.Crossref 41. Bottomley DM, Hanks GW. Subcutaneous midazolam infusion in palliative care . J Pain Sympt Manage . 1990;5:259-261.Crossref 42. Parkes CM. Bereavement: Studies of Grief in Adult Life . Madison, Conn: International Universities Press; 1972. 43. Parkes CM, Weiss R. Recovery From Bereavement . New York, NY: Basic Books Inc Publishers; 1983. 44. Plumb MM, Holland J. Comparative studies of psychological function in patients with advanced cancer, I: self-reported depressive symptoms . Psychosom Med . 1977;39:264-276.Crossref 45. Plumb MM, Holland JC. Comparative studies of psychological function in patients with advanced cancer, II: interviewer-rated current and past psychological symptoms . Psychosom Med . 1981;43:243-254.Crossref 46. Lindemann E. Symptomatology and management of acute grief . Am J Psychiatry . 1944;101: 141-148. 47. Brown JT, Stoudemier GA. Normal and pathological grief . JAMA . 1983;250:378-382.Crossref 48. Clayton P. Mourning and depression: their similarities and differences . Can J Psychiatry . 1974; 1:309-312. 49. Massie MJ, Holland JC. The cancer patient with pain: psychiatric complications and their management . J Pain Sympt Manage . 1992;7:99-109.Crossref 50. Massie MJ. Depression . In: Holland JC, Rowland JH, eds. Handbook of Psychooncology . New York, NY: Oxford University Press; 1989:283-290. 51. Levine PM, Silberfarb PM, Lipowski ZJ. Mental disorders in cancer patients . Cancer . 1978;42: 1385-1391.Crossref 52. Holland JC, Hughes AH, Tross S, et al. Comparative psychological disturbance in patients with pancreatic and gastric cancer . Am J Psychiatry . 1986;143:982-986. 53. Goldberg RJ. Systematic understanding of cancer patients who refuse treatment . Psychother Psychosom . 1983;39:1507-1512.Crossref 54. Maltsburger JT, Buie DH. Countertransferance hate in the treatment of suicidal patients . Arch Gen Psychiatry . 1974;30:625-633.Crossref 55. Burt R. Taking Care of Strangers . New York, NY: Free Press; 1979. 56. Fernandez F, Adams F, Holmes VF, Levy JK, Neidhart M. Methylphenidate for depressive disorders in cancer patients: an alternative to standard antidepressants . Psychosomatics . 1987;28: 455-462.Crossref 57. Katon W, Sullivan MD. Depression and chronic medical illness . J Clin Psychiatry . 1990;51( (suppl) ): 3-11. 58. Fernandez F, Adams F, Levy JK, Holmes VF, Neidhart M, Mansell PW. Cognitive impairment due to AIDS-related complex and its response to psychostimulants . Psychosomatics . 1988;29:38-46.Crossref 59. Burns MM, Eisendrath SJ. Dextroamphetamine treatment for depression in terminally patients . Psychosomatics . 1994;35:80-83.Crossref 60. Woods SW, Tesar GE, Murray GB, Cassem EH. Psychostimulant treatment of depressive disorders secondary to medical illness . J Clin Psychiatry . 1986;47:12-15. 61. Masand P, Pickett P, Murray GB. Psychostimulants for secondary depression in medical illness . Psychosomatics . 1991;32:203-208.Crossref 62. MacKenzie TB, Popkin MK. Suicide in the medical patient . Int J Psychiatry Med . 1987;17:3-22.Crossref 63. Yarnell SK, Battin MP. AIDS, psychiatry and euthanasia . Psychiatr Ann . 1988;18:598-603. 64. Fleishman S, Lesko LM. Delirium and dementia . In: Holland JC, Rowland JH, eds. Handbook of Psychooncology . New York, NY: Oxford University Press; 1989:342-355. 65. Snider WD, Simpson DM, Nielson S, Gold JWM, Metroka CE, Posner JB. Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients . Ann Neurol . 1983;14:403-418Crossref 66. Roth LH, Meisel A, Lidz CW. Tests of competency to consent to treatment . Am J Psychiatry . 1977;134:279-284. 67. Buchanan AE, Brock DW. Deciding for Others . New York, NY: Cambridge Unversity Press; 1989. 68. Robins E. Psychiatric emergencies: suicide . In: Kaplan HS, Sadock BJ, eds. Comprehensive Textbook of Psychiatry . Baltimore, Md: Williams & Wilkins; 1985:1311-1315. 69. Groves JE. Taking care of the hateful patient . N Engl J Med . 1978;298:883-887.Crossref 70. Bursztajn H, Gutheil TG, Warren MJ, Brodsky A. Depression, self-love, time and the 'right' to suicide . Gen Hosp Psychiatry . 1986;8:91-95.Crossref 71. Jackson DL, Youngner S. Patient autonomy and 'death with dignity.' N Engl J Med . 1979;301: 404-408.Crossref 72. Wolf SM. Holding the line on euthanasia . Hastings Cent Rep . 1989;19( (suppl) ):13-15.Crossref 73. Singer PA, Siegler M. Euthanasia: a critique . N Engl J Med . 1990;322:1881-1883.Crossref 74. Gaylin W, Kass LR, Pellegrino ED, Siegler M. ' Doctors must not kill. ' JAMA . 1988;259:2139-2140.Crossref 75. American Geriatrics Society Public Policy Committee. Voluntary active euthanasia . J Am Geriatr Soc . 1991;39:826. 76. American Medical Association Council on Ethical and Judicial Affairs. Decisions near the end of life . JAMA . 1992;267:2229-2233.Crossref 77. Cassel CK, Meier DE. Morals and moralism in the debate over euthanasia and assisted suicide . N Engl J Med . 1990;323:750-752.Crossref 78. Dubovsky SL. Averting suicide in terminally ill patients . Psychosomatics . 1978;19:113-115.Crossref 79. Quill TE, Cassel CK, Meier DE. Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide . N Engl J Med . 1992;327:1380-1384.Crossref 80. Mishler E. The Discourse of Medicine: Dialectics of Medical Interviews . Norwood, NJ: Ablex; 1984. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Patient Requests to Hasten Death: Evaluation and Management in Terminal Care

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420180041005
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Abstract

Abstract Terminally ill patients often hope that death will come quickly. They may broach this wish with their physicians, and even request assistance in hastening death. Thoughts about accelerating death usually do not reflect a sustained desire for suicide or euthanasia, but have other important meanings that require exploration. When patients ask for death to be hastened, the following areas should be explored: the adequacy of symptom control; difficulties in the patient's relationships with family, friends, and health workers; psychological disturbances, especially grief, depression, anxiety, organic mental disorders, and personality disorders; and the patient's personal orientation to the meaning of life and suffering. Appreciation of the clinical determinants and meanings of requests to hasten death can broaden therapeutic options. In all cases, patient requests for accelerated death require ongoing discussion and active efforts to palliate physical and psychological distress. In those infrequent instances when a patient with persistent, irremediable suffering seeks a prompt and comfortable death, the physician must confront the moral, legal, and professional ramifications of his or her response. Rarely, acceding to the patient's request for hastening death may be the least terrible therapeutic alternative. (Arch Intern Med. 1994;154:2039-2047) References 1. van der Maas PJ, van Delden, JJM, Pijnenborg L. Euthanasia and other medical decisions concerning the end of life . Health Policy . 1992;22 (special issue[pts (1) and 2]):193-195.Crossref 2. van der Maas PJ, van Delden JJM, Pijnenborg L, Looman CWN. Euthanasia and other medical decisions concerning the end of life . Lancet . 1991; 338:669-674.Crossref 3. Breitbart W. Suicide . In: Holland JC, Rowland JH, eds. Handbook of Psychooncology . New York, NY: Oxford University Press; 1989:291-299. 4. Whitlock FA. Suicide, cancer and depression . Br J Psychiatry . 1978;132:268-274. 5. Breitbart W. Suicide in cancer patients . Oncology . 1987;1:49-54. 6. Brown JH, Henteleff P, Barakat S, Rowe CJ. Is it normal for terminally ill patients to desire death? Am J Psychiatry . 1986;143:208-211. 7. Owen C, Tennant C, Levi J, Jones M. Suicide and euthanasia: patient attitudes in the context of cancer . Psychooncology . 1992;1:79-88.Crossref 8. Bolund C. Suicide and cancer, I: demographic and social characteristics of cancer patients who committed suicide in Sweden, 1973-76 . J Psychosoc Oncol . 1985;3:17-30.Crossref 9. Bolund C. Suicide and cancer, II: medical and care factors in suicides by cancer patients in Sweden, 1973-76 . J Psychosoc Oncol . 1985;3:31-52.Crossref 10. Louhivuori KA, Hakama M. Risk of suicide among cancer patients . Am J Epidemiol . 1979;109:59-65. 11. Storm HH, Christensen N, Jensen OM. Suicides among Danish patients with cancer: 1971 to 1986 . Cancer . 1992;69:1507-1512.Crossref 12. Marzuk PM, Tierney H, Tardiff K, Gross EM, Morgan EB, Hsu M. Increased risk of suicide in persons with AIDS . JAMA . 1988;259:1333-1337.Crossref 13. Cote TR, Biggar RJ, Dannenberg AL. Risk of suicide among persons with AIDS . JAMA . 1992; 268:2066-2068.Crossref 14. Snyder S, Reyner A, Schmeidler J, Bogursky E, Gomez H, Strain JJ. Prevalence of mental disorders in newly admitted medical inpatients with AIDS . Psychosomatics . 1992;33:166-170.Crossref 15. Humphry D. Final Exit . Eugene, Ore: Hemlock Society; 1991. 16. Twycross RG, Lack SA. Symptom Control in Far Advanced Cancer: Pain Relief . London, England: Pitman Publishing; 1984. 17. Cleeland CS. The impact of pain on patients with cancer . Cancer . 1984;54:235-241.Crossref 18. Portenoy RK. Cancer pain: pathophysiology and syndromes . Lancet . 1992;339:1026-1031.Crossref 19. Levin DN, Cleeland CS, Dar R. Public attitudes toward cancer pain . Cancer . 1985;42:1385-1391.Crossref 20. Owens C, Tennant C, Levi J, Jones M. Suicide and euthanasia: patient attitudes in the context of cancer . Psychooncology . 1992;1:79-88.Crossref 21. Breitbart W. Cancer pain and suicide . In: Foley KM, Bonica JJ, Ventafridda V, eds. Advances in Pain Research and Therapy . New York, NY: Raven Press; 1990;16:399-412. 22. Helig S. The San Francisco Medical Society euthanasia survey: results and analysis . San Francisco Med . 1988;61:24-34. 23. Ventafridda V, Tamburini M, Caraceni A, DeConno F, Naldi F. A validation study of the WHO method for cancer pain relief . Cancer . 1987;59: 350-356.Crossref 24. Grond S, Zech D, Schug SA, Lynch J, Lehmann KA. Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life . J Pain Sympt Manage . 1991; 6:411-422.Crossref 25. Foley KM. The relationship of pain and symptom management to patient requests for physician-assisted suicide . J Pain Sympt Manage . 1991; 6:289-297.Crossref 26. Marks RM, Sachar ES. Undertreatment of medical inpatients with analgesics . Ann Intern Med . 1973;78:173-181.Crossref 27. Hanks GW, Justin DM. Cancer pain: management . Lancet . 1992;339:1031-1036.Crossref 28. Cleeland C. Barriers to the management of cancer pain . Oncology . April 1987( (suppl) ):19-26. 29. Max MB. Improving outcomes of analgesic treatment: is education enough? Ann Intern Med . 1990; 113:885-889.Crossref 30. Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer . J Palliat Care . 1991;7( (2) ):25-29. 31. Lichter I, Hunt E. The last 48 hours of life . J Palliat Care . 1990;6( (4) ):7-15. 32. Ventafridda V, Ripamonti C, DeConno F, Tamburini M, Cassileth BR. Symptom prevalence and control during cancer patients' last days of life . J Palliat Care . 1990;6( (3) ):7-11. 33. Billings JA. Outpatient Management of Advanced Cancer . Philadelphia, Pa: JB Lippincott; 1985. 34. Twycross RG, Lack SA. Therapeutics in Terminal Cancer . 2nd ed. New York, NY: Churchill Livingstone Inc; 1984. 35. Walsh TD. Symptom Control . Boston, Mass: Blackwell Scientific Publications Inc; 1989. 36. Patt RB. Cancer Pain . Philadelphia, Pa: JB Lippincott; 1993. 37. Admiraal P. Cited by: Lo B. Euthanasia: the continuing debate . West J Med . 1988;149:211-212. 38. Truog RD, Berde CB, Mitchell C, Grier HE. Barbiturates in the care of the terminally ill . N Engl J Med . 1992;327:1678-1681.Crossref 39. Wanzer SH, Federman DD, Adelstein SJ, et al. The physician's responsibility toward hopelessly ill patients: a second look . N Engl J Med . 1989;320:844-849.Crossref 40. Greene WR, David WH. Titrated intravenous barbiturates in the control of symptoms in patients with terminal cancer . South Med J . 1991;84: 332-337.Crossref 41. Bottomley DM, Hanks GW. Subcutaneous midazolam infusion in palliative care . J Pain Sympt Manage . 1990;5:259-261.Crossref 42. Parkes CM. Bereavement: Studies of Grief in Adult Life . Madison, Conn: International Universities Press; 1972. 43. Parkes CM, Weiss R. Recovery From Bereavement . New York, NY: Basic Books Inc Publishers; 1983. 44. Plumb MM, Holland J. Comparative studies of psychological function in patients with advanced cancer, I: self-reported depressive symptoms . Psychosom Med . 1977;39:264-276.Crossref 45. Plumb MM, Holland JC. Comparative studies of psychological function in patients with advanced cancer, II: interviewer-rated current and past psychological symptoms . Psychosom Med . 1981;43:243-254.Crossref 46. Lindemann E. Symptomatology and management of acute grief . Am J Psychiatry . 1944;101: 141-148. 47. Brown JT, Stoudemier GA. Normal and pathological grief . JAMA . 1983;250:378-382.Crossref 48. Clayton P. Mourning and depression: their similarities and differences . Can J Psychiatry . 1974; 1:309-312. 49. Massie MJ, Holland JC. The cancer patient with pain: psychiatric complications and their management . J Pain Sympt Manage . 1992;7:99-109.Crossref 50. Massie MJ. Depression . In: Holland JC, Rowland JH, eds. Handbook of Psychooncology . New York, NY: Oxford University Press; 1989:283-290. 51. Levine PM, Silberfarb PM, Lipowski ZJ. Mental disorders in cancer patients . Cancer . 1978;42: 1385-1391.Crossref 52. Holland JC, Hughes AH, Tross S, et al. Comparative psychological disturbance in patients with pancreatic and gastric cancer . Am J Psychiatry . 1986;143:982-986. 53. Goldberg RJ. Systematic understanding of cancer patients who refuse treatment . Psychother Psychosom . 1983;39:1507-1512.Crossref 54. Maltsburger JT, Buie DH. Countertransferance hate in the treatment of suicidal patients . Arch Gen Psychiatry . 1974;30:625-633.Crossref 55. Burt R. Taking Care of Strangers . New York, NY: Free Press; 1979. 56. Fernandez F, Adams F, Holmes VF, Levy JK, Neidhart M. Methylphenidate for depressive disorders in cancer patients: an alternative to standard antidepressants . Psychosomatics . 1987;28: 455-462.Crossref 57. Katon W, Sullivan MD. Depression and chronic medical illness . J Clin Psychiatry . 1990;51( (suppl) ): 3-11. 58. Fernandez F, Adams F, Levy JK, Holmes VF, Neidhart M, Mansell PW. Cognitive impairment due to AIDS-related complex and its response to psychostimulants . Psychosomatics . 1988;29:38-46.Crossref 59. Burns MM, Eisendrath SJ. Dextroamphetamine treatment for depression in terminally patients . Psychosomatics . 1994;35:80-83.Crossref 60. Woods SW, Tesar GE, Murray GB, Cassem EH. Psychostimulant treatment of depressive disorders secondary to medical illness . J Clin Psychiatry . 1986;47:12-15. 61. Masand P, Pickett P, Murray GB. Psychostimulants for secondary depression in medical illness . Psychosomatics . 1991;32:203-208.Crossref 62. MacKenzie TB, Popkin MK. Suicide in the medical patient . Int J Psychiatry Med . 1987;17:3-22.Crossref 63. Yarnell SK, Battin MP. AIDS, psychiatry and euthanasia . Psychiatr Ann . 1988;18:598-603. 64. Fleishman S, Lesko LM. Delirium and dementia . In: Holland JC, Rowland JH, eds. Handbook of Psychooncology . New York, NY: Oxford University Press; 1989:342-355. 65. Snider WD, Simpson DM, Nielson S, Gold JWM, Metroka CE, Posner JB. Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients . Ann Neurol . 1983;14:403-418Crossref 66. Roth LH, Meisel A, Lidz CW. Tests of competency to consent to treatment . Am J Psychiatry . 1977;134:279-284. 67. Buchanan AE, Brock DW. Deciding for Others . New York, NY: Cambridge Unversity Press; 1989. 68. Robins E. Psychiatric emergencies: suicide . In: Kaplan HS, Sadock BJ, eds. Comprehensive Textbook of Psychiatry . Baltimore, Md: Williams & Wilkins; 1985:1311-1315. 69. Groves JE. Taking care of the hateful patient . N Engl J Med . 1978;298:883-887.Crossref 70. Bursztajn H, Gutheil TG, Warren MJ, Brodsky A. Depression, self-love, time and the 'right' to suicide . Gen Hosp Psychiatry . 1986;8:91-95.Crossref 71. Jackson DL, Youngner S. Patient autonomy and 'death with dignity.' N Engl J Med . 1979;301: 404-408.Crossref 72. Wolf SM. Holding the line on euthanasia . Hastings Cent Rep . 1989;19( (suppl) ):13-15.Crossref 73. Singer PA, Siegler M. Euthanasia: a critique . N Engl J Med . 1990;322:1881-1883.Crossref 74. Gaylin W, Kass LR, Pellegrino ED, Siegler M. ' Doctors must not kill. ' JAMA . 1988;259:2139-2140.Crossref 75. American Geriatrics Society Public Policy Committee. Voluntary active euthanasia . J Am Geriatr Soc . 1991;39:826. 76. American Medical Association Council on Ethical and Judicial Affairs. Decisions near the end of life . JAMA . 1992;267:2229-2233.Crossref 77. Cassel CK, Meier DE. Morals and moralism in the debate over euthanasia and assisted suicide . N Engl J Med . 1990;323:750-752.Crossref 78. Dubovsky SL. Averting suicide in terminally ill patients . Psychosomatics . 1978;19:113-115.Crossref 79. Quill TE, Cassel CK, Meier DE. Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide . N Engl J Med . 1992;327:1380-1384.Crossref 80. Mishler E. The Discourse of Medicine: Dialectics of Medical Interviews . Norwood, NJ: Ablex; 1984.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 26, 1994

References