HIV-Positive Individuals’ ‘Loss of Self’ Contributes to Desire for Euthanasia, Assisted Suicide
Physical "disintegration" and "loss of community" -- the "progressive diminishment of opportunities to initiate and maintain close personal relationships" -- combine to give HIV patients a feeling of "loss of self" that contributes to their desires for euthanasia or assisted suicide, a study in the Aug. 4 issue of the Lancet states. Researchers from the Joint Center for Bioethics at the University of Toronto interviewed 32 HIV patients who participated in the HIV Ontario Observational Database from November 1996 to June 1998 about their feelings on euthanasia and assisted suicide and asked under what circumstances they might consider either practice. Sixty-three percent of participants said they would pursue euthanasia or assisted suicide as a means of ending their lives, while 9% said they had rejected the idea and 28% remained undecided. Many of those interviewed said that physical deterioration led to "dependency" on others, something they found "intolerable," and survey participants "frequently" expressed a desire to maintain a sense of "dignity." Loss of community resulted from a loss of mobility, "exclusion and alienation by others" and the patient's own "isolating actions," resulting from a "fear of rejection." These factors combined to give patients a feeling that "their fundamental nature or essence had been irrevocably eroded, or that this was at risk of occurring," the study authors state. Participants determined that euthanasia and assisted suicide were a "means of limiting" the feeling of loss of self, and none indicated a desire to pursue either practice "outside of the circumstances that led to their perception of loss of self."
Factors that lead to a feeling of loss of community, such as "disownment" by family, stigmatization and histories of drug and/or sexual abuse, suggest that the decision to pursue euthanasia or assisted suicide could be altered if "meaningful changes in individuals' social circumstances" were made, "independently from disease progression," the authors note. Because guidelines governing euthanasia or assisted suicide policy are drawn "mainly within the doctor-patient relationship" they might "obscure the role" of these "broader social influences," they conclude (Lavery et al., Lancet, 8/4). In an accompanying commentary piece, Anthony Back and Robert Pearlman of the Veterans Affairs Puget Sound Health Care System write that "requiring clinicians to decide whether a patient has suffered enough, or has lost enough, or is isolated enough," is not easily encompassed in guidelines. Instead, they suggest that the "availability of reasonable palliative care be taken into account in any patient's decision-making process" regarding assisted suicide or euthanasia. This would set a "benchmark standard" for palliative care in the United States, where such care is not "reliably available," and could "shed light on what palliative medicine can do for all dying persons, whether they desire physician-assisted suicide or not," they conclude (Beck/Pearlman, Lancet, 8/4).