Individuals exploring physician aid in dying in Oregon appear to be motivated by worries about future pain and loss of autonomy rather than current symptoms, according to another report in the same issue. Linda Ganzini, M.D., M.P.H., and colleagues at Portland Veterans' Affairs Medical Center and Oregon Health and Science University, Portland, surveyed 56 individuals who either requested physician aid in dying or contacted a related advocacy organization. Participants were asked to rate the importance of 29 reasons for seeking this option on a scale of one (least important) to five (most important).

The most important reasons-with median (midpoint) scores of five-were wanting to die at home and control the surrounding circumstances of death; loss of independence; and concerns about future pain, poor quality of life and inability to care for one's self. All current physical symptoms were rated as unimportant (one).

"Our data suggest that when patients first request physician aid in dying, they do so not because of physical symptoms or quality of life at the time of the request but in anticipation of future suffering that they perceive as intolerable. Their desire to die is not strong, and they do not believe that their life is poor in quality, meaningless or worthless. Rather, they appear to be protecting against the risk of future experience they do not believe they can endure," the authors write. "When confronted with a request for physician aid in dying, health care providers should first work to bolster the patient's sense of control and to educate and reassure the patient regarding management of future symptoms."

Arch Intern Med. 2009;169[5]:489-492.

Archives of Internal Medicine