by Becky Ham
Patients with advanced AIDS who suffer from problems like memory loss or failing coordination are significantly more likely to wish for an early death than patients without these problems, according to new research.
The findings suggest that cognitive deterioration may contribute modestly to terminally ill patients' desires to die more quickly, particularly if the deterioration is obvious and distressing, say Hayley Pessin, Ph.D., of Memorial Sloan-Kettering Cancer Center and colleagues.
"Patients who perceived themselves as having cognitive difficulties demonstrated greater desire for hastened death than those who were either cognitively intact or impaired but unaware of their deficits," Pessin and colleagues say in the May issue of General Hospital Psychiatry.
Pessin and colleagues say it is increasingly important to examine all the reasons why terminally ill patients might want to die early, particularly as debates over doctor-assisted suicide and other ways to hasten death become more prevalent in health care and public policy.
"As cognitive abilities such as abstract reasoning, problem solving and memory become compromised, patients may have more difficulty making decisions and finding ways to improve their situation. In addition, the loss of cognitive abilities may directly impede one's quality or enjoyment of life. Finally, an awareness of cognitive deficits may contribute to a patient's sense of deterioration and increase their emotional distress," Pessin explains.
The researchers screened 109 patients with advanced AIDS for signs of cognitive impairments like memory and attention loss, poor coordination, difficulties with abstract reasoning and other brain deficits. They also asked patients how distressed they were about these problems, and whether they wished for an early death.
Many of the patients suffered some loss of cognitive functioning: 71 percent of the patients had noticeable symptoms of HIV-related dementia and most of them reported being "quite a bit" distressed by their problems.
Patients with the most obvious problems, like memory and concentration loss, were more likely to express a wish to die early than patients who had problems with abstract reasoning and other more subtle deficits.
This suggests that "not only does the presence of cognitive impairment appear to impact desire for hastened death, but the patient's perception of their impairment is a crucial influence as well," Pessin says.
The study was supported by the National Institute of Mental Health.
- Health Behavior News Service
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