One in four terminally ill patients in Oregon who opt for physician-assisted suicide have clinical depression and the Death with Dignity Act may not be adequately protecting them, concludes a study in the BMJ.

The extent to which psychiatric disorders may influence patients' choices to hasten death is hotly debated. Under the 1997 act, doctors are supposed to refer patients to a psychologist or psychiatrist if there is concern that their judgment might be impaired. However, it is well-known that health care professionals often fail to recognise depression. In 2007, none of the 46 Oregonians who died by lethal ingestion were evaluated by a psychiatrist or a psychologist.

Researchers from Oregon Health and Science University assessed 58 Oregonians who were terminally ill and had requested physician assisted suicide or contacted an aid in dying organisation to determine if they had depression or anxiety. They found that some did. Fifteen met the criteria for depression and 13 for anxiety. Forty-two patients had died by the end of the study, including at least three who met the criteria for depression.

The authors point out that "the current practice of Death with Dignity Act may not adequately protect all mentally ill patients" and they have called for "increased vigilance and systematic examination for depression among patients who may access legalised aid in dying."

While this study may have alarmed American readers, a doctor from the Netherlands, where euthanasia is legal, was unperturbed. Writing in an accompanying editorial, Dr Marije van der Lee, of the Helen Dowling Institute, said that diagnosing depression and determining whether it has impaired judgement are difficult. Depression does not necessarily impair judgement, she said; what is most important is making an informed decision. "We should focus on trying to 'protect' patients from becoming depressed in the first place, rather than focus on protecting patients from assisted suicide," she said. ~ Science Daily, Oct 8