Correspondence

Physician-Assisted Suicide and Patients with HIV Disease

N Engl J Med 1997; 337:56-57July 3, 1997

Article

To the Editor:

As a physician working in an AIDS hospice in London, I was surprised to read of the high rate of physician-assisted suicide among patients with AIDS in San Francisco as reported by Slome et al. (Feb. 6 issue).1 Six hundred patients with human immunodeficiency virus disease are admitted each year to our hospice, yet there has been only one request for euthanasia in the past three years. Clearly, a number of factors may account for this difference, but I believe the most important is the lack of palliative-care services in the United States as compared with the United Kingdom.

It is striking that Slome et al. did not present palliative care as an option to the physicians on their questionnaire and do not mention it at all in their paper. The information given in their case vignette is limited, and the possibility of exploring the reasons for the patient's request for a lethal prescription is not raised. Is he afraid of pain, the process of dying, or a loss of dignity? Has he witnessed the painful death of someone close to him? Would holistic care attentive to his symptoms and also his psychological, social, and spiritual needs, as well as those of his care givers, have obviated the need for a lethal prescription?

The finding that 48 percent of respondents would be likely or very likely to grant the request of a patient with AIDS for assistance in a suicide is a matter of concern, given the absence of information about the reasons for the request. Are these physicians able to deal clinically and emotionally with issues of mortality affecting their patients? Do they recognize a peaceful and dignified death as a legitimate and attainable goal of medicine? It is crucial that this group of physicians recognize what palliative care offers, because AIDS remains a terminal illness. Several steps that focus on improving the quality of life of dying patients and those caring for them have already been taken in the United States, including the approval of a new diagnosis code for palliative care.2 Introducing palliative care for patients with AIDS would improve their quality of life in its final stages and would substantially reduce the number of requests for assisted suicide.

Maeve McKeogh, M.R.C.P.I.
Mildmay Mission Hospital, London E2 7NA, United Kingdom

2 References

1. 1

   Slome LR, Mitchell TF, Charlebois E, Benevedes JM, Abrams DI. Physician-assisted suicide and patients with human immunodeficiency virus disease. N Engl J Med 1997;336:417-421
   Full Text | Web of Science | Medline

2. 2

   Cassel CK, Vladeck BC. ICD-9 code for palliative or terminal care. N Engl J Med 1996;335:1232-1234
   Full Text | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   (1999) Review Essays. Religious Studies Review 25:1, 3-47
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2. 2

   Meier, Diane E., Emmons, Carol-Ann, Wallenstein, Sylvan, Quill, Timothy, Morrison, R. Sean, Cassel, Christine K., . (1998) A National Survey of Physician-Assisted Suicide and Euthanasia in the United States. New England Journal of Medicine 338:17, 1193-1201
   Full Text