Terminally Ill Often Change Their Minds about Will to Live, Study Shows

By Burke J. Balch, JD, director
Robert Powell Center for Medical Ethics

Editor’s note. This story, from the September 14, 1999, edition of National Right to Life News, is the latest installment in our year-long “Roe at 40” series where we bring you some of the very best articles going back to 1973. I hope you will forward this excellent analysis using your social networks. If you are not a subscriber to the “pro-life newspaper of record,“ please call us at 202-626-828.

Burke Balch, J.D.

Burke Balch, J.D.

Suicide is a permanent decision. Once you’ve killed yourself, it’s too late to change your mind. Yet proponents of the legalization of assisting suicide maintain that killing oneself can be a rational, autonomous choice, and argue that a waiting period, such as the 15-day one in Oregon’s statute, provides a sufficient safeguard against the potential ambivalence and reversibility of an expressed desire to die.

It has long been known that the overwhelming majority of people who attempt suicide and are stopped later change their minds and do not go on to kill themselves. Less than 4% have done so five years later, and only 10 to 14% ten years later. Euthanasia advocates sometimes dismiss such statistics as inapplicable to those who are terminally ill. Now a recently published study of terminally ill cancer patients suggests that their desire to live or die is subject to similar fluctuations.

The September 4, 1999, issue of the British medical journal “Lancet” reports the results of a study by the Canadian psychiatrist Dr. Harvey M. Chochinov and others that involved asking 168 patients in a palliative care unit to rate their desire to live on a scale of 1 to 100 twice daily. The survey also recorded information about a variety of their other attitudes and symptoms.

The study found not only that on average an individual’s desire for death or life changed dramatically, but also that the more time went by, the more likely it was to change. Thus, the average maximum change in a 12-hour period was 33.1 on the scale of 100; in a 24-hour period, 35.8; in a 7-day period, 48.8; and in a 30-day period, 63.0. In the words of the study’s authors, “These large fluctuations suggest that will to live is highly unstable.”

This data raises severe questions about the claim that a 15day waiting period is sufficient to ensure that a terminally ill individual’s desire for assisted suicide is truly stable and unlikely to change, since in a month an average terminally ill person’s desire for death could dramatically change, for example, from 15 to 78 on the 1 to 100 scale. (The larger the number, the less the patient wants to die.)

Another telling result from the study came from correlating the patient’s will to live with the patient’s experience of physical and psychological symptoms. In the first 24 hours after admission to the palliative care unit, a low will to live (or high desire to die) was correlated with the degree of the patient’s anxiety. For one to two weeks after admission, the greatest predictor of a low will to live was depression, while for the period three to four weeks after admission (which the study authors considered “reflective of a time frame approaching death”) the strongest correlation with a low will to live was shortness of breath.

Because treatment is available for anxiety, depression, and shortness of breath, these results suggest that better treatment of these symptoms in palliative care could greatly affect the expressed desire to die. Commenting on the study, Dr. Gregory Hamilton, president of Physicians for Compassionate Care, said, “This study demonstrates numerically that feelings of suicidal ideation or suicidal despair can be influenced through treatment and should not be taken at face value as some kind of abstract philosophical right.

Dr. Hamilton concluded, “People’s feelings about themselves and about the value of their lives vary over time. What we need to do with patients who are very ill is to take care of them.”