Will to Live in the Terminally Ill.

Harvey Max Chochinov et al., Will to Live in the Terminally Ill, 354 LANCET 816 (1999).

A patient's state of mind is the single most important factor in understanding of a request for physician-hastened death. Euthanasia and physician-assisted suicide raise critical issues about the psychological underpinnings of death-hastening requests. This study is part of a program of research that has addressed various psychiatric dimensions of palliative care. The defining characteristic of this research has been that dying patients have served as the key informants. These studies have helped establish the prevalence of clinical depression among the terminally ill and the extent to which dying patients may endorse a desire for death. Although we know that occasional or fleeting thoughts of a desire for death are common among the terminally ill, and that some of these patients express a genuine desire for death, little is known about how these thoughts may change over the course of time.

This study examined patients with cancer in palliative care. Will to live was measured twice daily throughout the hospital stay on a self-report 100 mm visual analogue scale. This scale was incorporated into the Edmonton symptom assessment system, a series of visual analogue scales measuring pain, nausea, shortness of breath, appetite, drowsiness, depression, sense of well-being, anxiety, and activity. Maximum and median fluctuations in will-to-live ratings, separated by twelve hours, twenty-four hours, seven days, and thirty days, were calculated for each patient.

Of 585 patients admitted to palliative care during the study period (November 1993 to May 1995), 168 (29%; aged 31-89 years) met criteria of cognitive and physical fitness and agreed to take part. The pattern of median changes in will-to-live score suggested that will to live was stable. By contrast, the average maximum changes in...