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Is a desire for hastened death (also known as assisted suicide, or aid in dying) associated with being depressed? Among people with a desire for hastened death, does treatment of depression diminish that desire to end their lives?
Reference: Smith, K. A., Harvath, T. A., Goy, E. R., & Ganzini, L. (2015). Predictors of Pursuit of Physician-Assisted Death//doi-org.ezproxy.lib.usf.edu/10.1016/j.jpainsymman.2014.06.010 Retrieved from http://www.sciencedirect.com.ezproxy.lib.usf.edu/science/article/pii/S0885392414003984
Impact Factor for ‘Journal of Pain and Symptom Management’: 3.378 (source: InCites Journal Citation Reports)
In order to determine the personal and interpersonal variables that can predict the pursuit of Physician-Assisted Death (PAD), the researchers recruited terminally ill patients from a variety of sources, like Compassion and Choices of Oregon, end-of-life advocacy organization, hospices, ethics consultants, and from palliative cares & oncology physicians at large medical centers in Portland. Only the patients that had inquired seriously for PAD or had requested for lethal medication or had received lethal medications were included in the experimental group. While for the control/comparison group, patients that had an advanced disease but no interest in PAD were recruited. For the experimental group, as a part of the initial screening, the participants were given a Folstein McHugh Mini-Mental State Examination or Short Portable Mental Status Questionnaire to determine whether the participants were cognitively impaired. Cognitively impaired participants were excluded from the study. For measurement of each predictor variable, different scales were used, including Modified Wisconsin Brief Pain Inventory short form for Pain, Hospital Anxiety and Depression Scale for Depression, The Beck Hopelessness Scale for Hopelessness, The Relationship Questionnaire for Attachment styles, Functional Assessment of Chronic Illness Therapy-Spiritual Well Being Scale for Spirituality, and Duke University of North Carolina Functional Support Questionnaire for Social Support. Moreover, to be an ethically viable study, all the participants were given informed consent to participate. The study was approved by institutional review boards of Portland Veterans Affairs Medical Center and other participating agencies.
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In the study of fifty-five participants who pursued PAD and thirty-nine participants who did not seek PAD, it was found that unmarried and highly educated participants were more likely to pursue PAD. More, significantly higher levels of depression, hopelessness, dismissive attachment, and considerably lower levels of spirituality were associated with those pursuing PAD. The study also found significant inter-correlations between the predictor variables, including the negative correlation between spirituality and depression and hopelessness and positive correlation with social support. The dismissive attachment was negatively associated with spirituality but positively correlated with hopelessness. Lastly, depression and hopelessness were found to be negatively correlated with social support, and depression was positively correlated with hopelessness. Additionally, data revealed that increasing the level of education of participant by one year led to increased chances of the pursuit of PAD by 1.36 times. Similarly, for an increase in one-point spirituality led to an increase in chances for the pursuit of PAD by 0.88 times.
The Timeliness of the research article can be rated two because of the article being published in 2015 (4 years ago), and many other U.S. states have legalized PAD, and by the end of 2019 total of nine states will have legalized PAD as opposed to four in 2015. This data affects both reliability and generalizability of the study with timeliness (“Physician-Assisted Suicide Fast Facts”). More, later studies in 2016 in the Netherlands found mixed results for the association of depression or psychosis with PAD (Doernberg et al., 2016). Due to mixed results in later years, more updated research with participants from different places is needed. The Relevance of the article can be rated three because the study properly addresses the first part of the question regarding the relatedness of depression with assisted deaths, but it does not at all reference to any possible treatments for depression to reduce assisted deaths. As a strength, the article consists of a study based on inquiry with patients as opposed to researches that are conducted with proxy informants such as physicians and family.
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The Authority of the article can be rated four because of the achievements and the qualifications of the authors of the paper. Although there is no history of previous researches available for Dr. Kathryn Smith, Dr. Theresa Harvath, and Dr. Elizabeth Goy on google scholar, there is much more information available for Dr. Linda Ganzini, who has around 8000 citations total on her previously published articles. Adding to the strengths, all the investigators possess a doctoral degree with additional degrees in health science or medical sciences, which makes the article more trustworthy and acceptable. Next, the Accuracy of the article can be rated five because the article is based on a clinical study performed on patients with IRB approval, and the methods and sources of information are cited in the paper. The references cited consists only of previously published peer-reviewed research articles. There are no limitations to the strength of the accuracy of the paper. The Purpose of the article can also be rated five because the article was published in an academic journal to expand knowledge and targeted for academic readers. There was no political or ideological influence in the paper as the author mentioned in the introduction that the purpose of the paper was to overcome the limitation of previous researches and test predictor variables for PAD. Lastly, there is no identifiable bias in the information presented as the article is peer-reviewed, and both the strengths & limitations of the study are mentioned in the discussion section. Overall the information presented in the article is valid but not so reliable due to poor timeliness and partly outdated information in the article. Additionally, the article may not be an excellent article to get the proper information from as it also lacks information sought in the first place.
The strengths of the methodology of the study include that the participants recruited for the study were patients who had a made a ‘serious’ request for the medication for PAD, this would have helped researchers to eliminate any errors in the study regarding the personal and interpersonal variables predicting pursuit of PAD. Compared to the previous articles published this study consisted of inquiry of patient themselves who pursued PAD instead of studies based on proxy informants and the study also possessed a control group with participants having an advanced disease with no interest in the pursuit of PAD. Comparing the data between the groups while also using previously accepted scales helped increase the validity of the data. The limitation of the study was the presence of convenience sample and the generalizability of the data since all the participants were from Oregon and may have lived in the same environment, the data might not be comparable to participants in a study from Montana or perhaps Maine. Another limitation is that the study participants or the sample may have been early in the end-of-life phase as most participants were not enrolled in hospice care as opposed to the population data in which mostly all patients who used PAD were enrolled in hospice care.
The research article addressed the question only partly and specifically the first part of the question regarding the association of depression with hastened death or assisted death. The author does mention that the research study conducted helps the physicians in understanding the factors that might cause a terminally ill patient to pursue PAD and this signifies that author might be prompting towards the treatment of potentially identified factors to reduce patients being influenced to pursue PAD. But there is no explicit mentioning in the article that treatments specifically for depression might help reduce the desire to end their lives. On the other hand, the article very informatively discussed the role of depression in PAD. Depression was measured by using a subscale of Hospital Anxiety and Depression, which makes the data provided more valid and reliable. Furthermore, based on the TRAAP ratings discussed earlier, except for the timeliness of the article, the article is very authoritative and accurate for the information presented. The article also provides a definitive answer regarding the association of depression with patients pursuing PAD. Hence, the article may be a good source of information for preliminary research as it addressed the question south only partially.
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