Life-sustaining treatment and assisted death choices in depressed older patients
Life-sustaining treatment and assisted death choices in depressed older patients
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DOI：
10.1046/j.1532-5415.2001.49036.x
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发表时间：
2001-02-01
影响因子：
6.3
通讯作者：
Schwartz, HI
中科院分区：
文献类型：
--
作者：
Blank, K;Robison, J;Schwartz, HI
目的：本研究的主要目的是检查老年、疾病、住院患者的抑郁情绪对他们对维持生命治疗、医生协助自杀（PAS）和安乐死的偏好的影响，并确定经济限制对他们选择的影响程度。设计：横断面研究。单位：综合医院。参与者：158名60岁或以上的住院非痴呆患者，平均年龄74.1岁（范围60-94岁）。根据流行病学研究中心的抑郁（CES-D）评分，样本被分为抑郁组（n = 71）和非抑郁对照组。测量方法：受试者接受结构化访谈，评估他们的生命维持治疗选择，以及是否有效。在各种假设条件下，他们会接受或拒绝PAS或安乐死。随着财务影响的引入，对这些选择进行了重新评估。此外，评估还包括抑郁、自杀、认知、社会支持、功能和宗教信仰的测量。结果：除了患者目前的状况外，在大多数假设的临床情景中，抑郁症与PAS和安乐死的接受度高度相关。与非抑郁症患者相比，当考虑到他们目前的状况时，抑郁症患者接受PAS的可能性是正常人的13倍（95%置信区间[CI] 1.68-110.98），当面对假设的绝症或昏迷时，接受PAS的可能性是正常人的两倍以上。抑郁症本身与维持生命的治疗选择的相关性很弱，但是，当经济影响被引入时，明显更多的抑郁症受试者拒绝他们之前期望的治疗方案。自杀意念的存在，甚至是被动意念，都强烈地预示着生命维持治疗的拒绝，以及对PAS和安乐死的兴趣增加。通过逻辑回归证实了抑郁对PAS接受度的影响，这也表明在两种假设情景下，宗教应对与PAS兴趣降低显著相关。结论：在假设情境下，抑郁被试和有轻微、被动自杀意念的被试对PAS和安乐死的兴趣明显高于非抑郁被试。如果可能导致经济上的后果，抑郁症患者也特别容易拒绝治疗。
OBJECTIVES: The major purpose of this study was to examine the effect of depressed mood in older, medically ill, hospitalized patients on their preferences regarding life-sustaining treatments, physician-assisted suicide (PAS), and euthanasia and to determine the degree to which financial constraints affected their choices.DESIGN: Cross-sectional study.SETTING: General medical hospital.PARTICIPANTS: One hundred fifty-eight medically hospitalized, nondemented patients age 60 or older, mean age 74.1 (range 60-94). The sample was divided, based on Center for Epidemiologic Studies-Depression (CES-D) scores, into a depressed group (n = 71) and a nondepressed control group.MEASUREMENTS: Subjects underwent a structured interview evaluating their life-sustaining treatment choices and whether the!, would accept or refuse PAS or euthanasia under a variety of hypothetical conditions. These choices were reevaluated with the introduction of financial impact. In addition, assessment included measures of depression, suicide, cognition, social support, functioning, and religiosity.RESULTS: Depression was found to be highly associated with acceptance of PAS and euthanasia in most hypothetical clinical scenarios in addition to patients' current condition. Compared with nondepressed people, depressed respondents were 13 times as likely to accept PAS when considering their current condition (95% confidence interval [CI] 1.68-110.98), and over twice as likely to accept PAS when facing a hypothetical terminal illness or coma. Depression alone was weakly associated with life-sustaining treatment choices but, when financial impact was introduced, significantly more depressed subjects refused treatment options they had previously desired than did nondepressed subjects. The presence of suicidal ideation, even passive ideation, was strongly predictive of life-sustaining treatment refusals and increased interest in PAS and euthanasia. Depression's effect on acceptance of PAS was confirmed by logistic regression, which also showed that religious coping was significantly correlated with less interest in PAS in two hypothetical scenarios.CONCLUSION: Depressed subjects and even subjects with subtle, passive suicidal ideation were markedly more interested in PAS and euthanasia than nondepressed subjects in hypothetical situations. Depressed subjects were also particularly vulnerable to rejecting treatments if financial consequences might have resulted.