Blank K, Robison J, Doherty E, Prigerson H, Duffy J, Schwartz H I
Braceland Center for Mental Health and Aging, Institute of Living, Hartford, Connecticut 06106, USA.
J Am Geriatr Soc. 2001 Feb;49(2):153-61. doi: 10.1046/j.1532-5415.2001.49036.x.
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.
Cross-sectional study.
General medical hospital.
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.
Subjects underwent a structured interview evaluating their life-sustaining treatment choices and whether they 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.
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.
本研究的主要目的是调查老年、患有内科疾病的住院患者的抑郁情绪对其维持生命治疗、医生协助自杀（PAS）及安乐死偏好的影响，并确定经济限制对其选择的影响程度。
横断面研究。
综合医院。
158名60岁及以上、平均年龄74.1岁（范围60 - 94岁）、因内科疾病住院且无痴呆的患者。根据流行病学研究中心抑郁量表（CES - D）得分，样本被分为抑郁组（n = 71）和非抑郁对照组。
受试者接受结构化访谈，评估其维持生命治疗的选择，以及在各种假设情况下他们是否会接受或拒绝PAS或安乐死。在引入经济影响因素后，对这些选择进行重新评估。此外，评估还包括抑郁、自杀、认知、社会支持、功能和宗教信仰等方面的测量。
除患者当前状况外，在大多数假设临床情景中，抑郁与接受PAS和安乐死高度相关。与非抑郁者相比，抑郁受访者在考虑自身当前状况时接受PAS的可能性是前者的13倍（95%置信区间[CI] 1.68 - 110.98），在面对假设的晚期疾病或昏迷时接受PAS的可能性是前者的两倍多。单独的抑郁与维持生命治疗选择的关联较弱，但在引入经济影响因素后，抑郁受试者拒绝他们之前想要的治疗选择的人数明显多于非抑郁受试者。自杀意念的存在，即使是被动意念，也强烈预示着会拒绝维持生命治疗，并增加对PAS和安乐死的兴趣。逻辑回归证实了抑郁对接受PAS的影响，该回归还表明，在两种假设情景中，宗教应对方式与对PAS的兴趣较低显著相关。结论：在假设情况下，抑郁受试者甚至有轻微被动自杀意念的受试者对PAS和安乐死的兴趣明显高于非抑郁受试者。如果可能产生经济后果，抑郁受试者也特别容易拒绝治疗。
