title: The request for assistance in dying. The need for psychiatric consultation.
abstract: BACKGROUND
  Public initiatives and legislative proposals have increased the likelihood that some states will legalize euthanasia and assisted suicide as a means of ending the suffering of patients with terminal illness. However, suggested safeguards that would guide physicians in such cases have not properly addressed the need to evaluate psychosocial factors that could motivate patients' requests for premature death.
  
  
  METHODS
  Four cases of patients with cancer who expressed a wish to end their lives prematurely are described. These cases were evaluated with regard to mental and emotional functioning.
  
  
  RESULTS
  Pain and suffering, organic mental disease, depression, and personality issues play significant roles in patients' requests for assistance in dying.
  
  
  CONCLUSIONS
  Comprehensive psychosocial assessment is needed when evaluating requests for assistance in dying. This assessment may reveal hidden problems or conflicts that affect rational decision making, a prerequisite to informed consent for any procedure or intervention.
authors.affiliation: Department of Psychiatry, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa 33612-9497.
authors.forename: W F
authors.initials: WF
authors.lastname: Baile
authors.forename: J R
authors.initials: JR
authors.lastname: DiMaggio
authors.forename: D V
authors.initials: DV
authors.lastname: Schapira
authors.forename: J S
authors.initials: JS
authors.lastname: Janofsky
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D011570:Psychiatry; D011584:Psychology; D012017:Referral and Consultation; D017236:Suicide, Assisted / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*