title: Antecedents of euthanasia and suicide among older women.
abstract: OBJECTIVE
  To identify the characteristics of older women who sought Jack Kevorkian's assistance in dying and to compare them with those of an age-matched sample who committed suicide.
  
  
  METHODS
  This retrospective case-control study compared all 18 women age 55 and older who died with the assistance of Jack Kevorkian and whose deaths were investigated in Oakland County, Michigan from 1995 to 1997 with all 15 women age 55 and older who committed suicide in the same county during the same time period. We coded 203 variables in 7 domains from medical examiner files, including autopsy findings.
  
  
  RESULTS
  Significantly more of Kevorkian's cases had amyotrophic lateral sclerosis or multiple sclerosis (p = .018), a recent decline in health (p = .031), or inadequately controlled pain (p = .041). Women who committed suicide had more prevalent chronic illnesses and were more likely to have been diagnosed with clinically significant depression or other psychiatric disorders (p = .023). Both groups were significantly less likely to be married (p < .001) and more likely to be divorced (p < .001) than US Census data would predict.
  
  
  CONCLUSIONS
  The different vulnerabilities of older women who want to die and either commit suicide or seek assistance deserve continued careful research. Poorly controlled pain was a factor in seeking assistance in dying, and depression and psychiatric disorders characterized older women who committed suicide in our study. Not having a spouse may increase isolation and reinforce the hopelessness of women who are living with catastrophic illness.
authors.affiliation: Department of Internal Medicine, College of Medicine, University of South Florida, MDC 19, 12901 Bruce B Downs Blvd, Tampa, FL 33612-4799, USA. lroscoe@hsc.usf.edu
authors.forename: Lori A
authors.initials: LA
authors.lastname: Roscoe
authors.forename: Julie E
authors.initials: JE
authors.lastname: Malphurs
authors.forename: L J
authors.initials: LJ
authors.lastname: Dragovic
authors.forename: Donna
authors.initials: D
authors.lastname: Cohen
mesh_terms: D000368:Aged; D001293:Attitude to Death; D016022:Case-Control Studies; D002908:Chronic Disease / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D028601:Euthanasia, Active / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008824:Michigan; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D017236:Suicide, Assisted / Q000706:statistics & numerical data; D014930:Women / Q000523:psychology*