title: Predictors of pursuit of physician-assisted death.
abstract: BACKGROUND
  Physician-assisted death (PAD) was legalized in 1997 by Oregon's Death with Dignity Act. The States of Washington, Montana, Vermont, and New Mexico have since provided legal sanction for PAD. Through 2013, 1173 Oregonians have received a prescription under the Death with Dignity Act and 752 have died after taking the prescribed medication in Oregon.
  
  
  OBJECTIVE
  To determine the predictive value of personal and interpersonal variables in the pursuit of PAD.
  
  
  METHODS
  Fifty-five Oregonians who either requested PAD or contacted a PAD advocacy organization were compared with 39 individuals with advanced disease who did not pursue PAD. We compared the two groups on responses to standardized measures of depression, hopelessness, spirituality, social support, and pain. We also compared the two groups on style of attachment to intimate others and caregivers as understood through attachment theory.
  
  
  RESULTS
  We found that PAD requesters had higher levels of depression, hopelessness, and dismissive attachment (attachment to others characterized by independence and self-reliance), and lower levels of spirituality. There were moderate correlations among the variables of spirituality, hopelessness, depression, social support, and dismissive attachment. There was a strong correlation between depression and hopelessness. Low spirituality emerged as the strongest predictor of pursuit of PAD in the regression analysis.
  
  
  CONCLUSIONS
  Although some factors motivating pursuit of PAD, such as depression, may be ameliorated by medical interventions, other factors, such as style of attachment and sense of spirituality, are long-standing aspects of the individual that should be supported at the end of life. Practitioners must develop respectful awareness and understanding of the interpersonal and spiritual perspectives of their patients to provide such support.
authors.affiliation: Health and Counseling Center, Reed College, Portland, Oregon, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Smith
authors.affiliation: Betty Irene Moore School of Nursing, University of California-Davis, Sacramento, California, USA.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Harvath
authors.affiliation: Mental Health and Neurosciences Division, Department of Veterans Affairs Medical Center, Portland, Oregon, USA; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Goy
authors.affiliation: Health Services Research and Development Center of Innovation, Department of Veterans Affairs Medical Center, Portland, Oregon, USA; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: linda.ganzini@va.gov.
authors.forename: Linda
authors.initials: L
authors.lastname: Ganzini
mesh_terms: D000368:Aged; D001293:Attitude to Death; D017028:Caregivers; D003863:Depression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009369:Neoplasms / Q000523:psychology; D009922:Oregon; D010146:Pain; D012944:Social Support; D029181:Spirituality; D017236:Suicide, Assisted / Q000523:psychology*
keywords: Physician-assisted death; attachment; depression; end-of-life care; euthanasia; hopelessness; pain; spirituality