title: End-of-life mental health assessments for older aged, medically ill persons with expressed desire to die.
abstract: In recent years, assisted suicide has been legalized in four states for those who are terminally ill and wish to end their lives with the assistance of lethal doses of medications prescribed by a physician. The ethics-related and legal questions raised by end-of-life suicide and decisional capacity to refuse treatment assessments are complex. In treating patients with end-stage medical conditions or disorders that severely affect the future quality of their lives, clinicians tend to engage in suicide prevention at all costs. Overriding the patient's expressed desire to die conflicts with another value, however, that of the individual's right to autonomy. We provide a framework for understanding these difficult decisions, by providing a review of the epidemiology of suicide in later life; reviewing findings from a unique dataset of suicides among the elderly obtained from the Los Angeles County Coroner's Office, as well as data from states with legalized assisted suicide; presenting a discussion of the two frameworks of suicidal ideation as a pathological versus an existential reaction; and giving a case example that highlights the dilemmas faced by clinicians addressing decisional capacity to refuse treatment in an elderly, medically ill patient who has expressed the wish to die.
authors.affiliation: Dr. Weinberger is Professor of Clinical Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, and Chief Psychologist, USC Institute of Psychiatry, Law, and Behavioral Science, Los Angeles, CA. Dr. Sreenivasan is Clinical Professor of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, and Director, Forensic Outreach Services, Greater Los Angeles VA Medical Center, Los Angeles, CA. Dr. Garrick is Professor of Psychiatry, Geffen School of Medicine, University of California, Los Angeles and Chief of General Hospital Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA. leweinbe@usc.edu.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Weinberger
authors.affiliation: Dr. Weinberger is Professor of Clinical Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, and Chief Psychologist, USC Institute of Psychiatry, Law, and Behavioral Science, Los Angeles, CA. Dr. Sreenivasan is Clinical Professor of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, and Director, Forensic Outreach Services, Greater Los Angeles VA Medical Center, Los Angeles, CA. Dr. Garrick is Professor of Psychiatry, Geffen School of Medicine, University of California, Los Angeles and Chief of General Hospital Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA.
authors.forename: Shoba
authors.initials: S
authors.lastname: Sreenivasan
authors.affiliation: Dr. Weinberger is Professor of Clinical Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, and Chief Psychologist, USC Institute of Psychiatry, Law, and Behavioral Science, Los Angeles, CA. Dr. Sreenivasan is Clinical Professor of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, and Director, Forensic Outreach Services, Greater Los Angeles VA Medical Center, Los Angeles, CA. Dr. Garrick is Professor of Psychiatry, Geffen School of Medicine, University of California, Los Angeles and Chief of General Hospital Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Garrick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003430:Cross-Sectional Studies; D004992:Ethics, Medical; D005104:Expert Testimony / Q000941:ethics / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000941:ethics / Q000331:legislation & jurisprudence; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D013405:Suicide / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D017236:Suicide, Assisted / Q000941:ethics / Q000331:legislation & jurisprudence*; D019452:Terminally Ill / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000941:ethics / Q000331:legislation & jurisprudence; D000092864:Suicide Prevention