A new University of Queensland report suggests that doctors may unconsciously wish that terminally ill patients who fail to respond to treatment would die.
"Doctors - like family members and nurses - may sometimes have very negative feelings about terminally ill patients who have not responded to treatment," Associate Professor Brian Kelly and Associate Professor Frank Varghese said.
"Doctors may have a whole range of feelings about their patients, including hate."
Dr Kelly and Dr Varghese of the University Psychiatry Department at Princess Alexandra Hospital have completed a literature review examining doctors' feelings about patients and their influence on end-of-life decisions or assisted suicide requests. They presented the paper on psychiatric issues of euthanasia and assisted suicide at the American Psychiatric Association's (APA) annual meeting in Washington this month. The paper will be published in the APA Annual Review of Psychiatry.
"From the literature it was clear that patients' requests for assisted suicide are complex issues involving the social, family and health system contexts and possibly also the presence of psychiatric illness, especially depression," Dr Kelly said. "The literature suggests that assisted suicide is not all that different from other types of suicides.
"We believe that helping a person to commit suicide or euthanasia is a clinical issue, not just an ethical problem. Our review found that when a patient requests assisted suicide this represents an unusual doctor-patient interaction. Furthermore, we suggest that when a patient does make that kind of end-of-life request something has gone wrong in the doctor/patient relationship. The subtext is: are you sick of me and wish me dead? Do you have a sense of defeat in treating my illness?"
Dr Varghese said the dangers of euthanasia legislation, such as the Northern Territory and Oregon, U.S. laws, were that they did not take account of doctors' feelings about patients. The euthanasia debate wrongly assumed that doctors would always act benignly towards patients.
"If legislation allows doctor to assist in suicide, it prevents doctors from addressing the underlying issues," he said. "The current prohibition against killing allows doctors to explore other areas. Assisted suicide underestimates what the doctor has to offer the doctor-patient relationship. It is not the patient's wish to die that is the question, but the doctor's wish to kill."
Media: For further information contact Dr Brian Kelly telephone 07 3240 2864 or Dr Frank Varghese, telephone 07 3240 2875.
