A surprising number of terminally ill hospice patients choose to speed their deaths by refusing food and drink, a study in Oregon suggests.
In fact, the survey of hospice nurses found that patients pick this means of ending life -- which is legal everywhere in the United States -- twice as often as physician-assisted suicide, which is legal only in Oregon.
The study further found that these patients are not depressed and typically die tranquilly, within two weeks.
The patients said they were ready to die, their quality of life was poor or they were afraid it would become so, and they saw no point in going on. They also wanted to die at home -- where nearly all hospice care is given -- and control the circumstances of their death, the nurses reported.
Nearly three-quarters of Oregon's 429 hospice nurses returned the survey. One-third of those who did said at least one of their patients in the previous four years had deliberately hastened death by stopping food and fluids.
As striking as the numbers themselves is the fact that the nurses rated the overall quality of those deaths as "8" on a scale in which zero was "very bad" and 9 was "very good." Three-quarters of those scores were 7 or above, according to the study in today's New England Journal of Medicine.
In all, 102 of the 307 nurses who answered the survey had worked with patients who ended their lives this way. At least 16 other patients stopped eating and drinking but later resumed doing so.
Over the same four years, 55 other terminally ill patients had used Oregon's assisted suicide law to get their doctors to prescribe a lethal dose of narcotics.
Other hospice professionals said that although having patients decide to refuse food and drink is far from an everyday occurrence, they found the survey's results completely believable.
Dr. William Lamers of Malibu, Calif., medical consultant to Hospice Foundation of America, estimated that he had treated 50 such patients in 30 years of hospice practice.
"It is not an uncommon thing for people to talk about it -- not uncommon for them to say, 'I'm not hungry. I don't want to eat any more, I just want to go," Lamers said.
Lamers, also a psychiatrist, said these people were clearly not depressed: "They're just saying, in a very reasonable way, 'I've lived a full life, I know what's happening, I don't see any reason in extending it."'