Findings on Physician-assisted Suicide Suggest Need to Address Depression in MS Patients

By Katy Mena-Berkley
Friday, September 1, 2017

A survey of people with multiple sclerosis reveals significant interest in physician-assisted suicide — findings that highlight the value of dealing with mental health issues among this population, according to researchers.

Coupled with behavioral health challenges such as depression, chronic conditions that have a potentially strong negative impact on quality of life can make ending one’s life seem like a viable solution for some patients. A 2016 study in the European Journal of Neurology found the risk of both attempted and completed suicide among MS patients was approximately double that found in the general population. As of this writing, California, Colorado, Montana, Oregon, Vermont, Washington state and the District of Columbia permit physician-assisted suicide.

A research team for the more recent study, findings of which were published in Neurology in March 2017, surveyed 7,534 respondents from the North American Research Committee on Multiple Sclerosis (NARCOMS) registry. Led by Ruth Ann Marrie, MD, PhD, FRCPC, Professor of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, researchers inquired about patients’ willingness to consider physician-assisted suicide in five hypothetical situations:

  • If they were experiencing unbearable pain
  • If they felt they were creating a financial burden on caregivers
  • If they felt extreme emotional distress
  • If they were unable to do fulfilling things
  • If they were unable to enjoy activities that make life worth living

Survey Results

The survey found 7.1 percent of respondents would definitely consider physician-assisted suicide in all of these situations. Roughly 65 percent would probably or definitely consider this option if they were in unbearable pain. About half said they might choose suicide if they were unable to enjoy activities that were once fulfilling.

“Responses to our study suggest that people with MS do think about this issue, although it is likely that many have not talked about this with their healthcare providers,” Dr. Marrie says. “Depression is common in people with MS and is associated with reduced quality of life, pain, increased hospitalizations and other adverse outcomes. Fortunately, depression can be treated if it is identified.”

The authors note in the study, “The association of depression with considering [physician-assisted death] emphasizes the importance of diagnosing and treating depression.”

Seeking Solutions

The experience of one behavioral medicine expert with Cleveland Clinic sheds a different perspective on the findings.

“I know that the suicide rate is high [among MS patients], but I don’t see that in my patient population,” says Amy Sullivan, PsyD, ABPP, Director of Behavioral Medicine Training and Research with the Mellen Center for MS. “My patients are going to do what it takes to get through their depression and their anxiety so that they can effectively manage their MS.”

Sullivan recommends having behavioral medicine providers in neurology settings where clinicians address MS.