High hypothetical interest in physician-assisted death in multiple sclerosis

Ruth Ann Marrie; Amber Salter; Tuula Tyry; Gary R Cutter; Stacey Cofield; Robert J Fox

doi:10.1212/WNL.0000000000003831

High hypothetical interest in physician-assisted death in multiple sclerosis

Neurology. 2017 Apr 18;88(16):1528-1534. doi: 10.1212/WNL.0000000000003831. Epub 2017 Mar 15.

Authors

Ruth Ann Marrie¹, Amber Salter², Tuula Tyry², Gary R Cutter², Stacey Cofield², Robert J Fox²

Affiliations

¹ From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH. rmarrie@hsc.mb.ca.
² From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH.

PMID: 28298551
DOI: 10.1212/WNL.0000000000003831

Abstract

Objective: To assess the opinions of persons with multiple sclerosis (MS) regarding physician-assisted death (PAD).

Methods: We surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding PAD. For each of 5 hypothetical situations, respondents indicated whether they definitely would, probably would, probably would not, or definitely would not consider PAD. They also reported their sociodemographics, disability status using Patient-Determined Disease Steps, depression status, pain status, religiosity, and degree of social support. Using multivariable logistic regression models, we evaluated the factors associated with an individual reporting that he or she would definitely or probably consider PAD in each situation.

Results: Of 7,534 respondents, 6,011 (79.8%) were female, and 6,884 (92.9%) were white. Their mean (SD) age was 59.9 (10.2) years. Fifty percent of respondents reported at least moderate disability. Of the 6,792 respondents who responded to any of the PAD questions, 6,400 responded to all questions. Of these, 458 (7.1%) indicated that they would definitely consider PAD in all of the situations listed, while 1,275 (19.9%) indicated that they definitely would not consider PAD in any of the situations listed. If experiencing unbearable pain, 4,383 (65.3%) of respondents would definitely or probably consider PAD. On multivariable analysis, religiosity, social support, depression, pain, disability, sex, and race were associated with considering PAD in some or all of the situations presented.

Conclusions: Depending upon the situation, a large proportion of persons with MS would consider PAD. The association of depression with considering PAD emphasizes the importance of diagnosing and treating depression.

MeSH terms

Anxiety / epidemiology
Attitude to Death*
Attitude to Health
Depression / epidemiology
Female
Humans
Logistic Models
Male
Middle Aged
Multiple Sclerosis / epidemiology
Multiple Sclerosis / psychology*
Multiple Sclerosis / therapy
Multivariate Analysis
Registries
Religion
Self Report
Sex Factors
Social Support
Socioeconomic Factors
Suicide, Assisted / psychology*
Thinking