Intended for healthcare professionals


Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey

BMJ 2008; 337 doi: (Published 08 October 2008) Cite this as: BMJ 2008;337:a1682
  1. Linda Ganzini, professor12,
  2. Elizabeth R Goy, assistant professor 12,
  3. Steven K Dobscha, associate professor12
  1. 1Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Health Services Research and Development, Portland Veterans Affairs Medical Center, PO Box 1034, Portland, OR 97239, USA
  2. 2Department of Psychiatry, Oregon Health and Science University
  1. Correspondence to: Linda Ganzini Linda.Ganzini{at}
  • Accepted 2 August 2008


Objective To determine the prevalence of depression and anxiety in terminally ill patients pursuing aid in dying from physicians.

Design Cross sectional survey.

Setting State of Oregon, USA.

Participants 58 Oregonians, most terminally ill with cancer or amyotrophic lateral sclerosis, who had either requested aid in dying from a physician or contacted an aid in dying advocacy organisation.

Main outcome measures Diagnosis of depression or anxiety according to the hospital anxiety and depression scale and the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders.

Results 15 study participants met “caseness” criteria for depression, and 13 met criteria for anxiety. 42 patients died by the end of the study; 18 received a prescription for a lethal drug under the Death with Dignity Act, and nine died by lethal ingestion. 15 participants who received a prescription for a lethal drug did not meet criteria for depression; three did. All three depressed participants died by legal ingestion within two months of the research interview.

Conclusion Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.


  • Contributors: LG participated in the design, receipt of funding, data analysis, and manuscript preparation. ERG participated in the design, data gathering, and manuscript preparation. SKD participated in the design, data analysis, and manuscript preparation. All authors saw and approved the final version. LG is the guarantor.

  • Funding: Northwest Health Foundation. The funding source had no role in any aspect of the study or this paper.

  • Competing interests: None declared.

  • Ethical approval: The study was approved by the institutional review board of the Portland Veterans Affairs Medical Center and the participating medical centres.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

  • Accepted 2 August 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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