Date

May 2013

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Physician assisted death (PAD) is a legal end-of-life (EOL) option in Oregon, Washington, and Montana. Since Oregon’s Death with Dignity Act (DWDA) was enacted in late 1997, a total of 1,050 Oregonians have had DWDA prescriptions written and 637 patients have died from use of the prescribed medications. However, patient motivation for pursuit of PAD is not well understood and because of this nurses and other health care providers have struggled to understand how to best provide care for those who request prescriptions under the DWDA. This study examined the influence of commonly hypothesized factors in patient pursuit of PAD. It was a secondary analysis of data from 55 terminally ill Oregonians at the EOL who pursued PAD compared with data from 40 terminally ill Oregonians at EOL who did not pursue PAD. t-Tests were used to compare the two groups on measures of dismissive attachment, hopelessness, depression, pain, and desire for control. Those who pursued PAD were found to have significantly higher levels of hopelessness, depression, and dismissive attachment. Logistic regression analysis revealed that higher hopelessness, higher levels of education, and being unmarried predicted pursuit of PAD while controlling for depression, age, dismissive attachment, pain, and desire for control. The construct of hopelessness taps into expectations of the future and the impact of dismissive attachment may be related to concern about a state of dependency at the end of life that would be intolerable. These findings suggest that concern for the future may play a large role in the decision to pursue PAD. Clinicians should address current symptoms, but also inquire about expectations and fears related to the dying process that may be causing distress and tailor interventions accordingly.

Identifier

doi:10.6083/M40863BK

School

School of Nursing

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