Symposia
Health Psychology / Behavioral Medicine - Adult
Courtney Daum, B.S.
Clinical Research Coordinator
University of Washington, Seattle
Seattle, Washington
Elizabeth Loggers, M.D., Ph.D.
University of Washington School of Medicine
Seattle, Washington
Introduction: Washington state law does not require psychological evaluations to pursue Medical Aid in Dying (MAID). However, opponents and advocates of DWD have stated psychological evaluations should be required as a safeguard for persons with mental health conditions. Presence of mental health conditions and frequency of psychological evaluations have unknown impacts on likelihood of MAID completion. We hypothesize patients with mental health conditions are equally as likely to inquire about MAID, yet more likely to have a psychological evaluation, and less likely to complete the MAID process. This talk will discuss differences in MAID process and outcomes for those with a history of mental health conditions versus without.
Methods: We conducted a chart review of 499 cancer patients who inquired about MAID at a comprehensive cancer center in Seattle, Washington. Data collection included documented socio-demographics, mental health history, cancer history, use of supportive care services, psychological evaluations, and details about whether the individual completed the MAID process.
Results: Subjects were predominately non-Hispanic (n=456, 91.9%), White (n=432, 86.6%) males (n=291, 58.3%), English speaking (n=484, 97.0%), and non-religious (n=312, 62.5%). 51.7% (n=258) patients had no documented mental health conditions. Among patients with one or more documented mental health conditions (n=241, 48.3%), 142 (59.0%) had a history of anxiety, 130 (53.9%) depression, 56 (23.2%) substance use disorder, 8 (1.6%) bipolar disorder, and 7 (1.4%) PTSD. 10 (2.0%) had documented suicidal ideation or prior attempt(s). 12 of 15 psychological evaluations occurred in patients with prior mental health conditions. Rates of engagement with supportive care services prior to MAID inquiry and rate of lethal medication ingestion were the same for those with and without a mental health condition.
Discussion: Almost half of cancer patients inquiring about MAID had a documented history of a mental health conditions. Patients with a prior documented mental health condition were more likely to receive a psychological evaluation, however, rates of psychological evaluations overall were low. Despite having prior mental health conditions histories, these patients did not engage with supportive care services at greater rates than those without, though these patients’ ingested medication at the same rate as patients without a history of mental health conditions.