New study shows the life and death importance of the doctor-patient relationship

An Australian psychiatric study has found that doctors may be inadvertently contributing to the desire of many terminally ill patients to die sooner rather than later.

The report into the Association between clinician factors and a patient’s wish to hasten death focused on terminally ill cancer patients and found that the doctor-patient relationship was an important factor in a patient’s wish to hasten death.

Psychiatrist, Associate Professor Frank Varghese from The University of Queensland’s School of Medicine, conducted the study with researchers from across Australia. They found that less training in the psychological aspects of medicine and counselling was significantly associated with a high reported wish to hasten death by the patient.

“We found that doctors were more willing to hasten the death of patients if it were legal to do so and if a request by the patient was made,” Dr Varghese said.

“This may suggest that in a setting where there is a greater perception of a patient’s emotional distress and hopelessness, combined with the doctor’s limited psychological training and his or her own difficulty in caring for the patient, the doctor may be more inclined to hasten the death of the patient.”

It is currently illegal in Australia and most jurisdictions around the world for a doctor to assist suicide but researcher Professor Brian Kelly from the University of Newcastle said the study raised issues related to legislation assisted suicide.

“The report raises serious concerns about the adverse effect such legislation has on the role of a doctor in the care of a dying patient, the goals of medical treatment and the need to promote better skills in the caring for emotional needs of patients who are dying and their families,” Dr Kelly said.

“Doctors face many stresses in the care of dying patients, and their reactions to the patients’ distress and the doctor’s reactions to severe and incurable illnesses in their patients may inadvertently lead the doctor to support the patient in their interest of assisted suicide.

“They should instead be taking an approach that aims to understand the basis of the patients’ request and distress in the usual therapeutic role, and identifying the ways of assisting the patient and family.”

The study, which was published in Psychosomatics and received a Dorfman Journal Paper award from the Academy of Psychosomatic Medicine in the US, shows that a patient’s hopelessness could lead the doctor to have a greater level of hopelessness.

Dr Varghese said an attitude that conveyed endorsement of the wish to hasten death on the part of the doctor could facilitate that stance on the part of the patient.

“A doctor who was overwhelmed by the patient’s unaddressed emotional distress, with limited training in the psychological aspects of medicine, may be more inclined to favour hastening death for a patient,” Dr Varghese said.

A total of 252 individual doctor-patient pairs participated in the study, which was conducted using patients and doctors from the Princess Alexandra Hospital and Mt. Olivet Hospital in Brisbane.

It was supported by the Queensland Cancer Fund, the National Health and Medical Research Council, the Princess Alexandra Hospital, the British Red Cross Trust Fund and Mt. Olivet Hospital.

Media: For more information, contact Associate Professor Frank Varghese (telephone 07 3395 1807) or Loma Todhunter (telephone 07 3240 2860) or Chris Saxby at UQ Communications (telephone 07 3365 2479, email c.saxby@uq.edu.au).