DESIRE FOR DEATH AMONG TERMINALLY ILL PATIENTS WITH AIDS

Sloan-Kettering Institute For Cancer Res, New York NY

Investigators

Linked publications & trials

Abstract

DESCRIPTION (Applicant's Abstract): Despite the hope created by the recent introduction of protease inhibitors, patients with AIDS are still dying in large numbers,and palliative care/quality of life issues in patients with advanced AIDS remains an important area of clinical investigation. Perhaps the most compelling and clinically relevant issue in palliative care today concerns desire for death and physician assisted suicide (PAS). Despite the recent Supreme Court decisions, the issue of whether or not to legalize PAS will continue to be actively debated in many state legislatures. It is anticipated that several states will legalize PAS, and guidelines are being developed for its use that involve psychiatric evaluation as an important component. There have been several recent studies of patients with cancer or AIDS, including one on interest in PAS among ambulatory patients with AIDS published by the investigator's research group, demonstrating that depression plays an important and perhaps central role in some patients' desire for death or interest in PAS. With only one exception, these studies have failed to directly assess/measure desire for death among terminally ill patients,and no research to date has attempted to answer the question of whether treatment for depression has a significant impact on patients' desire for death. This project's overall aim is to describe desire for death among patients with end-stage AIDS, determine the correlates of desire for death, and assess the impact of treatment for major depression on patients' desire for death. Specifically, the investigators will assess the prevalence, severity, consistency over time (8 weeks), and medical/psychosocial correlated of desire for death among terminally ill AIDS patients, as well as the relationship between desire for death and a clinical diagnosis of Major Depressive Episode. Desire for death will be monitored over an 8-week period in a group of patients who receive a standardized pharmacological treatment for depression. This study aims to provide the first direct evaluation of the desire for death among terminally ill patients with AIDS, and will provide data on the critical issue of whether or not treatment for depression influences patients' desire for death.