The influence of cognitive impairment on desire for hastened death among terminally ill AIDS patients

Hayley Ann Pessin, Fordham University

Abstract

Understanding the relationship between cognitive impairment and desire for hastened death has important implications for palliative care practice and the debate over the legalization of physician-assisted suicide. The presence of cognitive impairment may significantly influence terminally ill patient's attitudes towards hastened death. As cognitive abilities become compromised, patients may have more difficulty making decisions and finding alternative solutions besides death to improve their situation. This loss of cognitive abilities may result in a direct decrease in the patient's quality or enjoyment of life. The awareness of cognitive deficits may contribute to a patient's sense of deterioration and increase emotional distress levels. The primary objectives of this study were: (1) to examine the relationship between cognitive impairment and desire for death directly in a terminally ill AIDS population, (2) to further characterize the specific aspects of cognitive functioning that impact desire for death among terminally ill patients with AIDS, and (3) to examine the relationships among desire for death, cognitive functioning, and other relevant physical and psychological symptoms associated with advanced disease. ^ The sample included 128 terminally ill patients with AIDS receiving palliative care in a long-term care facility. Participants completed a clinical assessment that included a self-report measure of desire for hastened death, the Schedule of Attitudes toward Hastened Death (SAHD), a self-report measure of desire for hastened death in the medically ill, and the HIV-Dementia Scale (HIV-DS), Mini-Mental Status Exam (MMSE), and the Dementia Rating Scale (DRS), cognitive screening measures designed to detect the presence of cognitive impairment. Results demonstrated that there was a significant association between desire for death and the presence of cognitive impairment as indicated by clinical cutoff scores on the HIV-DS, MMSE, and DRS. The presence of memory impairment, as measured by the DRS subscale, provided an independent and unique contribution to desire for hastened death. Patients' self-reported awareness of and distress around cognitive difficulties was also significantly associated with increased desire for death. Therefore, it can be concluded that the presence of mild to moderate cognitive impairment and the awareness of these deficits were related to terminally ill patients with AIDS' desire for hastened death. ^

Subject Area

Psychology, Clinical|Psychology, Cognitive|Health Sciences, Health Care Management

Recommended Citation

Hayley Ann Pessin, "The influence of cognitive impairment on desire for hastened death among terminally ill AIDS patients" (January 1, 2001). ETD Collection for Fordham University. Paper AAI3017560.
http://fordham.bepress.com/dissertations/AAI3017560

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