Multidimensional Study of the Attitudes Towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder

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Full work available on: https://drive.google.com/file/d/1KZaDYOU0qBb3z9j-1LLyoG8is6LYMwEp/view?usp=sharing 

Introduction: Euthanasia is an ancient theme that, especially since individual autonomy became the healthcare paradigm in contemporary societies, has sparked profound reflections and declared dissensions between different socio-ideological quadrants. The experience of the countries where it is decriminalised shows a tendency to broaden the clinical, age and legal assumptions for its access. People in mental distress due to a psychiatric illness are now able to request physician-assisted death in some jurisdictions. Now, given the impossibility of identifying an incurable or irreversible injury through ancillary diagnostic tests and the fact that psychiatric disorders demand complex and holistic treatments (not always available), where psycho, social and familial approaches assume particular and decisive relevance, it is difficult to determine that a disease is incurable and provokes unbearable suffering. In older adults with psychiatric disease, a clinically and socially idiosyncratic group where physiological weaknesses and social losses accumulate, and the chronological proximity to death becomes progressively more self-aware, these shortcomings assume particular relevance. Our research aimed to highlight the problem of the low literacy levels in this age group, reflect on the Constitutional feasibility of Euthanasia in Portugal, make available a validated psychometric instrument to assess attitudes towards euthanasia and do a multidimensional study of the attitudes towards euthanasia of older adult patients with mixed anxiety-depressive disorder.

Materials and Methods: The field research study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience. One hundred fourteen patients were included in the cross-cultural adaptation and validation of Faria's Attitude about Euthanasia scale. A pre-final scale version was tested in a small group with good results. The validity of the internal structure was analysed using exploratory factorial analysis. The multidimensional study included 114 patients and 25 age-matched controls. Six months later, a reassessment was conducted. Patients and controls were compared using descriptive statistics and a multiple-regression model.

Results: There is a severe problem with the low literacy levels of older Portuguese adults, particularly those with depressive and anxiety symptoms, which interfere with their decision-making capacity for well-informed and free decisions in healthcare. The Constitution of the Portuguese Republic does not prohibit physician-assisted death. The internal consistency study verified the reliability and significant correlations in the construct validity of the adapted Faria's attitude about the euthanasia scale. It showed good internal consistency. One factor was retained in the principal component analysis. The results support the scale's usefulness and validity.

Regarding the multidimensional analysis, eighty-one point six per cent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness and fantasy and lower personal distress.

Conclusion: When addressing euthanasia in older adult patients with mixed anxiety and depressive disorder, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and mild disease persists, significantly affecting their well-being and cognitive performance.

 

Keywords: anxiety, depression, euthanasia, older adults


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