Thanks go out to bioethicist Wesley Smith on whose blog I learned that a study released Tuesday revealed that a quarter of requests for assisted suicide in Oregon last year were from people who were depressed. None were evaluated by a psychiatrist or a psychologist.

Published in the British Medical Journal, the study, "Prevalence of depression and anxiety in patients requesting physicians' aid in dying" takes on added urgency since Washington state has a measure on the November ballot which is closely modeled on Oregon's law, which, for now, is the only one of its kind in the United States.

Researchers at Oregon Health & Science University (OHSU) evaluated 58 terminally ill patients "who requested physician-assisted suicide or contacted an aid-in-dying organization," the Los Angeles Times reported. "They found that 25% of the patients could be defined as clinically depressed, which should render them ineligible to receive a lethal prescription." Of the 18 who went on to commit suicide, three met the criteria for a diagnosis of depression.

Proponents of Oregon's "Death With Dignity" law pooh-poohed the study. But Dr. Charles Bentz, an internist in Beaverton and president of Physicians for Compassionate Care, said, "At best, it's what they say -- three out of 58 patients." Dr. Bentz added, "At worst, this is just the tip of the iceberg."

It is very noteworthy that as defined in the study depression "is not merely a feeling of sadness," according to the Oregonian. "It means feeling 'sad or blue and unable to experience pleasure almost all of the time for two weeks,'" said Dr. Linda Ganzini, a psychiatrist at OHSU, who led the study. She noted, "That's different from someone getting unfortunate news and feeling intermittent sadness."

The study (which the British Medical Journal published online Tuesday) concluded that "the current practice of the Death With Dignity Act may fail to protect some patients whose choices are influenced by depression." The authors call for "increased vigilance and systematic examination for depression among patients who may access legalised aid in dying."

Smith was not impressed. On his blog he commented, "As I have repeatedly pointed out, the guidelines are not actually there to protect the vulnerable, but merely to give the appearance of control. And if one doctor says no, the patient just goes doctor shopping until one is found who will prescribe--usually referred by Compassion and Choices. So, there is no protection of depressed patients in Oregon, and none is really intended.

"Beyond that, the guidelines in Oregon and Washington do not require actual treatment of the depressed before a prescription is issued. Indeed, the attitude of Dutch euthanasia supporters demonstrate that even if depression is detected, it really doesn't matter in making the killing decision."

As evidence Smith links to a story in the New Scientist. There we learn that the study was accompanied by an editorial written by Dr Marije van der Lee from the Helen Dowling Institute in the Netherlands.

"She believes that depression does not necessarily impair judgement and says that in the Netherlands what is most important is that the patient makes an informed decision," the New Scientist reports. The publication quotes her as saying, "[W]e should focus on trying to 'protect' patients from becoming depressed in the first place, rather than focus on protecting patients from assisted suicide."

Smith concluded, "Of course. When doctors and mental health professionals abandon depressed patients to death, who will protect them?"

Part Two -- PET Scans Show Patients in Minimally Conscious State Feel Pain