Advanced AIDS patients who suffer from problems like memory loss or failing coordination are significantly more likely to wish for an early death than patients without these problems, new research shows. The findings suggest that cognitive deterioration may contribute somewhat to terminally ill patients' desires to die more expeditiously, especially if the deterioration is obvious and distressing, according to Hayley Pessin, Ph.D., of Memorial Sloan-Kettering Cancer Center, and colleagues.

The researchers screened 109 patients with advanced AIDS for indicators of cognitive impairments like memory and attention loss, difficulties with abstract reasoning, poor coordination and other brain deficits. Patients were also asked how distressed they were about these problems, and whether they wished for an early death.

A considerable number of the patients suffered some cognitive functioning loss: 71 percent of the patients had noticeable symptoms of HIV-related dementia and most reported being "quite a bit" distressed by their problems. Patients with the most obvious problems, such as memory and concentration loss, were more likely to express a wish to die early than patients who had problems with abstract reasoning and other less obvious deficits.

"As cognitive abilities such as abstract reasoning, problem solving and memory become compromised, patients may have more difficulty making decisions and finding ways to improve their situation. In addition, the loss of cognitive abilities may directly impede one's quality or enjoyment of life. Finally, an awareness of cognitive deficits may contribute to a patient's sense of deterioration and increase their emotional distress," explained Pessin. The presence of cognitive impairment appears to impact the desire for hastened death, and the patient's perception of their impairment is a crucial influence, said Pessin.

The researchers point to the increasing need to examine all of the reasons why terminally ill patients may desire an early death, particularly as debates over doctor-assisted suicide and various ways to hasten death become more prevalent in health care and public policy.

The full report, "The Role of Cognitive Impairment in Desire for Hastened Death: a Study of Patients with Advanced AIDS," was published in General Hospital Psychiatry (2003;25(3):194-199).

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