From the Journals

AD biomarker not tied to increased interest in physician-assisted death

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Brittany Maynard’s long-lasting impact

The fascinating thing about this study is that the idea for it arose when some of the individuals spontaneously mentioned assisted suicide during their initial interview, Annette L. Hanson, MD, said in an interview.

Dr. Annette Hanson

Dr. Annette Hanson

“This doesn’t surprise me,” Dr. Hanson said. “The interviews began in November 2014, literally the week after Brittany Maynard killed herself. Maynard was, and continues to be, the face of the assisted suicide movement as promoted by Compassion & Choices.” Ms. Maynard, who had been diagnosed with terminal brain cancer, announced her intention to move to Oregon to end her life in early 2014. “By October 2014, her face had been plastered on the cover of People magazine, and her story was featured on CNN and the Washington Post,” Dr. Hanson said. “This illustrates the effect of the right-to-die movement on suicide prevention.

“Would these subjects have thought of suicide in the absence of the Brittany Maynard publicity campaign? I doubt it.”

Dr. Hanson, a forensic psychiatrist, is assistant professor of psychiatry at the University of Maryland and at Johns Hopkins University, both in Baltimore.


 

FROM JAMA NEUROLOGY

Being diagnosed with an elevated amyloid-beta biomarker that indicates greater risk of Alzheimer’s disease did not lead to increased consideration of physician-assisted death (PAD), according to an analysis of patients interviewed during clinical trials on cognitive decline.

“Our findings suggest that learning one’s amyloid imaging result does not change baseline attitudes regarding the acceptability of PAD,” wrote Emily A. Largent, PhD, of the department of medical ethics and health policy at the University of Pennsylvania, Philadelphia, and coauthors. The study was published as a research letter in JAMA Neurology.

Participants were recruited from two ongoing clinical trials, one of which included patients with elevated amyloid-beta (n = 50), whereas the other did not (n = 30). All participants completed an interview 4-12 weeks after receiving their biomarker results; 47 and 30 participants, respectively, also completed a follow-up interview at 12 months.

When asked whether they had considered PAD, nearly two-thirds of interviewees with the Alzheimer’s disease biomarker stated that they neither had nor would. Roughly one in five from that group said they would pursue PAD if they began to suffer from cognitive impairment or became a burden on others. Interviewees who did not have elevated amyloid beta, when asked whether a reversed result would have led to PAD or suicide, showed interest in roughly similar proportion to their at-risk counterparts.

The coauthors acknowledged the limitations of their study, including not asking about other end-of-life preferences or perceived quality of life for people with dementia. They also noted that, although their sample mirrors the populations of the two studies they drew from, “its homogeneity limits generalizability.” As such, they stressed that “further research is indicated to better understand end-of-life care preferences among people at increased risk for dementia.”

The study was supported by grants from the Alzheimer’s Association and the National Institute on Aging. One author reported receiving grants from those two organizations during the study; another reported receiving grants from Lilly and Novartis. No other conflicts of interest were reported.

SOURCE: Largent EA et al. JAMA Neurol. 2019 Apr 29. doi: 10.1001/jamaneurol.2019.0797.

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