Depression and the Desire to Die Near the End of Life
This chapter examines how depression may affect a patient’s ability to make life-shortening decisions within the setting of care near the end of life, as well as a clinician’s willingness to support the patient’s preferences (that is, respecting his autonomy). It considers how the suspicion of depression can make the physician pause even when the obvious choice would be to support the patient’s decision. It also describes some of the defining features of depression, including hopelessness, suicidal ideation, and desire for hastened death. The chapter first reviews depression and similar clinical conditions in the context of end-of-life care before discussing the construct of capacity and the elements of its assessment. It then considers evidence on the relationship between depression and decisional capacity before concluding with suggestions to help guide decision-making.