>Lancet 2000; 355: 553 - 560 Download PDF (101
Kb) > >Undiagnosed depression can add to dying patients' suffering,
writes Susan Block (Harvard University, Cambridge, MA, USA) in a
paper >for the American College of Physicians and American Society of
Internal Medicine (ACP-ASIM) End-of-Life Care Consensus
Panel. > >Psychological distress may go unrecognised for several
reasons, says Block. Patients and physicians may fail to distinguish
the >"natural, existential distress" of the dying process from clinical
depression. In addition, the physician may hesitate to
explore >psychological issues for fear of causing further distress, and
may have a sense of "therapeutic nihilism" when caring for a >terminally
ill patient, she suggests. > >The "gold standard" for diagnosing
depression is the interview, says Block. Signs of depression include sadness,
hopelessness, >inability to derive pleasure from once-favoured activities,
or refusal of treatment. Pain is a major risk factor, especially
in >patients with cancer. "The first step in treating depression in
terminally ill patients is assessing and controlling pain", she >notes
(Ann Intern Med 2000; 132: 209-18). > >David Reuben (University of
California at Los Angeles, CA, USA) comments that "just because someone has a
terminal illness, it >doesn't mean it's normal or appropriate to have
depressive symptoms". However, he says, not all terminally ill patients who want
to >die are clinically depressed. "Some people have made a rational
decision that quality of life is not acceptable and want to end >their
lives." Block notes that 40% of terminally ill patients who consider suicide may
not be depressed. "But they may have other >fears, of pain or of being a
burden to their families. The challenge is to distinguish depression from a
rational choice to end >one's life", she says. > >Lois Snyder
(Center for Ethics and Professionalism for ACP-ASIM; www.acponline.org/ethics) notes that
in its approach to the >terminally ill, the USA is behind countries such
as Australia and the UK, which have a longer tradition of hospice care. "Our
goal >is to make a difference in end-of-life care. We want to improve
communication about the dying process." > >Norra
MacReady > >The Association of Cancer Online Resources, a non-profit
501 (c)-3 organization. ACOR, 173 Duane Street, Third Floor, NY, NY
10013 >WWW.ACOR.ORG/
