FEELINGS ABOUT ASSISTED SUICIDE.

Dr. Kevorkian is in jail, but many people still wonder why 20 of the 93 "suicides" he engineered were for people with MS, which is not a terminal disease. Walda Chesnut, an intern in the Society's Clinical Programs department, studied attitudes about assisted suicide held by people with MS in two states where the question has been posed most dramatically--Michigan, home of Dr. Death, and Oregon, where "right to die" legislation has been approved by the voting public.

Ms. Chesnut was supervised by Dr. Cathy Berkman of Fordham University's Graduate School of Social Service; the results were published in the Journal of Palliative Medicine (Vol. 2, no. 1, 1999).

A sample of 511 people with MS in the Oregon and Michigan chapters were mailed questionnaires. One-third of them replied. The questionnaire was blunt. It asked if you would consider assisted suicide for yourself in 5 grim hypothetical situations. They included being in unbearable pain or being unable to do anything that makes your life worth living.

Dr. Berkman and her colleagues, including National MS Society staff members Pamela Cavallo and Dr. Nancy Holland, caution that the group who replied selected themselves, which skews the results. Nevertheless the study sheds some light or some shadows on this issue.

SOME SYMPTOMS BUT NOT OTHERS

People were far more likely to think favorably of assisted suicide for themselves in a hypothetical situation if they were actually having many MS symptoms, and especially if those symptoms were emotional distress, intellectual loss, or memory loss. Bladder, balance, or vision symptoms seemed unrelated to their feelings. Counter to popular belief, severe disability was not related to favorable attitudes about assisted suicide. Instead, people who were alone, unemployed, without good friends, and not comforted by religion were more willing to consider it.

FINANCES ALSO A FACTOR

In the general public, people in lower income brackets are more likely to oppose assisted suicide. But in this sample of people with MS, people with lower income were more likely to have considered it. This reinforces a 1993 study of suicide in people with MS which showed that having constant trouble making ends meet greatly increased suicide risk. Dr. Berkman commented that some people with MS who have constant money worries might indeed choose physician-assisted suicide if it were legalized.

UNTREATED DEPRESSION

The 1993 study also suggested that undiagnosed or untreated depression is very common. Two-thirds of the people who attempted suicide had never been prescribed antidepressants. And on this questionnaire, serf-reported depression was strongly linked to favoring doctor-assisted death.

"Many people who say they want to hasten death really want help with living," said Pamela Cavallo. "No matter what your position on the ethics of suicide, the idea that people might choose to die when they have a treatable condition like depression or because they can't afford health care is just unacceptable."

RELATED ARTICLE: Be Aware

These signs are serious

Linda Samuel, MSW, headed the 1993 and 1995 studies on suicide in MS and serves as an expert advisor to the Society. Most people telegraph suicidal intentions one way or another, she pointed out. Family and friends should be aware that these signs should never be taken lightly:

* A person talks about suicide or says that things would be better for others if she or he were not around. This is always a cry for help, and should trigger some action on the part of family, friends, or caregivers.

* A person who has been very stressed and upset suddenly becomes calm and contained. It's easy to think this means the crisis is over, but it may mean the person has decided to solve problems with suicide.

* A person begins giving away possessions that have special personal meaning. Again, this may be a sign that the person has made a decision to stop living.

"Our research shows it's OK to ask if someone is thinking of suicide," Linda Samuel said. "Getting it out for discussion is a positive and helpful step. It will not make things worse. The very next thing to do is reach out. Call the National MS Society. Call a suicide help line. Call the person's health-care provider. Don't delay."

You can reach the Society office nearest you by dialing 1-800-FIGHT MS (1-800-344-4867), option #1.

Rose Cohen is a writer based in Brooklyn, New York.