Brenda W.J.H. Penninx, Ph.D., an epidemiologist with Vrije University in Amsterdam, and her coworkers examined the incidence of either major depression or minor depression among some 3,000 men and women ages 55 to 85 years old living in various areas throughout the Netherlands. Death certificates for all subjects who died between the start of the study in 1993 and the end of the study in 1997 were likewise obtained. After adjusting for possibly confounding socioeconomic factors such as age, sex, education, smoking, alcohol consumption, body mass index, physical activity, and chronic disease, the researchers found that major depression was associated with a 1.83-fold higher death risk in both men and women, and minor depression with a 1.80-fold higher death risk in men.

"It is an interesting finding," said Mustafa M. Husain, M.D., a psychiatrist with the University of Texas Southwestern Medical Center in Dallas and chair of the APA Committee on Access and Effectiveness of Psychiatric Services for the Elderly. Internists and cardiologists who deal with the elderly should be made aware of such data, he believes.

Certainly this study has implications for physicians who care for the elderly, agrees Scott Spier, M.D., chief of the division of psychiatry at Mercy Medical Center in Baltimore and a physician with a special interest in geriatric psychiatry. They should do their best to see that depressed older people, especially those in nursing homes, get the antidepressant medications they need. Being sad because you are stuck in a nursing home, he stresses, is not the same as being depressed.

George Dyck, M.D., a psychiatrist with the University of Kansas in Wichita and on the APA Committee on Long-Term Care and Treatment for the Elderly, views the Dutch investigation from still another perspective. Although seniors are more likely to talk about their depressions than they used to, he points out, older men are still more reluctant to do so than older women are. Thus the reason the Dutch investigators found that minor depression increased mortality risk among older men but not among older women, he speculates, may have been due to a number of older men playing down their depressions and thus being categorized as "minor" depressives when they actually belonged to the "major depression" category.

Still unclear, however, is why seniors are more likely to die when they are depressed than when they are not. The increased risk of death among depressives in the Dutch study could not be attributed to suicide. In fact, about a half of those with major depression succumbed to cardiovascular disease and a fair number of those with minor depression to respiratory disease. But might the causes lie still deeper in the human mind and body—might depression alter certain endocrinologic and immune pathways that predispose to specific diseases?

Mark Goulston, M.D., a Los Angeles-based psychiatrist and a senior psychiatrist at <www.Lifescape.com>, the primary behavioral and mental health resource to <www.Dr.Koop.com>, thinks so.

"Certainly an attitude can affect one’s immune system," he asserts. Indeed, there is evidence that depression can alter the endocrine and immunological states of not just seniors, but of younger persons as well."

But can depression truly trigger endocrinological and immune changes that are so dramatic that they can then lead to illness and death? This hypothesis has not yet been tested on a large scale among community-dwelling seniors. "This is actually the area I am interested in for my future research," Penninx told Psychiatric News.

SOURCE : http://www.psych.org/pnews/99-12-03/hasten.htm
 

· 1906 - First euthanasia bill drafted in Ohio. It does not succeed.

· 1935 - World's first euthanasia society is founded in London, England.

· 1938 - The Euthanasia Society of America is founded by the Rev. Charles Potter in New York.

· 1954 - Joseph Fletcher publishes Morals and Medicine, predicting the coming controversy over the right to die.

· 1957 - Pope Pius XII issues Catholic doctrine distinguishing ordinary from extraordinary means for sustaining life.

· 1958 - Oxford law professor Glanville Williams publishes The Sanctity of Life and the Criminal Law, proposing that voluntary euthanasia be allowed for competent, terminally ill patients.

· 1958 - Lael Wertenbaker publishes Death of a Man describing how she helped her husband commit suicide. It is the first book of its genre.

· 1967 - The first living will is written by attorney Louis Kutner and his arguments for it appear in the Indiana Law Journal.

· 1967 - A right-to-die bill is introduced by Dr. Walter W. Sackett in Florida's legislature. It arouses extensive debate but is unsuccessful.

· l968 - Doctors at Harvard Medical School propose redefining death to include brain death as well as heart-lung death. Gradually this definition is accepted.

· 1969 - Voluntary euthanasia bill introduced in the Idaho legislation. It fails.

· 1969 - Elisabeth Kubler-Ross publishes On Death and Dying, opening discussion of the once-taboo subject of death.

· 1970 - The Euthanasia Society (US) finishes distributing 60,000 living wills.

· 1973 - American Hospital Association creates Patient Bill of Rights, which includes informed consent and the right to refuse treatment.

· 1973 - Dr. Gertruida Postma, who gave her dying mother a lethal injection, receives light sentence in the Netherlands. The furore launches the euthanasia movement in that country (NVVE).

· 1974 - The Euthanasia Society in New York renamed the Society for the Right to Die. The first hospice American hospice opens in New Haven, Conn.

· 1975 - Deeply religious Van Dusens commit suicide. Henry P. Van Dusen, 77, and his wife, Elizabeth, 80, leaders of the Christian ecumenical movement, choose to die rather than suffer from disabling conditions. Their note reads, "We still feel this is the best way and the right way to go."

· 1975 - Dutch Voluntary Euthanasia Society (NVVE) launches its Members' Aid Service to give advice to the dying. Receives 25 requests for aid in the first year.

· 1976 - The New Jersey Supreme Court allows Karen Ann Quinlan's parents to disconnect the respirator that keeps her alive, saying it is affirming the choice Karen herself would have made. Quinlan case becomes a legal landmark. But she lives on for another eight years.

· 1976 - California Natural Death Act is passed. The nation's first aid in dying statute gives legal standing to living wills and protects physicians from being sued for failing to treat incurable illnesses.

· 1976 - Ten more U.S. states pass natural death laws.

· 1976 - First international meeting of right-to-die groups. Six are represented inTokyo.

· 1978 - Doris Portwood publishes landmark book Commonsense Suicide: The Final Right. It argues that old people in poor health might justifiably kill themselves.

· 1978 - Whose Life Is It Anyway?, a play about a young artist who becomes quadriplegic, is staged in London and on Broadway, raising disturbing questions about the right to die. A film version appears in 1982. Jean's Way is published in England by Derek Humphry, describing how he helped his terminally ill wife to die.

· 1979 - Artist Jo Roman, dying of cancer, commits suicide at a much-publicized gathering of friends that is later broadcast on public television and reported by the New York Times.

· 1979 - Two right-to-die organizations split. The Society for the Right to Die separates from Concern for Dying, a companion group that grew out of the Society's Euthanasia Education Council.

· 1980 - Advice column Dear Abby publishes a letter from a reader agonizing over a dying loved one, generating 30,000 advance care directive requests at the Society for the Right to Die.

· 1980 - Pope John Paul II issues Declaration in Euthanasia opposing mercy killing but permits the greater use of painkillers to ease pain and the right to refuse extraordinary means for sustaining life.

· 1980 -Hemlock Society is founded in Santa Monica, California, by Derek Humphry. It advocates legal change and distributes how to die information. This launches the campaign for assisted dying in America. Hemlock's national membership will grow to 50,000 within a decade. Right to die societies also formed the same year in Germany and Canada.

· 1980 - World Federation of Right to Die Societies is formed in Oxford, England. It comprises 27 groups from 18 nations.

· 1981 -Hemlock publishes how-to suicide guide, Let Me Die Before I Wake, the first such book on open sale

· 1983 - Famous author (Darkness at Noon etc) Arthur Koestler, terminally ill, commits suicide a year after publishing his reasons. His wife Cynthia, not dying, choses to commit suicide with him.

· 1983 - Elizabeth Bouvia, a quadriplegic suffering from cerebral palsy, sues a California hospital to let her die of self-starvation while receiving comfort care. She loses, and files an appeal.

· 1984 - Advance care directives become recognized in 22 states and the District of Columbia.

· 1984 - The Netherlands Supreme Court approves voluntary euthanasia under certain conditions.

· 1985 - Karen Ann Quinlan dies.

· 1985 - Betty Rollin publishes Last Wish, her account of helping her mother to die after a long losing battle with breast cancer. The book becomes a bestseller.

· 1986 - Roswell Gilbert, 76, sentenced in Florida to 25 years without parole for shooting his terminally ill wife. Granted clemency five years later.

· 1986 - Elizabeth Bouvia is granted the right to refuse force feeding by an appeals court. But she declines to take advantage of the permission and is still alive in l998.

· 1986 - Americans Against Human Suffering is founded in California, launching a campaign for what will become the 1992 California Death with Dignity Act.

· 1987 - The California State Bar Conference passes Resolution #3-4-87 to become the first public body to approve of physician aid in dying.

· 1988 - Journal of the American Medical Association prints It's Over, Debbie, an unsigned article describing a resident doctor giving a lethal injection to a woman dying of ovarian cancer. The public prosecutor makes an intense, unsuccessful effort to identify the physician in the article.

· 1988 - Unitarian Universalist Association of Congregations passes a national resolution favoring aid in dying for the terminally ill, becoming the first religious body to affirm a right to die.

· 1990 - Washington Initiative (119) is filed, the first state voter referendum on the issue of voluntary euthanasia and physician-assisted suicide.

· 1990 - American Medical Association adopts the formal position that with informed consent, a physician can withhold or withdraw treatment from a patient who is close to death, and may also discontinue life support of a patient in a permanent coma.

· 1990 - Dr. Jack Kevorkian assists in the death of Janet Adkins, a middle-aged woman with Alzheimer's disease. Kevorkian subsequently flounts the Michigan legislature's attempts to stop him from assisting in additional suicides.

· 1990 - Supreme Court decides the Cruzan case, its first aid in dying ruling. The decision recognizes that competent adults have a constitutionally protected liberty interest that includes a right to refuse medical treatment; the court also allows a state to impose procedural safeguards to protect its interests.

· 1990 - Hemlock of Oregon introduces the Death With Dignity Act into the Oregon legislature, but it fails to get out of committee.

· 1990 - Congress passes the Patient Self-Determination Act, requiring hospitals that receive federal funds to tell patients that they have a right to demand or refuse treatment. It takes effect the next year.

· 1991 - Dr. Timothy Quill writes about "Diane" in the New England Journal of Medicine, describing his provision of lethal drugs to a leukemia patient who chose to die at home by her own hand rather than undergo therapy that offered a 25 percent chance of survival. ·
· 1991 - Nationwide Gallup poll finds that 75 percent of Americans approve of living wills.

· 1991 - Derek Humphry publishes Final Exit, a how-to book on self-deliverance. Within 18 months the book sells 540,000 copies and tops USA bestseller lists. It is translated into twelve other languages. Total sales exceed one million.

· 1991 - Choice in Dying is formed by the merger of two aid in dying organizations, Concern for Dying and Society for the Right to Die. The new organization becomes known for defending patients' rights and promoting living wills, and will grow in five years to 50,000 members.

· 1991 - Washington State voters reject Ballot Initiative 119, which would have legalized physician-aided suicide and aid in dying. The vote is 54-46 percent.

· 1992 - Americans for Death with Dignity, formerly Americans Against Human Suffering, places the California Death with Dignity Act on the state ballot as Proposition 161.

· 1992 - Health care becomes a major political issue as presidential candidates debate questions of access, rising costs, and the possible need for some form of rationing.

· 1992 - California voters defeat Proposition 161, which would have allowed physicians to hasten death by actively administering or prescribing medications for self administration by suffering, terminally ill patients. The vote is 54-46 percent.

· 1993 - Advance directive laws are achieved in 48 states, with passage imminent in the remaining two.

· 1993 - Compassion in Dying is founded in Washington state to counsel the terminally ill and provide information about how to die without suffering and "with personal assistance, if necessary, to intentionally hasten death." The group sponsors suits challenging state laws against assisted suicide.

· 1993 - President Clinton and Hillary Rodham Clinton publicly support advance directives and sign living wills, acting after the death of Hugh Rodham, Hillary's father.

· 1993 - Oregon Right to Die, a political action committee, is founded to write and subsequently to pass the Oregon Death with Dignity Act.

· 1994 - The Death with Dignity Education Center is founded in California as a national nonprofit organization that works to promote a comprehensive, humane, responsive system of care for terminally ill patients.

· 1994 - More presidential living wills are revealed. After the deaths of former President Richard Nixon and former first lady Jacqueline Kennedy Onassis, it is reported that both had signed advance directives.

· 1994 - The California Bar approves physician-assisted suicide. With an 85 percent majority and no active opposition, the Conference of Delegates says physicians should be allowed to prescribe medication to terminally ill, competent adults self-administration in order to hasten death.

· 1994 - All states and the District of Columbia now recognize some type of advance directive procedure.

· 1994 - Washington State's anti-suicide law is overturned. In Compassion v. Washington, a district court finds that a law outlawing assisted suicide violates the 14th Amendment. Judge Rothstein writes, "The court does not believe that a distinction can be drawn between refusing life-sustaining medical treatment and physician-assisted suicide by an uncoerced, mentally competent, terminally ill adult."

· 1994 - In New York State, the lawsuit Quill et al v. Koppell is filed to challenge the New York law prohibiting assisted suicide. Quill loses, and files an appeal.

· 1994 - Oregon voters approve Measure 16, a Death With Dignity Act ballot initiative that would permit terminally ill patients, under proper safeguards, to obtain a physician's prescription to end life in a humane and dignified manner. The vote is 51-49 percent.

· 1994 - U.S. District Court Judge Hogan issues a temporary restraining order against Oregon's Measure 16, following that with an injunction barring the state from putting the law into effect.

· 1995 - Oregon Death with Dignity Legal Defense and Education Center is founded. Its purpose is to defend Ballot Measure 16 legalizing physician-assisted suicide.

· 1995 - Washington State's Compassion ruling is overturned by the Ninth Circuit Court of Appeals, reinstating the anti suicide law.

· 1995 - U.S. District Judge Hogan rules that Oregon Measure 16, the Death with Dignity Act, is unconstitutional on grounds it violates the Equal Protection clause of the Constitution. His ruling is immediately appealed.

· 1995 - Surveys find that doctors disregard most advance directives. Journal of the American Medical Association reports that physicians were unaware of the directives of three-quarters of all elderly patients admitted to a New York hospital; the California Medical Review reports that three-quarters of all advance directives were missing from Medicare records in that state.

· 1995 - Oral arguments in the appeal of Quill v. Vacco contest the legality of New York's anti-suicide law before the Second Circuit Court of Appeals.

· 1995 - Compassion case is reconsidered in Washington state by a Ninth Circuit Court of Appeals panel of eleven judges, the largest panel ever to hear a physician-assisted suicide case.

· 1996 - The Northern Territory of Australia passes voluntary euthanasia law. Nine months later the Federal Parliament quashes it.

· 1996 - The Ninth Circuit Court of Appeals reverses the Compassion finding in Washington state, holding that "a liberty interest exists in the choice of how and when one dies, and that the provision of the Washington statute banning assisted suicide, as applied to competent, terminally ill adults who wish to hasten their deaths by obtaining medication prescribed by their doctors, violates the Due Process Clause." The ruling affects laws of nine western states. It is stayed pending appeal.

· 1996 - A Michigan jury acquits Dr. Kevorkian of violating a state law banning assisted suicides.

· 1996 - The Second Circuit Court of Appeals reverses the Quill finding, ruling that "The New York statutes criminalizing assisted suicide violate the Equal Protection Clause because, to the extent that they prohibit a physician from prescribing medications to be self-administered by a mentally competent, terminally ill person in the final stages of his terminal illness, they are not rationally related to any legitimate state interest." The ruling affects laws in New York, Vermont and Connecticut. (On 17 April the court stays enforcement of its ruling for 30 days pending an appeal to the U.S. Supreme Court.)

· 1996 - The U.S. Supreme Court announces that it will review both cases sponsored by Compassion in Dying, known now as Washington v. Glucksberg and Quill v. Vacco.

· 1997 - Oral arguments set for the New York and Washington cases on physician assisted dying. The cases were heard in tandem on 8 January but not combined. A ruling is expected in June.

· 1997 - ACLU attorney Robert Rivas files an amended complaint challenging the 128 year-old Florida law banning assisted suicide. Charles E. Hall, who has AIDS asks court permission for a doctor to assist his suicide. The court refuses.

· 1997 - On 13 May the Oregon House of Representatives votes 32-26 to return Measure 16 to the voters in November for repeal (H.B. 2954). On 10 June the Senate votes 20-10 to pass H.B. 2954 and return Measure 16 to the voters for repeal. No such attempt to overturn the will of the voters has been tried in Oregon since 1908.

· 1997 - On 26 June the U.S. Supreme Court reverses the decisions of the Ninth and Second Circuit Court of Appeals in Washington v. Glucksberg and Quill v. Vacco, upholding as constitutional state statutes which bar assisted suicide. However, the court also validated the concept of "double effect," openly acknowledging that death hastened by increased palliative measures does not constitute prohibited conduct so long as the intent is the relief of pain and suffering. The majority opinion ended with the pronouncement that "Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in a democratic society."

· 1997 - Dutch Voluntary Euthanasia Society (NVVE) reports its membership now more than 90,000, of whom 900 made requests for help in dying to its Members' Aid Service.

· 1997 - Britain's Parliament rejects by 234 votes to 89 the seventh attempt in 60 years to change the law on assisted suicide despite polls showing 82 percent of British people want reform.

· 1997 - On 4 November the people of Oregon vote by a margin of 60-40 percent against Measure 51, which would have repealed the Oregon Death with Dignity Act, l994. The law officially takes effect (ORS 127.800-897) on 27 October l997 when court challenges disposed of.

· 1998 - Dr. Kevorkian assists the suicide of his 92nd patient in eight years. His home state, Michigan, passes new law making such actions a crime. It took effect September, 1 1998, but Kevorkian carries on helping people to die -- 120 by November.

· 1998 - Oregon Health Services Commission decides that payment for physician-assisted suicide can come from state funds under the Oregon Health Plan so that the poor will not be discriminated against.

· 1998 - 16 people die by making use of the Oregon Death With Dignity Act, receiving physician-assisted suicide in its first full year of implementation.

· 1998 - Measure B on the Michigan ballot to legalize physician-assisted suicide defeated by 70 - 30%.

· 1999 - Dr. Kevorkian sentenced to 10-25 years imprisonment for the 2nd degree murder of Thomas Youk after showing video of death by injection on national television.

· 1999 - 26 people die by physician-assisted suicide in the second full year of the Oregon PAS law.

· 2000 - World Euthanasia Conference, Boston

· 2000 - Citizens' Ballot Initiative in Maine to approve the lawfulness of Physician- Assisted Suicide was narrowly defeated 51-49 percent.

· 2001 - Kevorkian's appeal decision reached after 2 years 7 months. Judges reject it.

· 2001 - MS victim Diane Pretty asks UK court to allow her husband to help her commit suicide. The London High Court, the House of Lords, and the Court of Human Rights, in Strasbourg, all say no. She dies in hospice a few weeks later.

· 2002 - Dutch law allowing voluntary euthanasia and physician-assisted suicide takes effect on 1 February. For 20 years previously it had been permitted under guidelines.

· 2002 - Belgium passes similar law to the Dutch, allowing both voluntary euthanasia and physician-assisted suicide.

· 2003 - US Attorney-General Ashcroft asks the 9th Circuit Court of Appeal to reverse the finding of a lower court judge that the Oregon Death With Dignity Act l994 does not contravene federal powers. 129 dying people have used this law over the last five years to obtain legal physician-assisted suicide. The losers of this appeal will almost certainly ask the US Supreme Court to rule.