In the AIDS population, a prior suicide history has been noted to be the most prominent vulnerability factor. This same data has now been demonstrated in terminally ill patients in a study by Chochinov, who looked at the desire for death in patients with far advanced disease. This data again supported the fact that there was a significant degree of depression in this population of patients, which though untreated, was yet the driving force for patient's request for physician-assisted death. Fatigue, characterised by exhaustion of physical, emotional, spiritual, financial, familial, communal, or other resources, also increases the risk for suicide in both the cancer patient and the AIDS patient. The degree to which both patient fatigue and family fatigue play a role is expressed in statements and suicide notes.
Patients perceive themselves to be a burden to themselves and to their families.
Loss of control and a sense of helplessness in the face of cancer are also important factors. Impairments or deficits induced by cancer or cancer treatments, including loss of mobility, paraplegia, loss of bowel or bladder function, amputation, aphonia, sensory loss, inability to eat or swallow, appear to increase the risk of suicide. However, it is the loss of cognitive facilities, characterised by both delirium and disinhibition that are most closely correlated to a patient's successful suicide. The previous sections point up the critical reality of how sick these patients are and the magnitude of the need for a broad palliative care program that addresses their need to maintain a quality of life at the end of their lives. There is good evidence to suggest that one of the major barriers to patients receiving appropriate end of life care is physicians' lack of knowledge and training to treat pain and other symptoms, and to assess and treat psychological and existential issues.