Late-Life Suicide in Terminal Cancer

Late-Life Suicide in Terminal Cancer: A Rational Act or Underdiagnosed Depression? is an article published in the Journal of Pain and Symptom Management; a journal which focuses on the evaluation, treatment, and pain management options for patients with terminal illnesses (Cheung, Douwes, & Sundram, 2017). This article assesses the relationship between suicide and terminal illnesses in older adults in New Zealand. The study presents data from the Coronial Services of New Zealand, providing medical history and other information from adults over age 64 who committed suicide over a five-year period. From this data, physicians and scientists determined which patients who committed suicide also had a form of terminal cancer.

Rational suicide was operationalized by looking at the types of cancer, when each patient was diagnosed, time frame between diagnosis and suicide, and Siegel’s motivational factors for suicide which assesses an understanding with those who are uninvolved observers (Cheung, Douwes, & Sundram, 2017). The results provided 214 cases of suicide with approximately ten percent comprised of older adults with terminal cancer. A little over eight percent of individuals who had terminal cancer and committed suicide were diagnosed with depression, and approximately four percent out of the same group sought help to treat mental health issues before a cancer diagnosis. Finally, about eighty-three percent of the terminal cancer and suicide group met Siegel’s motivational factors, meaning the suicide was understandable to outside individuals.

Since this study was conducted in New Zealand, it must be stated that palliative care facilities in the region are not as prevalent as other countries. Even though depression was a small factor in the cases studied, other mental illnesses and diseases were a factor among the total population observed. Having access to appropriate care in order to treat these diagnoses may reduce the desire for individual assisted suicide. However, with that illustrated, people with terminal illnesses, such as cancer, have demonstrated an ability to rationalize their own hastened deaths. Experts suggested further research to cover a more encompassing body of patients whose age range is less limited, and a broader study group from multiple regions is included, along with different methods to analyze depression in those who seek suicide (Cheung, Douwes, & Sundram, 2017).

The timeliness of this article is relatively current, as it was published in 2017. However, the goal was to assess possible associations between depression and physician assisted suicide on a broad basis, and this article has a more specific focus within the subsets of age and location. The information is still considered current to a specific age group of sixty-five years old and older adults. It does not appear as though the article has been updated recently, but the topic is becoming more important with an ever growing and aging population. Since physician assisted suicide is newly legal in only a few states within the United States, research in this area is limited due to time, location, population, and most likely religious factors. Research regarding this topic does expand, specifically looking at different types of terminal cancer and mental illness in general. Although the information is significant, it would be best used in conjunction with other peer-reviewed articles, providing meta-analysis across cultures, ages, geographical locations, and mental and physical health conditions (Cheung, Douwes, & Sundram, 2017).

The article is relevant, in that it does address depression and suicide, in support of terminally ill cancer patients making their own decisions to end their lives as an understandable point of view from any position. However, even though physician assisted suicide is mentioned, it is not specifically studied in this article. It was difficult to find information relevant to the topic with a journal impact factor greater than 2 that provided a comprehensive analysis of the subject. The information does meet the requirements of this assignment, and it is at an appropriate level for most audiences.

Even though some of the terminology may be difficult or too advanced for some people to read the extent of the full article, the abstract covers the material in a way that most laypeople should be able to understand. The information provided in this source mainly addresses differences between possible reasons for suicide and terminal cancer, and whether depression can be considered as a factor in those cases. This article provides some of the most current research about the general topic, and therefore it is relevant and possibly more reliable than other articles available. Based on relevance alone, a combination of at least one more research article would be necessary to address the topic or conduct further research (Cheung, Douwes, & Sundram, 2017).

The publisher is Elsevier Inc., a company based in Amsterdam and North Holland that provides global support in the health and science field, according to the LinkedIn profile ( This company is reputable, as they publish over four hundred thousand peer-reviewed articles every year (Elsevier Inc., 2013). The main author, Dr. Gary Cheung MBchB FRANZCP, is a researcher in Auckland, New Zealand, who focuses on old age psychiatry per his profile ( Dr. Cheung specialized in old age psychiatry before completing his PhD this year. His focus is suicidal behavior in aging adults, which is relevant to the article being assessed (Zealand, n.d.). Considering the amount of research he has produced, Dr. Cheung is considered an expert in this field of study. The article is supported by data collected and appears to have no biased opinions in it, and it appears personal experience is not a factor. Dr. Cheung’s contact information is provided in the article as a hyperlink. This article was peer-reviewed without revisions after publication. Based on authority and the author’s credentials and experience, this journal article has a high level of authority (Cheung, Douwes, & Sundram, 2017).

When considering accuracy, this article is supported by evidence and includes over fifty references. The information is reliable, but the construct validity of some of the questionnaires could be operationalized better to include more details about each patient and different ways to assess areas of suicidal ideation, mental illness, and terminal illness. The article’s main source of information in the methods section can be verified in the reference section, which is the report from the coronial services website ( The results of the data make sense and flow well throughout the article, as well. The information is provided from New Zealand, but also provides peer-reviewed research from multiple countries, including some facts from the United States. The information is supported by evidence and properly cited, and the citations are reliable sources.

As far as current knowledge on this topic, the information aligns with the original hypothesis that people are capable of making end of life decisions when faced with terminal illness. The article is well written, and no grammatical errors were found, hence it’s accuracy stands alone when it comes to writing a research paper on the material. However, additional articles to back up the claims would be beneficial.
The purpose of this journal article is to inform and to teach other researchers who are interested in this field of study. The intentions are clearly made through the hypothesis in the article, and it is factually based from data collected through the Coronial Services of New Zealand (Cheung, Douwes, & Sundram, 2017). The research has been conducted in an objective manner, and the intended audience is for academic readers and other researchers.

This information’s purpose stands on its own in relation to writing a research paper. However, it would be beneficial to include additional articles if the research required a bigger population looking at multiple factors.

The TRAAP test for this article was very efficient when evaluating all aspects of each category. Even though some assessments did not qualify as adequate support by themselves, overall the TRAAP method was able to identify specific qualities of excellent research. Only two assessments truly required additional information to compose a research paper. One was timeliness because the research failed to address associations between depression and physician assisted suicide specifically. The second was relevance because the research failed to produce comprehensive analysis regarding the original intent of this research paper. Other than that, authority, accuracy, and purpose met all qualifications to stand alone (Cheung, Douwes, & Sundram, 2017).

Overall, the reliability of this peer-reviewed journal article is strong. However, some changes would make the reliability strong enough for each section of the TRAAP test to be used on its own. For example, the timeliness would meet the criteria if the research could be reproduced at a quicker pace. Even though the article was relevant to the general topic, it did not cover other populations where physician assisted suicide is legal, especially in countries where people have the right to end their lives when dealing with extreme mental illness. None of this was considered, and the original question of associations between assisted suicide and depression were not answered. The authority, accuracy, and purpose were well supported, although researchers and scientists with appropriate credentials to support the research would be beneficial.

In order to assess the original question of physician assisted suicide and depression, a broader analysis between all terminal ill patients regardless of age, better questions to support construct validity and define mental illness, chronic illness, the will to die, and an overall understanding of all situations needs to be conducted. Additionally, specific research methods are needed to provide more information for consumers, so they can make accurate determinations from the data collected. This will also provide researchers an ability to produce more research with the newly presented information.


Cheung, G., Douwes, G., & Sundram, F. (2017, May 2). Late-Life Suicide in Terminal Cancer: A Rational Act or Underdiagnosed Depression? Journal of Pain and Symptom Management, 54(6), 835-842. doi:10.1016/j.jpainsymman.2017.05.004
Elsevier Inc. (2013). Empowering Knowledge. Retrieved November 11, 2018, from Elsevier:
Zealand, T. U. (n.d.). University directory search. Retrieved November 11, 2018, from The University of Auckland New Zealand:
Impact factor of journal: 3.249
Year article was published: 2017

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