A qualitative study on existential suffering and assisted suicide in Switzerland

Abstract

Background In Switzerland, people can be granted access to assisted suicide (AS) on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person’s conduct is not selfishly motivated. No restrictions relating to the ground of suffering are mentioned in the act. Existential suffering as a reason for wanting to die, however, gives raise to controversial issues. Moreover, existential suffering lacks definition and no consensus exists on how to evaluate and manage it. This study explores the perspectives of care professionals and volunteers from a “right-to-die organization” on existential suffering as a motive for assisted suicide requests. Methods A qualitative study based on face-to-face interviews was conducted with twenty-six participants: palliative care and primary care providers as well as EXIT right-to-die organization volunteers. Elements from the grounded theory approach were used. Results The twenty-six participants described existential suffering in a multiplicity of individual ways. In total, sixty-three stories were recounted. Their representations were grouped into eight categories: physical decline and its consequences, loneliness, fear of the future, life is over, loss of social significance, loss of hope for a better future, being a financial burden and loss of pleasurable activities. According to all participants, suffering coming from the loss of self-identity was always linked to physical decline, as if one’s image completely defined someone’s identity. Society’s perception of old people and vulnerable people were also often questioned. Another interesting point was that only four stories referring to a “pure” existential suffering were found. This suffering was related to a feeling that life has come to an end, without identification of any other related restriction or suffering. Conclusions Existential suffering is multifaceted. Legislators and right-to-die organisations have to address the question of what make a AS acceptable. The plurality of existential suffering implies the need of a very personalized care. A better understanding of what it is made of could provide a “toolbox” to people concerned by these requests, helping them to explore it in order to offer suffering people a wider range of alternatives. Electronic supplementary material The online version of this article (10.1186/s12910-019-0367-9) contains supplementary material, which is available to authorized users.

Physicians’ perceptions of palliative sedation for existential suffering: a systematic review

“…Moreover, doubts about its refractory nature destabilises clinical-ethical decision-making regarding PS-ES. A lack of robust conceptual and ethical arguments grounding PS-ES decision-making and practices clearly contributes to the controversial status of PS-ES and the absence of consensus among physicians 44. The abovementioned systematic review on ethical aspects of PS-ES14 revealed that implicit anthropological models and philosophical presuppositions underpin the ethical debate on PS-ES.…”

“…Similarly, alternatives to PS-ES are proposed without a strong ethical argumentation grounding them. In countries where euthanasia/physician-assisted suicide is legal, they are sometimes presented as more acceptable alternatives to PS-ES 44. Attempts to avoid the complexity and controversial aspects of PS-ES by replacing it with euthanasia/physician-assisted suicide risks sliding down a slippery slope.…”

The mediated discourse and voice of euthanasia: the Israeli media as a case study

“…Indeed, each one of the aforementioned characteristics encompasses a large variety of differentiating understandings by different groups and individuals (Boston, Bruce, and Schreiber 2011, 615). For instance, Gaignard and Hurst 2019, 3–6 pointed to eight motives for euthanasia deriving from existential sufferings: ‘physical decline and its consequences, loneliness, fear of the future, life is over, loss of social significance, loss of hope for a better future, being a financial burden, and loss of pleasurable activities’ (Gaignard and Hurst 2019, 3).…”

“…While ample studies point to a considerable amount of media attention to the topic of euthanasia, they are rarely data-driven and routinely do so in the narrow context of (assisted-suicide) tourism (Huxtable 2009, 327; Luley 2015, 618-19; Pratt, Tolkach, and 2019; Ladki et al 2016, 2-13; Shondell and Gonzalez 2013, 301; Yu, Wen, and Yang 2020, 5–6). Indeed, scholars have suggested media could be playing a central role in the social discourse surrounding euthanasia in society (Gaignard and Hurst 2019, 6; Pratt, Tolkach, and 2019, 3–4; Stone 2012, 1575). The media’s centrality regarding euthanasia plausibly derives from the potential of media capabilities as these regularly play a central role in society regarding all topics of life (Shomron and Schejter 2020, 2-3; Shomron and Schejter 2020, 1728; Shomron and Tirosh (2020)) as well as from the more specific media role as a mediator of mortality and death (Stone 2012, 1575–76; Walter 2009, 2–4).…”

“…The act of euthanasia refers to the intentional ending of a person’s life with the intent of alleviating great pain or suffering. This act is habitually assisted or administered by medical practitioners (Gaignard and Hurst 2019, 1–2; Huxtable 2009, 328–29; Shondell and Gonzalez 2013, 297). Yet the legitimacy of the act and its legalities often differ between countries, resulting in continuous and active debates in different societies (Boston, Bruce, and Schreiber 2011, 615–16; Ladki et al 2016).…”