Existential suffering as a motive for assisted suicide: difficulties, acceptability, management and roles from the perspectives of Swiss professionals

Abstract

Background. Existential suffering is often a part of the requests for assisted suicide (AS). Its definitions have gained in clarity recently and refer to a distress arising from an inner realization that life has lost its meaning. There is however a lack of consensus on how to manage existential suffering, especially in a country where AS is legal and little is known about the difficulties faced by professionals confronted with these situations. Objectives. To explore the perspectives of Swiss professionals involved in end-of-life care and assisted suicide on the management of existential suffering when it is part of AS requests, taking into account the question of roles, as well as on the difficulties they encounter along the way and their views on the acceptability of existential suffering as a motive for AS. Methods. A qualitative study based on face-to-face interviews was performed among twenty-six participants from the fields of palliative and primary care as well as from EXIT right-to-die organization. A semi-structured interview guide exploring four themes was used. Elements from the grounded theory approach were applied. Results. Almost all participants reported experiencing difficulties when facing existential suffering. Two-thirds considered existential suffering as a justifiable reason for requesting AS. Concerning the management of existential suffering, participants referred to the notion of being present, respect, explore the suffering, give meaning, working together, psychological support, spiritual support, relieve physical symptoms and palliative sedation. Conclusion. This study offers a unique opportunity to reflect on what are desirable responses to existential suffering when it is part of AS requests. Existential suffering is plural and certainly implies a multiplicity of responses as well. These situations remain however difficult and controversial according to Swiss professionals. Clinicians education should better address these issues and give them the tool to take care of patients with existential suffering.