The wish to hasten death: a review of clinical studies

Abstract

It is common for patients who are faced with physical or psychological suffering, particularly those in the advanced stages of a disease, to have some kind of wish to hasten death (WTHD). This paper reviews and summarises the current state of knowledge about the WTHD among people with end-stage disease, doing so from a clinical perspective and on the basis of published clinical research. Studies were identified through a search strategy applied to the main scientific databases.Clinical studies show that the WTHD has a multi-factor aetiology. The literature review suggests-perhaps in line with better management of physical pain-that psychological and spiritual aspects, including social factors, are the most important cause of such a wish. One of the difficulties facing clinical research is the lack of terminological and conceptual precision in defining the construct. Indeed, studies frequently blur the distinction between a generic wish to die, a WTDH (whether sporadic or persistent over time), the explicit expression of a wish to die, and a request for euthanasia or physician-assisted suicide.A notable contribution to knowledge in this field has been made by scales designed to evaluate the WTHD, although the problems of conceptual definition may once again limit the conclusions, which can be drawn from the results. Studies using qualitative methodology have also provided new information that can help in understanding such wishes.Further clinical research is needed to provide a complete understanding of this phenomenon and to foster the development of suitable care plans.

Suffering and euthanasia: a qualitative study of dying cancer patients’ perspectives

“…This corresponds well to previous research on the suffering of patients at end of life generally, as well as suffering in relation to euthanasia requests [6,8,[10][11][12][26][27][28][29]. Since humans are complex physical, psychological, social, and existential beings, suffering can originate from any, or many, of these dimensions [30].…”

“…Also, studies show that suffering from physical dimensions is not the most prominent motive for patients' wishes for a hastened death, despite the judgement of physicians. In contrast, patients perceive suffering from psychological, social, and spiritual dimensions as more important causes for such a wish [8,[11][12][13][14]. In a study of hospice patients, suffering and pain were regarded as separate entities [15].…”

Mental disorders and the desire for death in patients receiving palliative care for cancer

“…Conversely, however, only 39% of those with a serious desire for death would have opted for euthanasia, at least at the time of the interview. Thus, the desire for death and the desire for euthanasia are not synonymous,1 36 and it is possible that they have differing associations with mental disorders.…”

The Patient Dignity Inventory: Just another evaluation tool? Experiences with advanced cancer patients

“…The idea that an evaluation tool might have a therapeutic effect has been mentioned in connection other tools, such as the ESAS or the examination of the wish to die (Carvajal et al, 2011;Monforte-Royol et al, 2011). It seems that some tools promote professional -patient communication, but it is worth considering whether the therapeutic effect is an intrinsic quality of the PDI or whether it depends on applying it with an open, empathetic attitude (Carvajal et al, 2011).…”