What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care

Abstract

BackgroundDespite research efforts over recent decades to deepen our understanding of why some terminally ill patients express a wish to die (WTD), there is broad consensus that we need more detailed knowledge about the factors that might influence such a wish. The objective of this study is to explore the different possible motivations and explanations of patients who express or experience a WTD.MethodsThirty terminally ill cancer patients, their caregivers and relatives; from a hospice, a palliative care ward in the oncology department of a general hospital, and an ambulatory palliative care service; 116 semi-structured qualitative interviews analysed using a complementary grounded theory and interpretive phenomenological analysis approach.ResultsThree dimensions were found to be crucial for understanding and analysing WTD statements: intentions, motivations and social interactions. This article analyses the motivations of WTD statements. Motivations can further be differentiated into (1) reasons, (2) meanings and (3) functions. Reasons are the factors that patients understand as causing them to have or accounting for having a WTD. These reasons can be ordered along the bio-psycho-socio-spiritual model. Meanings describe the broader explanatory frameworks, which explain what this wish means to a patient. Meanings are larger narratives that reflect personal values and moral understandings and cannot be reduced to reasons. Functions describe the effects of the WTD on patients themselves or on others, conscious or unconscious, that might be part of the motivation for a WTD. Nine typical ‘meanings’ were identified in the study, including “to let death put an end to severe suffering”, “to move on to another reality”, and – more frequently– “to spare others from the burden of oneself”.ConclusionsThe distinction between reasons, meanings and functions allows for a more detailed understanding of the motivation for the WTD statements of cancer patients in palliative care situations. Better understanding is crucial to support patients and their relatives in end-of-life care and decision making. More research is required to investigate the types of motivations for WTD statements, also among non-cancer patients.

The desire to hasten death: Using Grounded Theory for a better understanding “When perception of time tends to be a slippery slope”

“…Only recently has a Swiss report described the intentions and motivations of a wish to die in patients with terminal cancer. 26,27 However, the authors included patients with and without a wish to die, and there is no information how many patients of the study sample did explicitly request hastened death. The authors describe a wide range of nine different intentions (ranging from the will to live to acting toward dying) and a similar range of motivations, including different reasons, meanings, and functions of the wish to die, including being an example to other on how to die, spare others the burden of oneself, re-establishing agency, or manipulation.…”

Meaning in Life as a Mediator Between Physical Impairment and the Wish to Hasten Death in Patients With Advanced Cancer

“…These factors are considered less likely to trigger a WTHD if they are properly managed. 25 Moreover, psychological and/or emotional factors 22,28e30 and spiritual and/or existential aspects, such as impaired spiritual well-being and loss of MiL, have also been linked to the WTHD. 11,21,31 The studies by Meier et al 8 and Morita et al 32 were the first to highlight the role that a lack of MiL can play in relation to the WTHD.…”

Supporting Wellbeing for People in Palliative Care: The Role of Sharing Stories for Wellbeing Life Story Workshops

“…This interaction between participants and staff promoted the sense of social bonding, a space for connection with others and a means of being in the world as an authentic self (Cour & Hansen, 2012;Kabel, 2013;Redhouse, 2014), arguably all qualities which promote a sense of positive wellbeing and purpose (Kasl-Godley et al, 2014). By baking again, it could be argued that the patient is regaining some control and shifting their identity back to their former self (Ohnsorge et al, 2014).…”

“…offers evidence that early palliative care intervention has positive effects in engaging with patients and that spiritual wellbeing is affected by not only religious or other beliefs but also by self-esteem and a sense of relatedness which could be promoted in such groups as SS4WB. Wellbeing may also be supported through ownership and choice Ohnsorge, Gudat and Rehmann-Sutter (2014). write of the complexity of autonomy particularly for cancer care patients and that fear of losing autonomy is common among this cohort.…”