An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Abstract

BackgroundThe desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD.MethodsFollowing an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy.FindingsAll 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD.ConclusionsThis international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

Contemporary Definitions of Suicidal Behavior: A Systematic Literature Review

“…Egel's definition of suicide (1999) ignores intent because, in his opinion, “intentions are not observable, they cannot occur in the consequents of hypotheses about individuals who have committed suicide” (Egel, , p. 393). Balaguer and colleagues’ () definition of WTHD also does not specify intent, and they do not specifically address intent in their article; however, the authors do highlight a link with suicide ideation: “WTHD would be an overarching term that would include suicidal ideation as one type of such a wish or, in the case of suicide, as an action related to it” (p. 10). So we are left with the question of whether the ideation the authors mention includes intent or not.…”

The desire to hasten death in advanced cancer patients at a Mexican palliative care service

“…It is a response to factors such as uncontrolled physical symptoms, psychological distress, social or existential suffering, and/or the presence of psychiatric disorders. The DHD must be set apart from the acceptance of imminent death or the desire to die naturally in the near future (Balaguer, Monforte-Royo, Porta-Sales, Alonso-Babarro, Altisent et al, 2016;Wilson, Dalgleish, Chochinov, Chary, Gagnon et al, 2016).…”

Preliminary psychometrics of the Existential Distress Scale in patients with advanced cancer

“…Individuals who feel that their existence is no longer meaningful may lose the will to live (Morita, ; Portnoy, Rana, Zimmermann, & Rodin, ; Wilson et al., ). Although related psychological states have been studied at the end of life, including depression (Lo et al., ), the desire for hastened death (Balaguer et al., ), the sense of dignity (Chochinov et al., ) and spiritual well‐being (Lo, Zimmermann, Gagliese, Li, & Rodin, ), there is no consensus about the definition and measurement of existential distress (Boston, Bruce, & Shreiber, ).…”