Assumptions and moral understanding of the wish to hasten death: a philosophical review of qualitative studies

Abstract

It is not uncommon for patients with advanced disease to express a wish to hasten death (WTHD). Qualitative studies of the WTHD have found that such a wish may have different meanings, none of which can be understood outside of the patient's personal and sociocultural background, or which necessarily imply taking concrete steps to ending one's life. The starting point for the present study was a previous systematic review of qualitative studies of the WTHD in advanced patients. Here we analyse in greater detail the statements made by patients included in that review in order to examine their moral understandings and representations of illness, the dying process and death. We identify and discuss four classes of assumptions: (1) assumptions related to patients' moral understandings in terms of dignity, autonomy and authenticity; (2) assumptions related to social interactions; (3) assumptions related to the value of life; and (4) assumptions related to medicalisation as an overarching context within which the WTHD is expressed. Our analysis shows how a philosophical perspective can add to an understanding of the WTHD by taking into account cultural and anthropological aspects of the phenomenon. We conclude that the knowledge gained through exploring patients' experience and moral understandings in the end-of-life context may serve as the basis for care plans and interventions that can help them experience their final days as a meaningful period of life, restoring some sense of personal dignity in those patients who feel this has been lost.

Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death

“…Nurses can also prepare themselves by reflecting on the substantive issues that are coming to the fore in a request of this nature. In their philosophic analysis of qualitative studies of the wish to hasten death, Rodriguez-Prat and van Leeuwen50 identified 4 moral themes inherent in these requests: dignity, autonomy, and authenticity; social interactions; the value of life; and the medicalization of care. As nurses reflect on these themes and how they influence a request to hasten death, they will be better prepared to engage authentically with patients across the spectrum of these evolving contexts.…”

The rocks and hard places of MAiD: a qualitative study of nursing practice in the context of legislated assisted death

“…Third, MAiD is new to Canada. Even though healthcare providers have always received requests to hasten death, only now do they have the legal authority to do so [22,23]. Further, the experience of the death itself is vastly different from a normal death [8].…”

Ethical issues when working with terminally ill people who desire to hasten the ends of their lives: a western perspective

“…It covers situations where practitioners provide lethal drugs to people, or administer it to them, to hasten their deaths. The deliberate causing of one's own death and the intentional allowing or causing of the death of other people are, however, highly emotional and morally sensitive issues (Cholbi, 2017;Rodríguez-Prat & van Leeuwen, 2018). The public policy in Western countries is therefore to protect the sanctity of life and this together with the policy to protect vulnerable people from potential abuse, is an obstacle for those who advocate for euthanasia (Pretty v United Kingdom, 2002;Rodriguez v. British Columbia [Attorney General], 1993).…”

“…These include wanting to control how they die and to ensure it is dignified (Rehmann-Sutter, Gudat, & Ohnsorge, 2015;Rodríguez-Prat & van Leeuwen, 2018). Others' ideation could be part of their adjustment to the dying process (Johnson, Cramer, Gardner, & Nobles, 2015) and psychologists should not confuse these clients' prospective grief and fear of dying, the unknown, and pain with anxiety and depression (Farberman, 1997).…”