Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review

Hudson, Peter; Kristjanson, Linda J.; Ashby, Michael; Kelly, Brian; Schofield, Penelope; Hudson, Rosalie; Aranda, Sanchia; O'Connor, Margaret Mary; Street, Annette

doi:10.1177/0269216306071799

Cited by 130 publications

(101 citation statements)

References 72 publications

(44 reference statements)

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“…A systematic review on the reasons for desire to die requests found 35 research studies that met the search terms. 2 Being a burden to others, loss of autonomy, physical symptoms, depression and hopelessness, existential concerns, and fear of the future were the most commonly named reasons. However, most of these studies reported on patients' opinions about why they may have a desire for hastened death in the future or about family members or health-care professionals' opinions of patients' reasons.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Background: Some patients with advanced and progressive diseases express a desire to hasten death. Aim: This study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide. Design: A modified form of Grounded Theory was used. Setting/participants: Patients from the departments of palliative medicine in three hospitals in Germany were recruited when they had made a statement or request to hasten death. Participants were interviewed face to face. Recruitment was stopped with 12 participants because of data saturation. Results: Thematic analysis revealed three main motivational themes: self-determination, agony, and time. Expectations toward health professionals, attitudes toward death, and secureness related to the end of life were additional main themes emerging from the analysis. Conclusions:The desire to hasten death may be used as an extreme coping strategy to maintain control against anticipated agony. Patients expected health professionals to listen to and respect their experiences. Emerging hypotheses included the following: (a) patients try to balance life time and anticipated agony, and the perception of time is distressing in this balancing act; (b) anticipated images of agony and suffering in the dying process occur frequently and are experienced by patients as intrusive; (c) patients expressing a desire to hasten death are in need of more information about the dying process; and (d) patients wanted their caregivers to listen to and respect their wish to hasten death, and they did not expect the caregivers to understand this as an order to actually hasten their death.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…This is a controversial topic and may contribute to why the fact that some patients desire death is not commonly debated in the literature. According to Hudson et al (2006), reasons for a desire to die are preliminary psychological, existential and social. Desire for death could also have its origin in an anxiety towards living life with severe illness .…”

Section: Discussionmentioning

confidence: 99%

Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care

Browall

Henoch

Melin‐Johansson

et al. 2014

European Journal of Oncology Nursing

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a b s t r a c tNurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress. Aim: The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer. Methods and sample: Nurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured. Results: Eighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live. Conclusions: This study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs.

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“…4,5 Moreover, having control over the dying process is identified as a key attribute of a good death in Western society. 1,2,6,7 For people who suffer unbearably and wish to hasten death, voluntary stopping of eating and drinking (VSED) [8][9][10][11] is described as a feasible method for them to control the timing and circumstances of their death.…”

Section: Introductionmentioning

confidence: 99%

Primary Care Patients Hastening Death by Voluntarily Stopping Eating and Drinking

Bolt

Hagens

Willems

2015

The Annals of Family Medicine

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PURPOSELittle is known about the role family physicians play when a patient deliberately hastens death by voluntarily stopping eating and drinking (VSED). The purpose of this study was to gain more insight for family physicians when confronted with patients who wish to hasten death by VSED. We aimed to describe physicians' involvement in VSED, to describe characteristics and motives of their patients, and to describe the process of VSED in terms of duration, as well as common symptoms in the last 3 days of life. METHODSWe undertook a survey of a random national sample of 1,100 family physicians (response rate 72%), and 500 of these physicians received questions about their last patient who hastened death by VSED. RESULTSOf the 978 eligible physicians, 708 responded (72.4%); 46% had cared for a patient who hastened death by VSED. Of the 500 physicians who received the additional questions, 440 were eligible and 285 (64.8%) responded; they described 99 cases of VSED. Seventy percent of these patients were aged older than 80 years, 76% had severe disease (27% with cancer), and 77% were dependent on others for everyday care. Frequent reasons for the patients' death wish were somatic (79%), existential (77%), and dependence (58%). Median time until death was 7 days, and the most common symptoms before death were pain, fatigue, impaired cognitive functioning, and thirst or dry throat. Family physicians were involved in 62% of cases.CONCLUSIONS Patients who hasten death by VSED are mostly in poor health. It is not unlikely for family physicians to be confronted with VSED. They can play an important role in caring for these patients and their proxies by informing them of VSED and by providing support and symptom management during VSED.

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Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review

Cited by 130 publications

References 72 publications

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

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

Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care

Primary Care Patients Hastening Death by Voluntarily Stopping Eating and Drinking

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