Suicide and Desire for Hastened Death in the Terminally Ill

Abstract

Patients in the palliative care setting are often faced with thoughts of a threatened or limited life expectancy due to their illness. The transition from curative to palliative treatment can signify to the patient that recovery from the illness is no longer possible and the most that medical care can offer is physical comfort. In some patients, this realization can lead to a desire for a more rapid death or even thoughts of suicide, as evidenced by elevated rates of suicide in patients with advanced medical illnesses. Understanding a patient’s expressions of the wish to hasten death in the context of serious medical illness has become more complicated over the past decades, particularly given the growing trend toward legalization of physician-assisted dying. Thus, it is crucial for healthcare providers to understand the risk factors for suicide and desire for hastened death in order to properly assess and respond to these patients. This chapter provides a broad overview of the reasons behind and risk factors for suicide and desire for hastened death, as well as how to assess and respond to these expressions in patients with advanced medical illness.