‘Unbearable suffering’: a qualitative study on the perspectives of patients who request assistance in dying

Abstract

Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become 'unbearable'. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future.

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

“…Nurses encountering end-of-life cancer patients in our study who expressed a desire to die did not perceive that patients were depressed as this is a common psychiatric reason or that the patients sensed hopelessness. Desire to die was described by Dees et al (2011) as living with unbearable suffering specifically related to feelings of hopelessness. Suffering was not constantly unbearable in all patients except for patients having a psychiatric diagnosis.…”

“…That is, existential suffering is a process that may be triggered by such negative feelings as death anxiety, fear and bereavement and may cause these feelings to last for a longer or a shorter period of time. Existential suffering may be unbearable, as described by Dees et al (2011), but is not endless. Telling stories repeatedly to nurses who respond with active listening and openness may support patients to strive for security and stability or a more profound grounding of their impending death, as described by Bruce and Boston (2011).…”

Assisted Suicide as a Remedy for Suffering? The End-of-Life Preferences of British “Suicide Tourists”

“…There is an emerging body of literature examining people's motivations for actively requesting an assisted suicide in jurisdictions where the practice is lawful (Dees et al 2011;Norwood 2007;Pearlman et al 2005;Pool 2000) and where this is not a legal option (Chapple et al 2006;Lavery et al 2001;Mak and Elwyn 2005). Overall, this literature suggests that requests for assisted suicide are rooted in suffering, which can have medical, psychological, social, and existential dimensions (Dees et al 2011).…”

The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada

“…However, research seems to indicate that the burden of suffering is fundamentally subjective. 45,46 If "ought implies can," 53, p 70 the challenge for psychiatry would seem to be developing an understanding of suffering in a way that is clinically measurable. Should psychiatrists create and validate a tool to measure suffering, or does existing legislation mistakenly presume to suggest that suffering is subject to a standard of quantifiable legitimacy?…”

“…This poses a clear challenge to psychiatry; research suggests that there is very little overlap between what health care professionals and patients perceive to motivate suffering. 45,46 Literature emphasizes the need for greater understanding of spiritual and existential suffering, as these are ill-defined, often neglected concepts. [47][48][49] In response to this, emerging psychotherapeutic interventions, such as meaning-focused group psychotherapy and existential psychotherapy, have been researched and developed to integrate meaning and spirituality into end-of-life care.…”