Unbearable suffering of patients with a request for euthanasia or physician‐assisted suicide: an integrative review

Abstract

There is no generally accepted definition of 'unbearable suffering' in the context of a request for EAS. On the basis of the articles reviewed, we propose the following conceptual definition: 'Unbearable suffering in the context of a request for EAS is a profoundly personal experience of an actual or perceived impending threat to the integrity or life of the person, which has a significant duration and a central place in the person's mind'. Further patient-centered qualitative research into suffering is needed to clarify this definition.

Suffering and euthanasia: a qualitative study of dying cancer patients’ perspectives

“…This corresponds well to previous research on the suffering of patients at end of life generally, as well as suffering in relation to euthanasia requests [6,8,[10][11][12][26][27][28][29]. Since humans are complex physical, psychological, social, and existential beings, suffering can originate from any, or many, of these dimensions [30].…”

“…When studying the motives of patients that have actually requested euthanasia in countries where it is legal, aspects of suffering are commonly identified [6,7,10]. Also, studies show that suffering from physical dimensions is not the most prominent motive for patients' wishes for a hastened death, despite the judgement of physicians.…”

“…In countries where euthanasia is permitted (Belgium, Luxembourg, and the Netherlands) the existence of intolerable suffering is one of several prerequisites for granting euthanasia requests [3][4][5]. However, there are no clear definitions of what constitutes intolerable suffering [6], which makes its assessment by physicians subjective. Previous studies in the Netherlands have shown that physicians vary in their assessment of suffering, and that there seems to be a preference for judging physical suffering as intolerable rather than suffering from other dimensions [7][8][9].…”

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

“…Dees et al 44 defines suffering in the context of PAD as a profoundly personal experience of an actual or perceived impending threat to the integrity of life of the person, which has a significant duration and a central place in the person's mind. 44, p 350 Arguably, psychiatrists will be asked to assess mental suffering in requests of PAD.…”

Engaging the Vulnerabilities of Alzheimer’s disease: a Care Ethics Perspective

“…30 The unbearable suffering associated with AD partly underscores how the loss of autonomy and the need to relieve suffering make patients vulnerable to exploring desperate solutions such as euthanasia which is spurred by medical, social and psychological suffering of unbearable proportions. 31 One of the paradoxes associated with this involves the relationship between individual autonomy and the relief of suffering as a justifying lens and the increasingly smaller options of good death that become open to patients 32 once requests or euthanasia in the context of AD become the norm. For Gordijn, the three possible scenarios involve incompetent patients, competent patients and incompetent patients with advance directives.…”