Understanding why patients request euthanasia when it is illegal: a qualitative study in palliative care units on the personal and practical impact of euthanasia requests

Abstract

Context: Some patients in palliative care units request euthanasia regardless of legislation. Although studies have explored the reasons for these requests, little is known about the subjective, relational, and contextual repercussions for the patient. Objectives: The aim of this study is to understand the purpose of euthanasia requests from the patient’s viewpoint and their personal and practical impact. Methods: We conducted in-depth interviews with patients requesting euthanasia, their family members, and health care providers in 11 French palliative care units. A thematic analysis of the data was performed. Results: In total, 18 patients were interviewed within 48 h of the request being made; 1 week later, 9 patients were interviewed again. Five main themes emerged: assuming the possibility of transgressing the forbidden, a call for unbearable suffering to be recognized, encouragement to change clinical practice, reclaiming a sense of freedom over medical constraints, and imagining a desirable future for oneself. Conclusions: A request for euthanasia appears to be a willful means to remove oneself from the impasse of an existence paralyzed by suffering. It creates a space for discussion, which promotes negotiation with patients on care practices and therapeutics, and strengthens patients’ sense of autonomy. Investigating the relationship between the evolution of euthanasia requests within the palliative care setting could be beneficial. It is important to encourage health care professionals to adopt a readiness to listen by interacting with patients in a way that is not momentarily action-oriented but rather focused on proactive discussion.

Voluntary Assisted Dying/Euthanasia: Will This Have an Impact on Cancer Care in Future Years?

“…Conversely, in a study of mostly older people requesting MHD who were not severely ill, suffering (which was largely defined in physical domains) was commonly cited as driving the request [ 20 ]. Leboul highlighted the potential for positive opportunities that may arise following a request for MHD even when it is not legally available [ 21 ]. In inpatient palliative care patients, such a request was seen as a call to recognise intolerable suffering, to change clinical practice, to reclaim a sense of removal of medical controls and to imagine “a desirable future for oneself’”.…”

“…In inpatient palliative care patients, such a request was seen as a call to recognise intolerable suffering, to change clinical practice, to reclaim a sense of removal of medical controls and to imagine “a desirable future for oneself’”. As such, even in the absence of likely fulfilment of the wish, the request created an opportunity to navigate care differently—to discuss, consider, and negotiate therapeutics, to enhance a sense of mastery in circumstances previously considered without such opportunities [ 21 ].…”

End-of-Life Narratives of Patients who Request Medical Assistance in Dying: A Qualitative Study Protocol

“…The aim is to suspend preconceived judgments about what MAiD entails and learn from the main actors the reasons behind their request for it. To structure the analysis, the profiles of the participants are categorised using the following variables: “gender” (male, female, other); “age” (18 to 40, 41 to 64, 65 or older – following the literature on MAiD requests in other countries [Dees et al, 2013; Leboul et al, 2022]); “level of education” (a. primary education and first stage of secondary education; b. second stage of secondary education and non-higher post-secondary education; c. second cycle of higher education and doctoral degree); “euthanasia context”, according to the law (a. severe, chronic and debilitating condition; b. serious and incurable illness causing intolerable physical or psychological suffering); and “stage of the process” of the application. Additional socio-demographic information is considered to describe the heterogeneity of profiles and their influence on the narratives (e.g., cultural background, rural/urban environment, socioeconomic level).…”

Explorando el discurso de enfermos crónicos sobre la legalización de la muerte médicamente asistida

“…En varias investigaciones se ha reportado que los enfermos en una etapa terminal solicitan ya sea la eutanasia o el suicidio asistido, aunque sea de manera hipotética. En un estudio cualitativo llevado a cabo en Francia por Leboul et al se encontró que algunos pacientes en la unidad de cuidados paliativos solicitaron la eutanasia, independientemente de la legislación (46).…”