When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals’ experiences where assisted dying is legal

Abstract

Background Laws allowing assisted suicide and euthanasia have been implemented in many locations around the world but some individuals suffering with terminal illness receiving palliative care services are hastening death or die by suicide without assistance. This systematic review aims to summarise evidence of palliative care professionals’ experiences of patients who died by suicide or hastened death in areas where assisted dying is legal and to understand when hastened death is considered to be a suicide. Methods AMED, CINAHL Complete, PsycINFO, PubMED, and Academic Search Ultimate were searched for articles from inception through June 2018. Quality assessment used the Hawker framework. Results A total of 1518 titles were screened resulting in thirty studies meeting eligibility criteria for this review. Published studies about professionals’ experiences from areas with legalised assisted dying includes limited information about patients who hasten death outside legal guidelines, die by suicide without assistance, or if the law impacts suicide among palliative care patients. Conclusion There are a range of experiences and emotions professionals’ experience with patients who die by euthanasia, assisted suicide, or hasten death without assistance. The included literature suggests improved communication among professionals is needed but does not explicitly identify when a hastened death is deemed a suicide in areas where assisted dying is practiced. More research is needed to help clarify what hastened death means in a palliative care context and identify how and if assisted dying impacts issues of suicide in palliative care settings. Electronic supplementary material The online version of this article (10.1186/s12904-019-0451-4) contains supplementary material, which is available to authorized users.

Psychological Distress Among Patients With Advanced Cancer

“…Hastened death differs from suicide. Hastened death defines someone who acts on their desire to control the circumstances of their death with or without assistance from another individual 61 . Suicide refers to self-caused death.…”

“…Hastened death defines someone who acts on their desire to control the circumstances of their death with or without assistance from another individual. 61 Suicide refers to self-caused death. Psychological distress among ACPs could trigger patients to have both hastened death and suicidal tendencies.…”

Gods or Monsters? Non-Explicit Consent in the hastening of deaths by Intensivists in Belgium

“…Keeping the patient artificially alive compromises the quality of the dying process of the patient. Hence, shortening life or hastening the death of the patient is only considered when keeping the patient alive compromises the quality of death of the patient [15].…”

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

“… 7 , 16 Having a wish to hasten death does not always mean that a person will act on the desire to die. 17 , 18 On the contrary, the demand for euthanasia generates the expectation for an effective response within a definite time span.…”