Hospice professionals' experiences with patients : a qualitative study of suicide and hastened death in Washington State

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Several jurisdictions around the world have passed medical aid-in-dying laws that allow a physician, or, in some areas, a nurse practitioner to legally prescribe lifeending medications to individuals faced with a serious illness. There are some individuals receiving hospice services that also die by suicide without legal lethal means. Little is known, however, about deaths that are identified as suicide by professionals working with hospice patients in home settings in areas where medical aid in dying is allowed. This qualitative study undertaken in Washington State, where the Death with Dignity Act was implemented in 2009, investigates suicide and hastened death through the experiences of hospice professionals working with patients in their homes. Data were collected through in-depth, semi-structured interviews with seven nurses, seven social workers, four physicians, and three chaplains. Analysis of these data indicates participants’ interpretation of suicide is often blurry, but there are some patients receiving home hospice services who take power into their own hands and die by suicide because they are not eligible for, have no knowledge of, or lack access to legalised medical aid in dying. Power is a factor shaping roles and beliefs among hospice professionals and those they serve. Participants in this study work with patients who utilise medical aid in dying despite personal or organisational challenges and conflicts. Many deaths by suicide may be interpreted as rational but a perceived taboo about suicide limits open conversations among professionals and within organisations. Culture, location, socioeconomic disparities, and organisational policy impact how patients perceive, accept, or afford legal options. Palliative care professionals need open communication with patients and each other about suicide and hastened death in homecare.