What Lies behind the Wish to Hasten Death? A Systematic Review and Meta-Ethnography from the Perspective of Patients

Cristina Monforte-Royo,Vinita Mahtani-Chugani,Albert Balaguer,Christian Villavicencio-Chávez,Joaquin Tomás-Sábado,James Kilner

doi:10.1371/journal.pone.0037117

Abstract

BackgroundThere is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish.Methods and FindingsSystematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life (‘having an ace up one's sleeve just in case’). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation.ConclusionsThe expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans.

Highlights

For several decades clinicians and researchers have shown a growing interest in analysing the wish to hasten death (WTHD) in the context of serious or incurable illness
The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one’s death
Clinicians and researchers have shown a growing interest in analysing the wish to hasten death (WTHD) in the context of serious or incurable illness. This phenomenon seems to affect a considerable number of patients, especially those facing the end of life or advanced stages of their illness [1,2,3]

Summary

Introduction

Clinicians and researchers have shown a growing interest in analysing the wish to hasten death (WTHD) in the context of serious or incurable illness. This phenomenon seems to affect a considerable number of patients, especially those facing the end of life or advanced stages of their illness [1,2,3]. In this regard, medical advances that increase life expectancy and disease chronicity, as well as other social phenomena found in developed societies (e.g. family or community breakdown), may contribute to making the WTHD more common [4,5,6,7]. This study aims to understand the experience of patients with serious or incurable illness who express such a wish

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