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Desire for hastened death

Mark Corbett
Conceivably, in an ideal world, all patients with a life-limiting illness would receive optimal hospice and palliative care so that no one would ever wish to hasten their own death. The reality, however, is that despite provision of optimal hospice and palliative care, individuals with terminal illness experience suffering, loss of meaning, or deterioration in quality of life to the extent where they express the desire to expedite the dying process. While there has been extensive discussion surrounding physician-assisted death (PAD), there has been less attention paid to the practice of voluntary stopping eating and drinking (VSED) near the end of life...
2016: Narrative Inquiry in Bioethics
Sophie Robinson, David W Kissane, Joanne Brooker, Courtney Hempton, Susan Burney
CONTEXT: The risk of suicide is elevated in palliative care patients compared to the general population. Various psychological factors, including depression, demoralization, loss of control, and low self-worth have been associated with a desire to hasten death. OBJECTIVES: The aim of this study was to investigate whether depression, demoralization, loss of control, and low self-worth mediated the relationship between global quality of life and desire to hasten death...
October 12, 2016: Journal of Pain and Symptom Management
Elissa Kolva, Barry Rosenfeld, Ying Liu, Hayley Pessin, William Breitbart
Desire for hastened death (DHD) represents a wish to die sooner than might occur by natural disease progression. Efficient and accurate assessment of DHD is vital for clinicians providing care to terminally ill patients. The Schedule of Attitudes Toward Hastened Death (SAHD) is a commonly used self-report measure of DHD. The goal of this study was to use methods grounded in item response theory (IRT) to analyze the psychometric properties of the SAHD and identify an abbreviated version of the scale. Data were drawn from 4 studies of psychological distress at the end of life...
June 9, 2016: Psychological Assessment
Ramona L Rhodes, Bryan Elwood, Simon C Lee, Jasmin A Tiro, Ethan A Halm, Celette S Skinner
BACKGROUND: Studies have identified racial differences in advance care planning and use of hospice for care at the end of life. Multiple reasons for underuse among African American patients and their families have been proposed and deserve further exploration. OBJECTIVE: The goal of this study was to examine perceptions of advance care planning, palliative care, and hospice among a diverse sample of African Americans with varying degrees of personal and professional experience with end-of-life care and use these responses to inform a culturally sensitive intervention to promote awareness of these options...
February 14, 2016: American Journal of Hospice & Palliative Care
Gwenaëlle Bidet, Lysanne Daoust, Michel Duval, Thierry Ducruet, Baruch Toledano, Nago Humbert, France Gauvin
BACKGROUND: An order protocol for distress (OPD), including respiratory distress and acute pain crisis, has been established for pediatric palliative care patients at Sainte-Justine Hospital (SJH). After discussion with the patient/his or her family, the OPD is prescribed by the attending physician whenever judged appropriate. The OPD can then be initiated by the bedside nurse when necessary; the physician is notified after the first dose is administered. OBJECTIVES: The study objectives were to evaluate the perceptions and experience of the medical/nursing staff towards the use of the OPD...
March 2016: Journal of Palliative Medicine
Albert Balaguer, Cristina Monforte-Royo, Josep Porta-Sales, Alberto Alonso-Babarro, Rogelio Altisent, Amor Aradilla-Herrero, Mercedes Bellido-Pérez, William Breitbart, Carlos Centeno, Miguel Angel Cuervo, Luc Deliens, Gerrit Frerich, Chris Gastmans, Stephanie Lichtenfeld, Joaquín T Limonero, Markus A Maier, Lars Johan Materstvedt, María Nabal, Gary Rodin, Barry Rosenfeld, Tracy Schroepfer, Joaquín Tomás-Sábado, Jordi Trelis, Christian Villavicencio-Chávez, Raymond Voltz
BACKGROUND: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. METHODS: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out...
2016: PloS One
M Á Cuervo Pinna, M Rubio, R Altisent Trota, J Rocafort Gil, M Gómez Sancho
BACKGROUND AND OBJECTIVES: The decriminalisation of euthanasia and assisted medical suicide has generated a continuous debate. The terminological confusion is one of the main difficulties in obtaining medical practice consensus. The objective of this study was to determine whether the terms of Euthanasia and physician assisted suicide are used with the same meaning by doctors in Extremadura (Spain). MATERIAL AND METHOD: A qualitative study was conducted using two focus groups in which doctors from different specialties who attended a large number of terminal patients participated...
January 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Yin-Chih Wang, Chia-Chin Lin
BACKGROUND: Spirituality is a central component of the well-being of terminally ill cancer patients. OBJECTIVE: The aim of this study was to examine the mediating or moderating role of spiritual well-being in reducing the impact of cancer-related symptoms on quality of life and the desire for hastened death in terminally ill cancer patients. METHODS: Eighty-five terminally ill cancer patients were assessed using the Taiwanese version of the M...
July 2016: Cancer Nursing
M Galushko, G Frerich, K M Perrar, H Golla, L Radbruch, F Nauck, C Ostgathe, R Voltz
OBJECTIVE: Desires for hastened death (DHD; wish to hasten death is also in use) are prevalent in terminally ill patients. Studies show that health professionals (HP) are often underprepared when presented with DHD. HPs in specialized palliative care (SPC-HP) often encounter DHD. This study aimed to identify SPC-HP responses to DHD in daily practice and their corresponding functions. METHODS: Narrative interviews were conducted with 19 SPC-HPs at four German University Hospitals...
May 2016: Psycho-oncology
Elaine M Beller, Mieke L van Driel, Leanne McGregor, Shani Truong, Geoffrey Mitchell
BACKGROUND: Terminally ill people experience a variety of symptoms in the last hours and days of life, including delirium, agitation, anxiety, terminal restlessness, dyspnoea, pain, vomiting, and psychological and physical distress. In the terminal phase of life, these symptoms may become refractory, and unable to be controlled by supportive and palliative therapies specifically targeted to these symptoms. Palliative sedation therapy is one potential solution to providing relief from these refractory symptoms...
2015: Cochrane Database of Systematic Reviews
Kathy Black, Ellen L Csikai
Due to the unprecedented increase in the United States aging demographics, many more people are living longer and reaching older ages than ever before. However, a longer life is not necessarily a better life, as the vast majority will face a period of prolonged deteriorating health prior to death. Although notable efforts have been underway that are designed to improve the end-of-life experience, increasing numbers of individuals express a desire and/or act upon an intent to end their lives precipitously. Though still limited, the options to actively participate in their own deaths are growing...
2015: Journal of Social Work in End-of-life & Palliative Care
Martina Pestinger, Stephanie Stiel, Frank Elsner, Guy Widdershoven, Raymond Voltz, Friedemann Nauck, Lukas Radbruch
BACKGROUND: Some patients with advanced and progressive diseases express a desire to hasten death. AIM: This study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide. DESIGN: A modified form of Grounded Theory was used. SETTING/PARTICIPANTS: Patients from the departments of palliative medicine in three hospitals in Germany were recruited when they had made a statement or request to hasten death...
September 2015: Palliative Medicine
Claudia Mazzocato, Laurence Séchaud
It is not uncommon for patients with an advanced disease to express a desire to their physician to hasten their death. Recent studies show that the motivation of such a desire is multifactorial and multidimensional, including depression, physical, psycho-social and spiritual suffering, fears about the process of dying and/or misunderstandings about the options for end-of-life care. The objective of this paper is to propose to the physician how to explore the dimensions of this request and some elements to answer it...
February 25, 2015: Praxis
William Breitbart, Barry Rosenfeld, Hayley Pessin, Allison Applebaum, Julia Kulikowski, Wendy G Lichtenthal
PURPOSE: To test the efficacy of meaning-centered group psychotherapy (MCGP) to reduce psychological distress and improve spiritual well-being in patients with advanced or terminal cancer. PATIENTS AND METHODS: Patients with advanced cancer (N = 253) were randomly assigned to manualized eight-session interventions of either MCGP or supportive group psychotherapy (SGP). Patients were assessed before and after completing the treatment and 2 months after treatment...
March 1, 2015: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Monica Branigan
PURPOSE OF REVIEW: As we approach the end of our lives, many of us will have a desire for hastened death (DHD). Fortunately, our ability to respond to suffering at the end of life is improving. At the same time, in many jurisdictions, changes are underway to legislate physician-assisted death. This compels us as clinicians to explore DHD in a compassionate way - to reduce suffering and reduce premature death. This challenge is becoming more compelling as a large cohort of individuals, who value autonomy and control, age and experience illness...
March 2015: Current Opinion in Supportive and Palliative Care
Elaine M Beller, Mieke L van Driel, Leanne McGregor, Shani Truong, Geoffrey Mitchell
BACKGROUND: Terminally ill people experience a variety of symptoms in the last hours and days of life, including delirium, agitation, anxiety, terminal restlessness, dyspnoea, pain, vomiting, and psychological and physical distress. In the terminal phase of life, these symptoms may become refractory, and unable to be controlled by supportive and palliative therapies specifically targeted to these symptoms. Palliative sedation therapy is one potential solution to providing relief from these refractory symptoms...
2015: Cochrane Database of Systematic Reviews
Raymond P Tucker, Carmen A Buchanan, Victoria M O'Keefe, Laricka R Wingate
The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample...
2014: Omega
Rebecca Saracino, Elissa Kolva, Barry Rosenfeld, William Breitbart
OBJECTIVE: To date, no measure of social support has been developed specifically for either palliative care or oncology settings. The present study examined the psychometric properties of the Duke-University of North Carolina Functional Social Support Questionnaire (DUFSS) in order to (1) assess the adequacy of the scale in the context of severe medical illness and (2) evaluate whether a brief subset of items might generate roughly comparable utility. METHOD: The 14-item DUFSS was administered to 1,362 individuals with advanced cancer or AIDS...
October 2015: Palliative & Supportive Care
Sophie Robinson, David W Kissane, Joanne Brooker, Susan Burney
CONTEXT: Demoralization can be understood as a condition that results from existential conflict. It presents with symptoms of hopelessness and helplessness caused by a loss of purpose and meaning in life. It is a significant mental health concern given there can be an associated desire for hastened death. OBJECTIVES: The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with progressive disease or cancer, including prevalence rates; the relationships between demoralization and sociodemographic, disease- and treatment-related, and psychological factors; and the psychometric properties of demoralization measures...
March 2015: Journal of Pain and Symptom Management
Ben A Rich
The specialty of psychiatry has a long-standing, virtually monolithic view that a desire to die, even a desire for a hastened death among the terminally ill, is a manifestation of mental illness. Recently, psychiatry has made significant inroads into hospice and palliative care, and in doing so brings with it the conviction that dying patients who seek to end their suffering by asserting control over the time and manner of their inevitable death should be provided with psychotherapeutic measures rather than having their expressed wishes respected as though their desire for an earlier death were the rational choice of someone with decisional capacity...
October 2014: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
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