Limits...
What lies behind the wish to hasten death? A systematic review and meta-ethnography from the perspective of patients.

Monforte-Royo C, Villavicencio-Chávez C, Tomás-Sábado J, Mahtani-Chugani V, Balaguer A - PLoS ONE (2012)

Bottom Line: This study aims to understand the experience of patients with serious or incurable illness who express such a wish.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.These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans.

View Article: PubMed Central - PubMed

Affiliation: Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.

ABSTRACT

Background: There 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 findings: Systematic 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.

Conclusions: 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. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans.

Show MeSH

Related in: MedlinePlus

Line of argument: Explanatory model of WTHD.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3351420&req=5

pone-0037117-g003: Line of argument: Explanatory model of WTHD.

Mentions: The explanatory model derived from these results showed the WTHD to be a reactive phenomenon, a response to multidimensional suffering, rather than simply being one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of a wish to hasten death are total suffering, loss of self, and fear, which together produce an overwhelming emotional distress in relation to which the WTHD is seen as a way out, i.e. the individual wishes to cease living in this way and to put an end to suffering while maintaining some control over the situation. As such, the model suggests a new meaning for the WTHD and highlights the factors related to — or which are the cause of — this wish. Although this conceptual model was developed on the basis of reports by hospice patients, those with cancer or HIV and elderly patients the fact that it was obtained by re-interpreting meanings across a number of different qualitative studies means that it may also be applicable to the experiences of other people living with chronic illness. The findings of the whole synthesis are summarized in Figure 3.


What lies behind the wish to hasten death? A systematic review and meta-ethnography from the perspective of patients.

Monforte-Royo C, Villavicencio-Chávez C, Tomás-Sábado J, Mahtani-Chugani V, Balaguer A - PLoS ONE (2012)

Line of argument: Explanatory model of WTHD.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351420&req=5

pone-0037117-g003: Line of argument: Explanatory model of WTHD.
Mentions: The explanatory model derived from these results showed the WTHD to be a reactive phenomenon, a response to multidimensional suffering, rather than simply being one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of a wish to hasten death are total suffering, loss of self, and fear, which together produce an overwhelming emotional distress in relation to which the WTHD is seen as a way out, i.e. the individual wishes to cease living in this way and to put an end to suffering while maintaining some control over the situation. As such, the model suggests a new meaning for the WTHD and highlights the factors related to — or which are the cause of — this wish. Although this conceptual model was developed on the basis of reports by hospice patients, those with cancer or HIV and elderly patients the fact that it was obtained by re-interpreting meanings across a number of different qualitative studies means that it may also be applicable to the experiences of other people living with chronic illness. The findings of the whole synthesis are summarized in Figure 3.

Bottom Line: This study aims to understand the experience of patients with serious or incurable illness who express such a wish.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.These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans.

View Article: PubMed Central - PubMed

Affiliation: Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.

ABSTRACT

Background: There 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 findings: Systematic 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.

Conclusions: 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. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans.

Show MeSH
Related in: MedlinePlus