Views of Psychologists About Their Role in Hastened Death

Hastened death practices are legal in several countries. Psychologists are increasingly taking a more active role in end-of-life issues, but the role of psychologists in requests to hasten death is not established. This study aims to contribute guidance for psychological practice in the context of requests to hasten death. We conducted a cross-sectional and cross-cultural study with Psychologists from Portugal and Luxembourg who answer closed and open questions to provide views about their role in hastened death. Psychological assessment, psychological support to patient and family, the exploration of patient decision-making and reorientation of patients were viewed as roles for psychologists. However, these roles may differ depending whether the patient has a terminal or non-terminal illness.

Increasing our understanding of nonphysical suffering within palliative care: A scoping review

Objective Nonphysical suffering is emotional, psychological, existential, spiritual, and/or social in nature. While palliative care is a discipline dedicated to the prevention and relief of suffering — both physical and nonphysical — little is known about existing research specific to nonphysical suffering within the context of palliative care. This scoping review helps to fill this gap. Method Three hundred and twenty-eight unique records were identified through a systematic search of three databases (MEDLINE, CINAHL, and PsycINFO). The following keywords were used: (suffering) AND (palliative OR “end of life” OR “end-of-life” OR hospice OR dying OR terminal* ill*). Thirty studies published between 1998 and 2019 met the inclusion criteria. Results Losses, worries, and fears comprise patients’ primary sources of nonphysical suffering. Patients face numerous barriers in expressing their nonphysical suffering to healthcare providers. The idea that patients can choose how they perceive their circumstances, thereby minimizing their nonphysical suffering, is pervasive in the research. The nature of nonphysical suffering experienced by family caregivers and palliative care clinicians is revealed in the review. The unique and sensitive interplay between nonphysical suffering and both palliative sedation and requests for hastened death is also evident. Overall, seven themes can be identified: (i) patients’ experiences of nonphysical suffering; (ii) patient coping mechanisms; (iii) efforts to measure nonphysical suffering; (iv) palliative sedation; (v) requests for hastened death; (vi) family suffering; and (vii) clinician suffering. Significance of results This is the first scoping review to map palliative care's research specific to suffering that is social, emotional, spiritual, psychological, and/or existential in nature. Its findings expand our understanding of the nature of nonphysical suffering experienced by patients, families, and palliative care clinicians. The review's findings have significant implications for front-line practice and future research.

Why People Think They Might Hasten Their Death When Faced With Irremediable Health Conditions Compared to Why They Actually Do so

This study surveys the differences of relatively healthy proponents of end-of-life choices and people with irremediable health conditions having already made the decision to hasten their deaths on what each group considers important in influencing a desire to hasten death. Psychosocial factors were more important than physical ones for both groups; but those contemplating what might influence them to hasten their deaths in the future thought pain and feeling ill would be much bigger factors than they turned out to be for those deciding to do so. Those having decided to hasten their deaths cited the lack of any further viable medical treatments and having to live in a nursing home as bigger factors. Identifying these psychosocial factors influencing a desire for a hastened death suggests that caregivers and medical providers may want to review what compassionate understanding and support looks like for people wanting to hasten their death.

Institutional Issues

Residents with intact decision-making capacity who wish to hasten death by VSED while living in institutional long-term care (LTC) settings may encounter barriers to enacting this choice. LTC facility administrators and clinical staff must balance concerns about resident safety and moral objections to hastened death with support for resident rights and self-determination. Achieving this balance involves careful resident assessment and interdisciplinary care planning to identify and mitigate causes of suffering where possible, along with staff training regarding VSED and rigorous documentation of the care plan and interventions. Involvement of hospice may help to: (1) clarify resident goals; (2) ensure alignment between these goals and the care plan; and (3) support physical, psychosocial, and spiritual care before and during VSED. Resident-centered care planning is facilitated by using a checklist to ensure that all major issues are addressed in these complex LTC situations.

CALM and the Desire for Death

This chapter considers the loss of the will to live, the desire for hastened death, and suicidality in patients with advanced disease. The challenge of distinguishing the loss of the will to live as a manifestation of depression from nonpathological death acceptance is explored and the clinical implications of such distinctions are examined. The quantitative findings from our longitudinal research regarding the prevalence, trajectory, and correlates of the desire for death in patients with advanced cancer are presented. The qualitative findings from this research revealed three distinct dimensions of the desire for death, only one of which reflects the literal wish to end life. The role of Managing Cancer and Living Meaningfully (CALM) in alleviating death anxiety, in examining the desire for death, in enhancing death preparation, and in improving communication with healthcare providers is considered here.