2 The primary reason given (in The Netherlands) for choosing euthanasia is “a loss of dignity.” The related practice of physician-assisted suicide (when a physician provides either equipment or medication or informs the patient of the most efficacious use of already available means for the purpose of assisting the patient to end his or her own life) 3 has been legal in the state of Oregon since 1997. 1) In The Netherlands, euthanasia comprises 2.1% of all deaths annually (the vast majority are among patients with cancer).
( Euthanasia is defined as the administration of a lethal agent by another person to a patient for the purpose of relieving the patient's intolerable and incurable suffering. One response to a desire for hastened death is exemplified by the practice of euthanasia in The Netherlands, where it is legal and tightly regulated. On the other end of the continuum is the actively suicidal individual. On one end of the spectrum is the patient who passively welcomes death. How Common Is the Desire for Hastened Death Expressed in the Setting of a Terminal Illness?ĭetermining how often patients want the dying process to be sped up is a complicated undertaking, as the experience of being terminally ill differs from patient to patient. We discuss the meaning of the request and several possible interventions. In this report, we present the case of a patient with terminal illness who expressed a desire to hasten his death. Understanding the nature of such requests allows physicians to ease suffering and reduce the desire for death in such patients. However, requests to hasten death generally signal the presence of physical, psychological, or social stressors that can frequently be ameliorated. To a physician, this request can be confusing, anxiety provoking, and infuriating. Therefore, when a patient with a terminal illness asks to hasten his or her own death, conflict often arises. Physicians take great pains to alleviate suffering and are trained to prolong life-especially when a satisfactory quality of life can be maintained. Have you ever wondered how often patients wish to have their death hastened in the face of terminal illness, and if so, why? Have you wondered whether depression, a loss of dignity, or pain push patients to forego life-extending care? Have you wondered whether faith and a belief in a higher power affect choices at the end of life? If you have, then the following case vignette (of a young man who developed a malignant osteosarcoma) should provide the forum for answers to these and other questions related to care at the end of life.Ĭaring for the dying patient is among the most challenging clinical tasks a physician faces.
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