Cristina Monforte-Royo and Denise Pergolizzi write on behalf of the EAPC Task Force on Wish to Hasten Death in Patients with Life-threatening Illnesses. They invite you to share your clinical experience concerning the wish to hasten death to guide palliative care towards recommended standards that can be used in clinical practice for this difficult subject.
Back in 2019, a European Association for Palliative Care (EAPC) task force was initiated to address the changing landscape around the wish to hasten death (WTHD) in Europe. In order to meet one of its objectives, the task force, entitled ‘Wish to Hasten Death (WTHD) in Patients with Life-threatening Illnesses: A clinical issue’, would like to hear your views via our online survey. It will take eight to ten minutes to complete. We are aiming to gain a better understanding of clinical experience and current perspectives and responses among palliative care professionals across Europe on the WTHD. (Read the definition of the WTHD here). This important phenomenon affects patients actively dying from advanced illnesses who feel there is no other way to relieve their suffering. It is also a complex phenomenon that can take on different meanings to different patients, varying in how it is expressed by patients and interpreted by professionals.
It’s been ten years since a review of 282 clinical studies about patients with advanced illnesses and their expressions of the WTHD was published. At the time, various lessons were learnt from the literature. It was clear that there were multiple causes that could be attributed to the WTHD, with an emphasis on psychosocial issues and not just physical sources. There was also evidence that, with time, patients can change their minds about their choices. Nevertheless, as a concept there was a lack of definition as to whether recognition was being given to general thoughts of a WTHD as opposed to actual desires and/or intentions to hasten death. And, in particular, there was scant information on how to respond.
Fast forward ten years and the public and political dialogue is rapidly changing across Europe around the WTHD. This can affect how patients express, and how we deal with, the WTHD. With more research, we have seen advances in our understanding of the WTHD in local and cultural contexts.
For instance, specialist palliative care professionals at four German university hospitals reported that they did not want to address thoughts about death and dying with patients, given assumptions it was emotionally burdensome and would be considered harmful to the patient. Meanwhile, in a study of palliative care patients in a public hospital in Spain, 87 per cent of patients considered that discussions about the WTHD were not bothersome.
Share your clinical experience with the wish to hasten death – complete the survey
This discrepancy between professional and patient perspectives, at least at these local levels, underscores an important question: what is happening in clinical practice across Europe? We want, and need to know, the clinical experience of healthcare professionals working in palliative care on the issue of the WTHD. We are particularly interested to know how this is assessed, if there is awareness of the many causes that precede a WTHD and, most importantly, whether healthcare professionals feel prepared and able to respond to its expression. With this information, we hope to develop guidelines and recommended standards for clinical practice to guide those working in palliative care to address this challenging topic. We are grateful to any, and all, palliative care professionals for their time and contribution to this important survey, which can be accessed at:
https://es.surveymonkey.com/r/2WW7PTM (English version)
https://es.surveymonkey.com/r/2WJQF8Y (versión Castellano)
- Monforte-Royo C, Villavicencio-Chávez C, Tomás-Sábado J, Balaguer A. The wish to hasten death : a review of clinical studies. Psychooncology. 2011;804:795–804. doi: 10.1371/journal.pone.0146184.
- Galushko M, Frerich G, Perrar KM, Golla H, Radbruch L, Nauck F, Ostgathe C, Voltz R. Desire for hastened death : how do professionals in specialized palliative care react ? 2016;543:536–43. doi: 10.1002/pon.3959.
- Crespo I, Monforte-Royo C, Balaguer A, Pergolizzi D, Cruz-Sequeiros C, Luque-Blanco A, Porta-Sales J. Screening for the Desire to Die in the First Palliative Care Encounter: A Proof-of-Concept Study. J Palliat Med. 2020 Sep 18. doi:10.1089/jpm.2020.0276. Epub ahead of print. PMID: 32945714.
- EAPC Task Force on ‘Wish to Hasten Death (WTHD) in Patients with Life-threatening Illnesses: A clinical issue’
- The WeCareChair: End of life Care at https://wecare.uic.es/
- Read more posts from the Wish to Hasten Death group on the EAPC blog.
More about the authors…
Cristina Monforte-Royo is a nurse researcher, Dean of the Nursing Department at the Universitat Internacional de Catalunya and Director of the WeCare Chair. Contact Cristina by email firstname.lastname@example.org
Denise Pergolizzi is a psychologist and a researcher with the WeCare Chair at the Universitat Internacional de Catalunya. Contact Denise by email email@example.com
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