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Will to live in the terminally ill.
H M Chochinov1, D Tataryn, J J Clinch
1Department of Psychiatry, University of Manitoba, Winnipeg, Canada. chochin@cc.umanitoba.ca
Lancet (London, England)
|September 15, 1999
Summary
A dying patient's will to live fluctuates significantly, influenced by factors like depression and anxiety. These influences shift as death nears, impacting end-of-life care decisions.
Area of Science:
- Palliative Care Medicine
- Psychosocial Oncology
- End-of-Life Studies
Background:
- Euthanasia and assisted suicide involve complex biomedical and psychosocial factors.
- Patient's will to live is a crucial, yet understudied, aspect of end-of-life care.
Purpose of the Study:
- To investigate the fluctuations in a dying patient's will to live.
- To identify factors influencing these fluctuations over time.
Main Methods:
- Assessed will to live twice daily in cancer patients in palliative care using a visual analogue scale.
- Incorporated the scale into the Edmonton Symptom Assessment System.
- Calculated maximum and median fluctuations in will-to-live ratings over various time intervals.
Main Results:
- While median will-to-live scores remained stable, maximum fluctuations were substantial (e.g., 68.0 mm over 30 days).
- Depression, anxiety, shortness of breath, and sense of well-being were key predictors of will to live.
- The influence of these predictors varied as death approached.
Conclusions:
- Dying patients exhibit significant variability in their will to live.
- The determinants of will-to-live changes evolve during the dying process.
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