Patient and family requests for hastened death

Patient and family requests for hastened death, upsetting as they are to the treating team, are usually a way for patients and their families to express their need for an increase in the intensity of communication, improved symptom control, or acknowledgment of an existential or spiritual crisis. Rarely do they represent the need for patients to control the time, place, and manner of their death. Using a hypothetical case study, this paper reviews the unspoken concerns underlying these requests; characteristics of patients who request a hastened death, and when and why they make the request; the Oregon Death with Dignity Act and its implementation since its passage in 1997; the effect these requests have on clinicians, their common reactions, and suggestions for self-care after such requests; techniques for responding to the requests and keeping the dialogue open with the patient and family; and the legal and ethical options available to clinicians outside of Oregon.