Desire for hastened death: exploring the emotions and the ethics

As we approach the end of our lives, many of us will have a desire for hastened death (DHD). Fortunately, our ability to respond to suffering at the end of life is improving. At the same time, in many jurisdictions, changes are underway to legislate physician-assisted death. This compels us as clinicians to explore DHD in a compassionate way - to reduce suffering and reduce premature death. This challenge is becoming more compelling as a large cohort of individuals, who value autonomy and control, age and experience illness.

Studies confirm that DHD is not always a request to die. Clarifying the intention behind the desire and exploring the individual factors and underlying reasons behind the wish have been described. Another theme questions our basic assumptions about these statements - a normal part of a human experience or an indicator of disease. This tension is also manifested in the appropriate balance between patient autonomy and preventing harm.

We have a professional responsibility to mindfully explore with the patient the suffering that can be relieved and the suffering that remains.