Patient Safety and Quality

Asking terminally ill patients why they want to hasten their death may provide opportunities to improve their situation

When a terminally ill patient asks a doctor for aid in dying, a new study, supported in part by the Agency for Healthcare Research and Quality (HS13853), suggests that the doctor should ask why the person wants to die now. Asking this question may reveal opportunities for intervention, including therapies to address pain, lack of energy, and fatigue, which may have eroded the patient's will to live. Interviews with patients and their families revealed that those who hastened their death perceived themselves as dying, but, for many, they were not dying fast enough.

On average, the 26 predominantly white, elderly patients who hastened their deaths had lived with their illness for 2.5 years and had actively planned their deaths for 3 months. Most felt that hastening their death was consistent with their spiritual or religious views. They all suffered from physical pain and other symptoms, as well as emotional pain. They described feeling lonely, having no energy left to fight against the illness, fears about the future, and a series of losses that undermined their sense of self and purpose. Many wanted to control the dying process and location of death, especially avoiding hospitals and nursing homes.

Ten people who had less than a week to live indicated that they were "dying and done," having experienced a final functional loss that signaled the end, such as constant vomiting or diarrhea. Eight people with less than a month stated they were "dying, but not fast enough." Five people with 1 to 6 months to live saw a "looming crisis" on their horizon that would prohibit them from swallowing pills or otherwise following through with their plans. Three patients with more than 6 months to live were "not recognized by others as dying, but suffering just the same."

See "Why now? Timing and circumstances of hastened deaths," by Helene Starks, Ph.D., M.P.H., Robert A. Pearlman, M.D., M.P.H., Clarissa Hsu, Ph.D., and others, in the September 2005 Journal of Pain and Symptom Management 30(3), pp. 215-226.

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