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Assumptions and moral understanding of the wish to hasten death: a philosophical review of qualitative studies

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Abstract

It is not uncommon for patients with advanced disease to express a wish to hasten death (WTHD). Qualitative studies of the WTHD have found that such a wish may have different meanings, none of which can be understood outside of the patient’s personal and sociocultural background, or which necessarily imply taking concrete steps to ending one’s life. The starting point for the present study was a previous systematic review of qualitative studies of the WTHD in advanced patients. Here we analyse in greater detail the statements made by patients included in that review in order to examine their moral understandings and representations of illness, the dying process and death. We identify and discuss four classes of assumptions: (1) assumptions related to patients’ moral understandings in terms of dignity, autonomy and authenticity; (2) assumptions related to social interactions; (3) assumptions related to the value of life; and (4) assumptions related to medicalisation as an overarching context within which the WTHD is expressed. Our analysis shows how a philosophical perspective can add to an understanding of the WTHD by taking into account cultural and anthropological aspects of the phenomenon. We conclude that the knowledge gained through exploring patients’ experience and moral understandings in the end-of-life context may serve as the basis for care plans and interventions that can help them experience their final days as a meaningful period of life, restoring some sense of personal dignity in those patients who feel this has been lost.

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Acknowledgements

The authors would like to thank Alan Nance for his contribution to translating and editing the manuscript. The authors are also grateful to the reviewers for their appropriate comments and suggestions.

Funding

The research leading to these results has received funding from the Junior Faculty programme grant, co-financed by L’Obra Social “La Caixa”, the WeCare Chair: End-of-life care at the Universitat Internacional de Catalunya and ALTIMA, and RecerCaixa 2015.

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Authors and Affiliations

  1. Faculty of Humanities, Universitat Internacional de Catalunya, C/ Immaculada, 22, 08017, Barcelona, Spain

    Andrea Rodríguez-Prat

  2. Department of IQ, Section Ethics, Philosophy and History of Medicine, Radboud University of Nijmegen, Nijmegen, The Netherlands

    Evert van Leeuwen

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  1. Andrea Rodríguez-Prat
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  2. Evert van Leeuwen
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Correspondence to Andrea Rodríguez-Prat.

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Rodríguez-Prat, A., van Leeuwen, E. Assumptions and moral understanding of the wish to hasten death: a philosophical review of qualitative studies. Med Health Care and Philos 21, 63–75 (2018). https://doi.org/10.1007/s11019-017-9785-y

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