title: Suffering and euthanasia: a qualitative study of dying cancer patients' perspectives.
abstract: OBJECTIVE
  Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia.
  
  
  METHODS
  Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories.
  
  
  RESULTS
  The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering.
  
  
  CONCLUSIONS
  Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. marit.karlsson@ki.se
authors.forename: Marit
authors.initials: M
authors.lastname: Karlsson
authors.forename: Anna
authors.initials: A
authors.lastname: Milberg
authors.forename: Peter
authors.initials: P
authors.lastname: Strang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003625:Data Collection; D005065:Euthanasia / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care; D013315:Stress, Psychological / Q000209:etiology; D019452:Terminally Ill / Q000523:psychology*