title: Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying.
abstract: BACKGROUND
  Assisted dying is legal in four European countries and three American states. Elsewhere, particularly in more affluent or mainly Protestant countries, it remains controversial. Dominant headlines feature professional (medical, legal, religious) arguments versus celebrity campaigners; ordinary people are less clearly represented.
  
  
  OBJECTIVE
  To synthesise the international evidence of people's views and attitudes towards assisted dying in order to inform current debate about this controversial issue.
  
  
  METHODS
  Systematic review and mixed method synthesis of qualitative and survey data.
  
  
  METHODS
  Eleven electronic databases from inception to October 2011; bibliographies of included studies.
  
  
  METHODS
  Two reviewers independently screened papers and appraised quality. Qualitative results were extracted verbatim; survey results were summarised in a table. Qualitative data were synthesised using framework methods and survey results integrated where they supported, contrasted or added to the themes identified.
  
  
  RESULTS
  Sixteen qualitative studies and 94 surveys were included; many participants considered the immediate relevance of assisted dying for them. Themes related to poor quality of life, a good quality of death, potential abuse of assisted dying and the importance of individual stance. People valued autonomy in death as much as in life. Attitudes were diverse, complex and related to definitions of unbearable suffering including physical, psycho-social and existential factors and were consistent regardless of social, economic, legal and health-care contexts.
  
  
  CONCLUSIONS
  Our review sheds light on ordinary people's perspectives about assisted dying, when they are ill or disabled. Unbearable suffering is a key construct, and common factors are revealed that lead people to ask for help to die. The consistency of international views indicates a mandate for legislative and medical systems worldwide to listen and understand this.
authors.affiliation: North Wales Centre for Primary Care Research, Bangor University, Wrexham Technology Park, Wrexham, UK. m.hendry@bangor.ac.uk
authors.forename: Maggie
authors.initials: M
authors.lastname: Hendry
authors.forename: Diana
authors.initials: D
authors.lastname: Pasterfield
authors.forename: Ruth
authors.initials: R
authors.lastname: Lewis
authors.forename: Ben
authors.initials: B
authors.lastname: Carter
authors.forename: Daniel
authors.initials: D
authors.lastname: Hodgson
authors.forename: Clare
authors.initials: C
authors.lastname: Wilkinson
mesh_terms: D017028:Caregivers / Q000523:psychology*; D006801:Humans; D026684:Personal Autonomy; D011639:Public Opinion; D011788:Quality of Life; D012067:Religion; D012297:Right to Die; D017236:Suicide, Assisted / Q000941:ethics / Q000523:psychology*