title: Exploring the experiences of bereaved families involved in assisted suicide in Southern Switzerland: a qualitative study.
abstract: BACKGROUND
  In Switzerland, helping with assisted suicide under certain conditions is not prosecuted. With approximately 300 cases annually, this leaves behind a large group of bereaved people where its consequences are mostly unknown. The study aimed to explore family involvement in decision making prior to assisted suicide, and to examine their ways of coping during the bereavement period.
  
  
  METHODS
  A qualitative interview study used the principles of Grounded Theory analysis. Eleven relatives of eight patients, who died in Southern Switzerland after assisted suicide, participated in semistructured interviews.
  
  
  RESULTS
  The large majority of family members faced moral dilemmas during the decision-making phase. Their respect for patient's autonomy was a key justification to resolve dilemmas. Two types of involvement were identified: categorised as 'passive' when the decision making was located with the patient, and 'active' when assisted suicide was proposed by the family member and/or the relative was involved in some way. The relatives reported feelings of isolation during and after assisted suicide. Family members reported fear of social stigma and did not openly disclose assisted suicide as the cause of death. None of those interviewed received formal psychological support.
  
  
  CONCLUSIONS
  Bereaved families express moral dilemmas, feelings of isolation and secrecy in the management of assisted suicide in Southern Switzerland. These features seem underestimated and not sufficiently recognised by the healthcare professionals. Management of assisted suicide requests should include consideration of family members' needs, in addition to those of the patient.
authors.affiliation: Palliative Care Department, Oncology Institute of Southern Switzerland, Ticino, Switzerland Palliative Care Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gamondi
authors.affiliation: Clinical Research Unit, Haute Ecole de Santé Vaud, Lausanne, Switzerland.
authors.forename: Murielle
authors.identifier: http://orcid.org/0000-0002-3207-259X
authors.initials: M
authors.lastname: Pott
authors.affiliation: Department of Palliative Medicine, University of Bristol, Bristol, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Forbes
authors.affiliation: International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
mesh_terms: D000328:Adult; D000368:Aged; D001293:Attitude to Death; D001601:Bereavement; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D017236:Suicide, Assisted / Q000523:psychology*; D013557:Switzerland
keywords: Bereavement; assisted suicide; family; hasten death; interviews