title: What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care.
abstract: BACKGROUND
  Despite research efforts over recent decades to deepen our understanding of why some terminally ill patients express a wish to die (WTD), there is broad consensus that we need more detailed knowledge about the factors that might influence such a wish. The objective of this study is to explore the different possible motivations and explanations of patients who express or experience a WTD.
  
  
  METHODS
  Thirty terminally ill cancer patients, their caregivers and relatives; from a hospice, a palliative care ward in the oncology department of a general hospital, and an ambulatory palliative care service; 116 semi-structured qualitative interviews analysed using a complementary grounded theory and interpretive phenomenological analysis approach.
  
  
  RESULTS
  THREE DIMENSIONS WERE FOUND TO BE CRUCIAL FOR UNDERSTANDING AND ANALYSING WTD STATEMENTS: intentions, motivations and social interactions. This article analyses the motivations of WTD statements. Motivations can further be differentiated into (1) reasons, (2) meanings and (3) functions. Reasons are the factors that patients understand as causing them to have or accounting for having a WTD. These reasons can be ordered along the bio-psycho-socio-spiritual model. Meanings describe the broader explanatory frameworks, which explain what this wish means to a patient. Meanings are larger narratives that reflect personal values and moral understandings and cannot be reduced to reasons. Functions describe the effects of the WTD on patients themselves or on others, conscious or unconscious, that might be part of the motivation for a WTD. Nine typical 'meanings' were identified in the study, including "to let death put an end to severe suffering", "to move on to another reality", and - more frequently- "to spare others from the burden of oneself".
  
  
  CONCLUSIONS
  The distinction between reasons, meanings and functions allows for a more detailed understanding of the motivation for the WTD statements of cancer patients in palliative care situations. Better understanding is crucial to support patients and their relatives in end-of-life care and decision making. More research is required to investigate the types of motivations for WTD statements, also among non-cancer patients.
authors.affiliation: Hospiz im Park, Hospital for Palliative Care, Stollenrain 12, CH-4144 Arlesheim, Switzerland.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Ohnsorge
authors.affiliation: Hospiz im Park, Hospital for Palliative Care, Stollenrain 12, CH-4144 Arlesheim, Switzerland.
authors.forename: Heike
authors.initials: H
authors.lastname: Gudat
authors.affiliation: Institute for the History of Medicine and Science Studies, University of Lübeck, Königstrasse 42, D-23552 Lübeck, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rehmann-Sutter
keywords: Aetiology; Cancer; Desire to die; Ethics; Meaning; Oncology; Palliative care; Wish to die; Wish to hasten death