title: Death wishes and explicit requests for euthanasia in a palliative care hospital: an analysis of patients files.
abstract: BACKGROUND
  In the current public debate in France about end-of-life and legalization of euthanasia, palliative care is considered as a suitable answer or an alternative or even a supplement to euthanasia. The debate is based on opinion surveys, partly because there is a lack of objective data about the incidence of euthanasia requests (ER) in palliative care settings. The aim of this study was to collect, classify and quantify the expressions of wishes to die (WD), based on computerized files for patients admitted to an 81-bed palliative care hospital (PCH) in Paris during 2010-2011.
  
  
  METHODS
  Two researchers analyzed the carers' notes extracted on the basis of containing the words "wish to die", "euthanasia" or any expressions relating to death. Notes related to WD and the corresponding patients were then classified in the order: ER, suicidal thought (ST) and other wish to die (OWD). Repeated ER were qualitatively analyzed according to a grid.
  
  
  RESULTS
  We found that 195 of the 2157 patients (9%) expressed a WD: 61 (3%) expressed an ER; 15 (1%) described ST and 119 (6%) expressed an OWD without requiring acting. The WD group was predominantly female, stayed longer in the hospital (median 24 vs. 13 days), and consumed more anxiolytics and antidepressants. None of age, disease or marital status was associated with ER. More women and widows expressed an OWD. Twenty-six ER patients also expressed an OWD and two a ST. Six patients repeated their ER: all had poorly controlled symptoms with repercussions for their mental state.
  
  
  CONCLUSIONS
  Our data show the existence of various expressions of WD with a low incidence of ER in a French PCH. The observation of WD including ER is suggestive of good communication between the patients and the care teams. Independent of the changeability of expressions of WD, their very existence should lead to a consideration of the dynamic changes in these WD, and to care staff paying additional attention to the individual, their suffering and the context.
authors.affiliation: Pôle Recherche et Enseignement Universitaire SPES (Soins Palliatifs En Société), Maison Médicale Jeanne Garnier, 106 av Emile Zola, 75015 Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Guirimand
authors.affiliation: Pôle Recherche et Enseignement Universitaire SPES (Soins Palliatifs En Société), Maison Médicale Jeanne Garnier, 106 av Emile Zola, 75015 Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Dubois
authors.affiliation: Pôle Recherche et Enseignement Universitaire SPES (Soins Palliatifs En Société), Maison Médicale Jeanne Garnier, 106 av Emile Zola, 75015 Paris, France.
authors.forename: Lucy
authors.initials: L
authors.lastname: Laporte
authors.affiliation: Pôle Recherche et Enseignement Universitaire SPES (Soins Palliatifs En Société), Maison Médicale Jeanne Garnier, 106 av Emile Zola, 75015 Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Richard
authors.affiliation: Pôle Recherche et Enseignement Universitaire SPES (Soins Palliatifs En Société), Maison Médicale Jeanne Garnier, 106 av Emile Zola, 75015 Paris, France.
authors.forename: Danièle
authors.initials: D
authors.lastname: Leboul
keywords: Euthanasia requests; Palliative care; Palliative care hospital; Suicidal thought; Wish to die