title: The desire to hasten death: Using Grounded Theory for a better understanding "When perception of time tends to be a slippery slope".
abstract: BACKGROUND
  Some patients with advanced and progressive diseases express a desire to hasten death.
  
  
  OBJECTIVE
  This study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide.
  
  
  METHODS
  A modified form of Grounded Theory was used.
  
  
  METHODS
  Patients from the departments of palliative medicine in three hospitals in Germany were recruited when they had made a statement or request to hasten death. Participants were interviewed face to face. Recruitment was stopped with 12 participants because of data saturation.
  
  
  RESULTS
  Thematic analysis revealed three main motivational themes: self-determination, agony, and time. Expectations toward health professionals, attitudes toward death, and secureness related to the end of life were additional main themes emerging from the analysis.
  
  
  CONCLUSIONS
  The desire to hasten death may be used as an extreme coping strategy to maintain control against anticipated agony. Patients expected health professionals to listen to and respect their experiences. Emerging hypotheses included the following: (a) patients try to balance life time and anticipated agony, and the perception of time is distressing in this balancing act; (b) anticipated images of agony and suffering in the dying process occur frequently and are experienced by patients as intrusive; (c) patients expressing a desire to hasten death are in need of more information about the dying process; and (d) patients wanted their caregivers to listen to and respect their wish to hasten death, and they did not expect the caregivers to understand this as an order to actually hasten their death.
authors: Department for Palliative Medicine, RWTH Aachen University, Aachen, Germany.
authors: Martina
authors: M
authors: Pestinger
authors: Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Comprehensive Cancer Center (CCC) Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors: Stephanie
authors: S
authors: Stiel
authors: Department for Palliative Medicine, RWTH Aachen University, Aachen, Germany.
authors: Frank
authors: F
authors: Elsner
authors: Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Guy
authors: G
authors: Widdershoven
authors: Department for Palliative Medicine, University Hospital Cologne, Cologne, Germany.
authors: Raymond
authors: R
authors: Voltz
authors: Department for Palliative Medicine, University Hospital Göttingen, Göttingen, Germany.
authors: Friedemann
authors: F
authors: Nauck
authors: Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany Centre for Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany Lukas.radbruch@malteser.org.
authors: Lukas
authors: L
authors: Radbruch
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001293:Attitude to Death; D005065:Euthanasia / Q000523:psychology*; D005190:Family / Q000523:psychology; D005260:Female; D005858:Germany; D066296:Grounded Theory; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017236:Suicide, Assisted / Q000523:psychology*; D013727:Terminal Care / Q000379:methods; D019452:Terminally Ill / Q000523:psychology*; D013998:Time Perception
keywords: Desire to die; agony; anticipated suffering; euthanasia; palliative care; physician-assisted suicide