Is trained communication about desire to die harmful for patients receiving palliative care? A cohort study

Background: Palliative patients frequently express a desire to die. Health professionals report uncertainty regarding potential risks of addressing it. Aim: We aim to evaluate effects of desire to die-conversations on palliative patients. Design: Within a prospective mixed-methods cohort study, we trained health professionals in dealing with desire to die. Afterwards, they held conversations about it with patients. Effects on depressiveness, hopelessness, wish to hasten death, death anxiety, patient-health professional-relationship, and will to live were evaluated at baseline (t0), 1 (t1), and 6 weeks afterwards (t2). Results were analyzed descriptively. Setting/participants: From April 2018 to March 2020, 43 health professionals asked 173 patients from all stationary and ambulatory palliative care settings (within 80 km radius) for participation. Complete assessments were obtained from n = 85 (t0), n = 64 (t1), and n = 46 (t2). Results: At t1, patients scored significantly lower on depressiveness (med = 8, M = 8.1, SD = 5.4) than at t0 (med = 9.5, M = 10.5, SD = 5.8) with Z = −3.220, p = 0.001 and Cohen’s d = 0.42. This was due to medium-severely depressed patients: At t1, their depressiveness scores decreased significantly (med = 9, M = 9.8; SD = 5.1) compared to t0 (med = 14, M = 15.2; SD = 3.9) with Z = −3.730, p ⩽ 0.000 and Cohen’s d = 1.2, but others’ did not. All other outcomes showed positive descriptive trends. Conclusions: Desire to die-conversations through trained health professionals do not harm palliative patients. Results cautiously suggest temporary improvement.

“Withstanding ambivalence is of particular importance”—Controversies among experts on dealing with desire to die in palliative care

In order to investigate controversies surrounding the desire to die phenomenon in palliative care by analyzing expert opinions on the topic, we carried out a secondary qualitative data analysis of free text comments collected during a Delphi survey that was designed to develop a conversation aid for dealing with desire to die in everyday clinical practice. Between 01/2018 and 03/2018, a two-round Delphi survey was carried out with national (German) and international palliative care experts. Free text comments were reinvestigated to identify controversies surrounding the desire to die phenomenon. An additional in-depth analysis focused on statements expressing attitudes towards proactively addressing (potential) desires to die. Within the Delphi survey, 103 of 149 multi-professional participants (almost all of them with practical and only six with exclusively theoretical expertise in palliative care) generated 444 free text comments. Thereof, we identified three main categories related to dealing with desire to die: “outer framework“, “extended care system” and “health-professional-patient-relationship”. Ambivalences, taboos and uncertainties surrounding desire to die in palliative care became apparent. Experts are divided concerning the practice of proactively addressing desire to die. Even if these conversations–especially the proactive approach–are also viewed critically, we conclude that open-ended and respectful communication about desire to die between health professionals and patients can be understood as an eligible intervention in palliative care. Proactively addressing the topic is a possible way to open up such conversations.

Representing suicide: Giving voice to a desire to die?

Drawing on interview and online ethnographic data from a study of suicide on the railways, this paper describes the ways in which many of the concepts, assumptions and practices of mainstream suicide prevention are challenged in the accounts of those who are planning, or have enacted, a suicide attempt. We reflect on the ethical dilemmas which can arise for researchers (and practitioners) when lived experience accounts diverge – theoretically, morally and in terms of practical implications – from present-day expert ones. In online, ‘pro-choice’ suicide discussions, people describe beliefs, attitudes, ways of thinking and acting which stand in contrast to existing professional and clinical descriptions of suicide and suicidal behaviour. Most obviously, there is often a rejection of ‘pro-life’ positions, which are framed as ideological, oppressive and naïve. For researchers engaging in online ethnography of ‘pro-choice’ spaces, dilemmas can arise in relation to the representation of perspectives which fundamentally challenge not only prevailing norms within suicide research and prevention practice but socio-cultural norms more widely. Similar issues can arise when considering how best to represent research participants when their accounts diverge from accepted ‘expert’ knowledge and beliefs. In-depth qualitative interviews with those who have thought about or attempted to take their own life indicate that existing theories and models of suicide which start from assumptions of deficit and pathology underestimate the extent to which suicide, as the end result of an often-complex series of actions, requires a person to engage in logistical processes of planning, decision-making, imagination and adaptation. The accounts described here, gathered using two different methodological approaches, highlight the ethical issues which can surface when there are competing claims to (expert) knowledge, as well as differences in beliefs, attitudes and moral stance towards life and death. We argue that researchers need to reflect on their own ethical-moral position in relation to suicide, and on the practical consequences of their privileging of some voices at the expense of other, less well represented, ones.

To Die Is Gain

This chapter locates incarceration within a broader economy of violence in the Roman world. Prison was legible, it argues, in relation to embodied scripts of honor and shame, self-mastery and slavishness, and what might be called the somatic grammar of subjugation. Among the elite, who were accustomed to bodily inviolability, imprisonment breached a key symbolic boundary that distinguished persons of honor from those subject to them. For Paul, however, as for others among the non-elite, prison was an acute instance of an all too familiar reality—namely, subjection to the mastery of more powerful men. Paul’s desire to die and be with Christ (Phil 1:23) must therefore be read alongside his vision of glorious somatic transformation, a transformation that is also and not incidentally an inversion of power relations, with Paul now sharing the sovereign glory of Christ, before whom all knees must finally bow.

The wish to die and hastening death in amyotrophic lateral sclerosis: A scoping review

BackgroundAmyotrophic lateral sclerosis (ALS) develops into a life-threatening condition 2 to 4 years after the onset of symptoms. Although many people with the disease decide in favour of life-sustaining measures, thoughts about hastening death are not uncommon.ObjectivesOur aim was to examine the scope of literature on the wish to die in ALS and provide an insight into determinants and motives for different end-of-life options.MethodsWe searched eight databases for English and German publications on death wishes in ALS for the period from 2008 to 2018 and updated the search up to May 2020. After the screening process, 213 full texts were included for the final analysis. We analysed the texts in MAXQDA, using deductively and inductively generated codes.ResultsWe identified end-of-life considerations, ranging from wishes to die without hastening death, to options with the possibility or intention of hastening death. Besides physical impairment, especially psychosocial factors, socio-demographic status and socio-cultural context have a great impact on decisions for life-shortening options. There is huge variation in the motives and determinants for end-of-life considerations between individuals, different societies, healthcare and legal systems.ConclusionsFor a variety of reasons, the information and counselling provided on different options for sustaining life or hastening death is often incomplete and insufficient. Since the motives and determinants for the wish to hasten death are extremely diverse, healthcare professionals should investigate the reasons, meaning and strength of the desire to die to detect unmet needs and examine which interventions are appropriate in each individual case.

Ethics and legal aspects of the right to die with dignity

Euthanasia is in liaison with ethics and law. This paper, which aims to contribute to the expert public debate on the introduction of euthanasia into Serbian legislation, the term terminology - euthanasia (as the Right to Die with Dignity) is the first to have been terminologically clarified. Furthermore, the text considers the obligations of other persons, arising out of this right and under what conditions the obligations of other persons arising from the said right constitute a restriction of their personality rights. By citing examples in the field of ethics and law, the text notes that the distinction between active and passive euthanasia is in fact a product of inadequate thinking in the implementation of this distinction. Based on the ethical argumentation of the double effect, also the text points to the inadequacy of the ethical approach in the function of legal regulation of the problem of euthanasia. Using abundant literature, which, from the legal and ethical point of view, problematizes euthanasia, the author has come to conclusion that the right to dignity is a social value that needs to be lawfully formulated, so that possible abuses can be prevented - and at the same time avoiding burdening the burden of responsibility to other persons (whether or not these are subjects of the judiciary or medicine), who should implement the patient's desire to die with dignity. Also, the author sought to base this article on the belief that Serbian legislation should legally shape the conditions for active direct euthanasia.

Suicide behavior among patient with mental disorder

Suicide is an act consciously taken by a person to end his life. The phenomenon of suicide in Indonesia is increasingly worrying. Indonesia, as a country that adheres to a culture of collectivity, also has a high suicide rate. WHO estimates that in 2020 the suicide rate in Indonesia could reach 2.4 percent of 100,000 people if it does not get serious attention from various parties.Suicide is one of the effects of mental disorders that are in the global spotlight today. This study aims to describe suicidal behavior in patients with mental disorders. This is a descriptive study. The research subjects were schizophrenic they were treated in the Installation of Integrated Mental Health Service in Banyumas Hospital. The data were collected using the Self Harm Behavior questionnaire. Result of the study is suicidal behavior are the desire to die, trying with sharp objects, hitting selves, hitting glass and drinking poisonous substance, and jumping from high building.

COVID-19 related lockdown: a trigger from the pre-melancholic phase to catatonia and depression, a case report of a 59 year-old man

Background The pre-melancholic model described by Tellenbach may provide a common model for understanding the psychological implications of the lockdown. In this case report, we describe a rare catatonic status as a psychological implication linked to the COVID-19 pandemic, a really unique global situation. Case presentation B is a 59 year-old man with mute psychiatric anamnesis whose mother suffered from a major depressive disorder. As the lockdown began, he started to develop concerns about his family’s economic condition. According to his wife, he could see no end to the epidemic and no future at all. Moving from this, he started to show a severe and rapidly progressive depression and to develop mood congruent delusions. In addition, he had increasing anhedonia, apathy, starvation and insomnia. This turned in the end into a catatonic-like state, along with a deep desire to die. Admitted to the psychiatry ward in a state of mutism, he was discharged after 15 days with a diagnosis of “Major depressive disorder, single severe episode with no psychotic behavior”. He was treated with Sertraline, Olanzapine and Lorazepam. Conclusions Our aim is to draw attention to the effect of the lockdown upon a Tellenbach-like personality structure. Identifying this type of pre-morbid personality structure could help clinicians understand and treat some cases of patients with severe major depressive disorders elicited by the COVID-19 pandemic.

Complicating Theory through Practice: Affirming the Right to Die for Suicidal People

Currently, suicidality is inadequately engaged with in suicide prevention methods. The key focus is on preventing people from dying, rather than validating suicidal ideation as a legitimate experience. As Alexandre Baril (2017; 2018; 2002) argues, in this refusal to validate suicidality, suicidal people are subjected to suicidism – a term Baril coined to describe the oppression suicidal people face which silences them and views their desire to die as illegitimate. Baril (2017) argues for a harm reduction approach to suicide which not only recognizes the validity of suicidality, but also supports suicidal people should they choose to die. In this paper, I seek to highlight Baril’s argument on affirming the choices of suicidal people through an engagement with three of his ideas: epistemic violence, biopower, and the injunction to happiness. While I agree with Baril’s harm reduction approach to suicide, I also contend that his argument becomes more complex when shifting from theory to practice. Therefore, alongside Baril’s work, I highlight the work of Kai Cheng Thom, who recognizes that failing to fight for suicidal people is equally as ableist as failing to listen to them.