What are the Reasons and Motivations in a Request for Euthanasia?

Several studies conducted in hospitals on requests for euthanasia have provided an insight into the reasons and motivations of patients. These studies were able to indicate the limited number of initial requests expressed by patients (between 0.7 and 3%), and their persistence which was even less (0.3% according to one of the studies).

The analysis note released this week provides further information on the reasons for such requests and of the medical circumstances of the patients.

Medical circumstances where pain requires psychological support

In the study from 2012 conducted by Ferrand, among the 476 requests to accelerate their death, expressed by patients, many (82.4%) had consulted either a psychologist or a psychiatrist. According to carers, 13.9% of patients asking for their death to be accelerated, suffer from an active depression syndrome. The study moreover indicates that these situations may “cast doubt on the ability of the patients to take important decisions on their end of life”.

Different perceptions by patients, carers and family members

When the request is expressed by the patient, The main clinical symptoms (>40%) are controlled physical suffering (55.3%), feeding difficulties (54.6%), motor function difficulties (46%). 5% suffer uncontrollably.

The three main reasons for patients requesting an accelerated death are linked to the perception of their image and their relational quality of life:

1. Guilt of being a burden on family and friends
2. Fear of projecting an intolerable image of their person
3. Useless life

The study reveals notable differences according to whether the request for an accelerated death is expressed by patients, carers or by close family members:

• Intellectual and communication difficulties are mentioned more frequently (respectively 5 and 4 times more) by family members and medical staff than by patients as well as excretion difficulties (twice as often) and feeding difficulties (1.5 times more).
• Uncontrollable pain is rarely mentioned by patients (5%). It is not perceived in the same way by family members and carers. The latter do not mention it at all.

A new approach based on direct interviews to allow patients who request euthanasia to express themselves

A recent study conducted in the Burgundy, Franche Comté region and released this year surveyed only patients calling for an accelerated death. On the basis of the 15 interviews conducted, the study confirmed the previous results.

Thus, the reasons given were on the one hand physical pain following acute episodes of illness, and on the other hand, a call by patients for recognition of existential suffering which they consider to be unbearable. This category includes:

1. Psychological distress to see one’s body and functions deteriorate, loss of control of their life.
2. A feeling of loneliness linked to the despair which they cannot share, a feeling of being of no use to others, difficulty in communicating…
3. Projective fear of suffering in future just before death, in particular with reference to traumatic episodes experienced by family members suffering at the approach of their end of life.

The study also revealed other motivations:

1. The desire to balance and enjoin the relations with the team of carers. The patients claimed to have noted a change of attitude by the team of carers after having made a request for euthanasia and felt reassured by the ability of the carers to manage the physical suffering and symptoms.
2. Reaffirmation of their freedom in relation to the medical constraints.
3. The ability to imagine a desirable future for oneself.
4. The test of the possibility of transgressing the prohibition of euthanasia.

The study concludes that the adoption of a sympathetic attitude by the palliative care units regarding such requests establishes a platform for discussion which is able to encourage interaction with the patient rather than responding to the euthanasia request with an irreversible solution.

The apprehension of the psychological impact of painful situations experienced by patients in palliative care remains an important theme in order to ensure a better quality of life right up to their end of life.