• Martina Pestinger, Stephanie Stiel, Frank Elsner, Guy Widdershoven, Raymond Voltz, Friedemann Nauck, and Lukas Radbruch.
• Department for Palliative Medicine, RWTH Aachen University, Aachen, Germany.
• Palliat Med. 2015 Sep 1; 29 (8): 711-9.

BackgroundSome patients with advanced and progressive diseases express a desire to hasten death.AimThis study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide.DesignA modified form of Grounded Theory was used.Setting/ParticipantsPatients 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.ResultsThematic 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.ConclusionsThe 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.© The Author(s) 2015.

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