"I'm Done": A patient's wish and will to die

Palliat Support Care. 2023 Dec 22:1-4. doi: 10.1017/S1478951523001931. Online ahead of print.

Abstract

Background: A desire for hastened death is commonly expressed by cancer patients. Although efforts to define and explore this issue have been undertaken, no standardized approach exists to address these desires.

Case description: Ms. J expressed a wish for accelerated death and subsequently experienced unexpected clinical decline resulting in a quick, natural death. Our team experienced a mixture of both emotional distress and awe after witnessing the pragmatic approach our patient had to her impending decline, that we felt was worthy of further exploration.

Conclusion: Most clinicians lack formal training in communication, potentially making cases like Ms. J's highly distressing. Clinicians should feel comfortable addressing and potentially inquiring about patients' desire to hasten death. While our initial reaction might be to correct this desire, we propose reframing this expression as an opportunity to explore more about our patients.

Keywords: Desire for hastened death; palliative medicine; psychosocial distress; symptom management; voluntarily stopping eating and drinking.