Existential suffering as a motive for assisted suicide: Difficulties, acceptability, management and roles from the perspectives of Swiss professionals

Marie-Estelle Gaignard; Sophie Pautex; Samia Hurst

doi:10.1371/journal.pone.0284698

Existential suffering as a motive for assisted suicide: Difficulties, acceptability, management and roles from the perspectives of Swiss professionals

PLoS One. 2023 Apr 21;18(4):e0284698. doi: 10.1371/journal.pone.0284698. eCollection 2023.

Authors

Marie-Estelle Gaignard^{1

2}, Sophie Pautex³, Samia Hurst¹

Affiliations

¹ Institute for Ethics, History and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
² Department of Oncology, Geneva University Hospitals, Geneva, Switzerland.
³ Division of Palliative Medicine Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.

Abstract

Background: Existential suffering is often a part of the requests for assisted suicide (AS). Its definitions have gained in clarity recently and refer to a distress arising from an inner realization that life has lost its meaning. There is however a lack of consensus on how to manage existential suffering, especially in a country where AS is legal and little is known about the difficulties faced by professionals confronted with these situations.

Objectives: To explore the perspectives of Swiss professionals involved in end-of-life care and AS on the management of existential suffering when it is part of AS requests, taking into account the question of roles, as well as on the difficulties they encounter along the way and their views on the acceptability of existential suffering as a motive for AS.

Methods: A qualitative study based on face-to-face interviews was performed among twenty-five participants from the fields of palliative and primary care as well as from EXIT right-to-die organization. A semi-structured interview guide exploring four themes was used. Elements from the grounded theory approach were applied.

Results: Almost all participants reported experiencing difficulties when facing existential suffering. Opinions regarding the acceptability of existential suffering in accessing AS were divided. Concerning its management, participants referred to the notion of being present, showing respect, seeking to understand the causes of suffering, helping give meaning, working together, psychological support, spiritual support, relieving physical symptoms and palliative sedation.

Conclusion: This study offers a unique opportunity to reflect on what are desirable responses to existential suffering when it is part of AS requests. Existential suffering is plural and implies a multiplicity of responses as well. These situations remain however difficult and controversial according to Swiss professionals. Clinicians' education should further address these issues and give professionals the tools to better take care of these people.

Copyright: © 2023 Gaignard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Humans
Palliative Care / methods
Stress, Psychological* / psychology
Suicide, Assisted* / psychology
Switzerland
Terminal Care* / psychology

Grants and funding

MEG conducted this work without funding as part of her Doctorate in Medicine. The Institute for Ethics, History, and the Humanities at the Geneva University Medical School provided access to library facilities. The Institute had no role in designing the study, nor in its execution, analyses, interpretation and in writing the manuscript.