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Attitudes towards, and wishes for, euthanasia in advanced cancer patients at a palliative medicine unit

Jacob Chr. Hølen

Stein Kaasa

Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim

Stein Kaasa

Department of Oncology and Radiotherapy, St. Olavs Hospital, Trondheim

Jon Håvard Loge

Department of Behavioural Sciences in Medicine, University of Oslo and Department of Oncology, Ullevaål University Hospital, Oslo, Norway

Lars Johan Materstvedt

Department of Philosophy, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

Background: Most studies on attitudes towards euthanasia and physician-assisted suicide (PAS) have been conducted in healthy populations. The aim of this study is to explore and describe attitudes towards, and wishes for, euthanasia/PAS in cancer patients with short life expectancy. Method: Semi-structured interviews with 18 cancer patients with a life expectancy of less than nine months. All patients were recruited from an inpatient palliative medicine unit. Results: Patients holding a positive attitude towards euthanasia/PAS do not necessarily want euthanasia/PAS for themselves. Wishes are different from requests for euthanasia/PAS. Fear of future pain and a painful death were the main reasons given for a possible wish for euthanasia/PAS. Worries about minimal quality of life and lack of hope also contributed to such thoughts. Wishes for euthanasia/PAS were hypothetical; they were future oriented and with a prerequisite that intense pain, lack of quality of life and/or hope had to be present. Additionally, wishes were fluctuating and ambivalent. Conclusion: The wish to die in these patients does not seem to be constant. Rather, this wish is more appropriately seen as an ambivalent and fluctuating mental ‘solution’ for the future. Health care providers should be aware of this when responding to utterances regarding euthanasia/PAS.

Key Words: cancer • desire for death • euthanasia • palliative care • physician-assisted suicide (PAS) • terminal illness

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