Desire for hastened death: how do professionals in specialized palliative care react? † M. Galushko 1,‡ , G. Frerich 1 * ,‡ , K. M. Perrar 1,6 , H. Golla 1,6 , L. Radbruch 2,3,6 , F. Nauck 4 , C. Ostgathe 5 and R. Voltz 1,6,7 1 Center for Palliative Medicine, University Hospital of Cologne, Köln, Germany 2 Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany 3 Palliative Care Center, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany 4 Departmentof Palliative Medicine, University Hospital, Göttingen, Germany 5 Division of Palliative Medicine & Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany 6 Center for Integrated Oncology, (CIO), Köln/Bonn, Germany 7 Clinical Trials Center Cologne, (ZKS), Köln, Germany *Correspondence to: Center for Palliative Medicine, University Hospital of Cologne, Köln, Germany. E-mail: gerrit. frerich@uk-koeln.de † Part of this study was presented as a poster at the 9th (2013, PB KT28) and the 10th (2014, PB106) German National Palliative Care Congress. The background of the study was briefly described as part of a German article ‘Suizidalität in der Palliativmedizin’ in ‘Psychotherapie im Alter’, (Hirsch, R. D., Lindner, R., and Wächtler, C. eds.), 1/11, (pp. 27–42), 3/11. ‡ Both authors contributed equally to this work. Received: 1 September 2014 Revised: 4 August 2015 Accepted: 10 August 2015 Abstract Objective: Desires for hastened death (DHD; wish to hasten death is also in use) are prevalent in terminally ill patients. Studies show that health professionals (HP) are often underprepared when presented with DHD. HPs in specialized palliative care (SPC-HP) often encounter DHD. This study aimed to identify SPC-HP responses to DHD in daily practice and their corresponding functions. Methods: Narrative interviews were conducted with 19 SPC-HPs at four German University Hospitals. Transcripts were analyzed using the documentary method. An inventory of established responses to DHD was compiled, and their corresponding functions in the context of the patient– SPC-HP interaction were reconstructed. Results: Twelve response categories and six corresponding functions were identified. On the patient level, responses categorized as symptom control, exploring the reasons and generating perspective, reorientation, and hope were particularly used to ease the patient’s burden. On the interaction level, creating a relationship was fundamental. On the SPC-HP level, various methods served the functions self-protection and showed professional expertise. Conclusions: Profound personal and professional development is necessary to respond to the inherent challenges presented by DHD. Establishing helpful relationships with patients is essential regardless of SPC-HP specialization. SPC-HPs should maximize their skills in establishing and maintaining relationships as well as strengthening their own resilience, possibly in specific training courses. Copyright © 2015 John Wiley & Sons, Ltd. Introduction The desire for hastened death (DHD; wish to hasten death is also in use) is reported by up to half of terminally ill cancer patients and is strongly and persistently expressed by nearly 10% [1–4]. On-going discussions surrounding the legalization of euthanasia and physician-assisted suicide show that there is great uncertainty about how to respond to DHD [5]. This is true not only for society as a whole but also for health professionals (HPs) in palliative care who often encounter DHD. In the Netherlands, almost 50% of general practitioners try to avoid the issue of euthanasia, finding it emotionally burdensome [6]. Oncology nurses often feel underpre- pared when responding to a DHD [7]. Guidelines for addressing terminally ill patients’ psycho-social and exis- tential distress are available [8–11], however, with a lack of evidence-based guidelines for responding to DHD [12], due also to the lack of a generally accepted concept [13–15]. In Germany, more than 90% of patients in specialized palliative care (SPC) have advanced cancer [16], and HPs working there (SPC-HP) [17] regularly encounter DHD. While it is generally assumed that DHD are often altered once effective palliative care is provided [18,19], what is not known is how SPC-HPs respond when encountering DHD. Thus, the aim of this study was to reconstruct experience-based knowledge on how SPC-HPs respond to DHD, what functions SPC-HPs’ strategies have, and whether they refer to existing guidelines [9,11]. Materials and methods Legal framework Euthanasia is forbidden in Germany, as detailed in §216 StGB (national criminal code). Assisted suicide is not Copyright © 2015 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology 25: 536–543 (2016) Published online 16 September 2015 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3959