Palliative Medicine 1–9 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269216315577748 pmj.sagepub.com The desire to hasten death: Using Grounded Theory for a better understanding “When perception of time tends to be a slippery slope” Martina Pestinger 1 , Stephanie Stiel 2,3 , Frank Elsner 1 , Guy Widdershoven 4 , Raymond Voltz 5 , Friedemann Nauck 6 and Lukas Radbruch 7,8 Abstract Background: Some patients with advanced and progressive diseases express a desire to hasten death. Aim: This study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide. Design: A modified form of Grounded Theory was used. Setting/participants: Patients 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. Results: Thematic 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. Conclusions: The 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. Keywords Desire to die, physician-assisted suicide, euthanasia, palliative care, anticipated suffering, agony 1 Department for Palliative Medicine, RWTH Aachen University, Aachen, Germany 2 Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany 3 Comprehensive Cancer Center (CCC) Erlangen—EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany 4 Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands 5 Department for Palliative Medicine, University Hospital Cologne, Cologne, Germany 577748PMJ 0 0 10.1177/0269216315577748Palliative MedicinePestinger et al. research-article 2015 Original Article 6 Department for Palliative Medicine, University Hospital Göttingen, Göttingen, Germany 7 Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany 8 Centre for Palliative Care, Malteser Hospital Seliger Gerhard Bonn/ Rhein-Sieg, Bonn, Germany Corresponding author: Lukas Radbruch, Department of Palliative Medicine, University Hospital Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany. Email: Lukas.radbruch@malteser.org What is already known about the topic? • One out of 10 patients with advanced progressive disease considers hastening death, although only a minority of these patients talk about their wish for hastened death with their caregivers. by guest on March 24, 2015 pmj.sagepub.com Downloaded from