What Lies behind the Wish to Hasten Death?

"We are Time" by Santiago Caruso http://www.santiagocaruso.com.ar/

“We are Time” by Santiago Caruso

By Stephanie Sugars

We can begin with What Lies behind the Wish to Hasten Death? (1)  a basic introduction to the inner workings of those considering “things I really don’t want to live through before I’m dead”.

Pop Quiz:

Where do you or your loved one stand in your intentions toward dying? If you too are considering your own dying, answer the questions for yourself. If your loved one is approaching death, then imagine her/his answer to each statement.

I used a mental toaster slide lever – cool, warm, hot – for each category.

1)  Wish to live
–Acceptance of dying

2)  Wish to die.

a.  Not considering hastening death

  — Looking forward to dying
–Hoping that dying happens more quickly
–Desiring to die (but hastening death is not considered)

     b.  Considering hastening death

Hypothetically considering hastening death (in future, if certain things happen)
–Actually considering hastening death, but at the moment (for moral or other reasons) it is not an option
–Actually considering hastening death, hastening death is a (moral) option

3)  Will to die
–Explicit request
–Refusing life-sustaining support (such as food or treatments) with the intention of hastening death
–Acting towards dying (such as suicide or assisted dying)

How’d you do?

Whether you believe in the “right to die” or the “sanctity of life” or “preservation of life at all costs,” I hope this gave you pause to consider more subtleties than our culture’s polarized debates around euthanasia, the good death.


Art by Moki.  http-//www.cuded.com/2013/03/surreal-paintings-by-moki/


Advanced Study

The authors of that study of 30 terminally ill patients in Switzerland (2), wrote a longer, fuller exploration of the same group. (3) I feel this is brilliant and important for anyone with or anyone serving those with terminal illness. (study participants died on average 23 days after their “exams”).

The depth of exploration is exciting and the authors’ open minds and hearts are reflecting in their approach to the participants and the study results.

The depth of exploration. T he authors seem to have open minds and hearts with their patients/study subjects. Their openness extends to their study results.

Here’s an excerpt:

Meanings of wish-to-die statements (open list):

A wish to die can be a wish

1. To allow a life-ending process to take its course

2. To let death put an end to severe suffering

3. To end a situation that is seen as an unreasonable demand

4. To spare others from the burden of oneself

5. To preserve self-determination in the last moments of life

6. To end a life that is now without value

7. To move on to another reality

8. To be an example to others

9. To not have to wait until death arrives

Take the toaster slide lever quiz on this one too.

from: http://www.thearthole.co.uk/

Graphic by Rob White, from: http://www.thearthole.co.uk/


This is from the article’s conclusion:

Without detailed understanding of the specific intention of a [wish to die] WTD, and without insight into its specific meanings, reasons and functions, it will be difficult to understand what a patient actually wants and why wishing it is important to her or him…caregivers have a triple responsibility: first, to cultivate the skill of active listening; second, to reflect on their own ideas and fears; and, third, to facilitate both the patient’s inner dialogue and discussion of his or her wishes about life and dying.


Dying has changed in my lifetime and it will continue to change. Those with access to extreme medical treatments will have to wrestle with those risks and benefits, while most will continue to be medically underserved. How we die is often a consequence of how we’ve lived.

But dying is not a medical event, it’s a consequence of being alive.  And, in the best of all possible worlds, it’s a communal event.  I’d like to see wise elders who’ve developed the insight and skills to stay present with dying – whether their own or their loved ones.

I’m not afraid of death, but to be there when it happens, the dying itself, well, I’ll need human and divine companionship for that ultimate adventure.

Thank you, dear readers for staying with me through this long discussion. And thank you for reflecting on lessons from the dying.

Oh, your final exam? The next deaths in your life!

My study tips – show up, pay attention, be open to the mystery.

Head for the light!


The Five Remembrances

* I am of the nature to grow old. I cannot escape growing old.

* I am of the nature to have ill health. I cannot escape having ill health.

* I am of the nature to die. I cannot escape death.

* All that is dear to me and everyone I love are of the nature of change. I cannot escape being separated from them.

* My deeds are my closest companions. I am the beneficiary of my deeds. My deeds are the ground on which I stand.


Painting by Catrin Arno.  http://www.redbubble.com/people/catrinarno/portfolio

Painting by Catrin Arno. http://www.redbubble.com/people/catrinarno/portfolio

(1) What Lies behind the Wish to Hasten Death? A Systematic Review and Meta-Ethnography from the Perspective of Patients

a free full text article


(2) Intentions in wishes to die: analysis and a typology–a report of 30 qualitative case studies of terminally ill cancerpatients in palliative care.

a free full text article

(3) What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care.

a free full text article


This article first appeared in a slightly different form on Stephanie Sugars’ LifeLine Blog.  It’s an excellent place for thoughtful,  factual and emotion-filled explorations of issues related to chronic illness and dying.

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