Relating to life and death a qualitative study of individuals with a long-lasting death wish related to unbearable psychiatric suffering

OBJECTIVE

This study describes the lived experiences of persons with a long-lasting death wish related to unbearable psychiatric suffering (DWUPS) regarding their relationship to life and death. The findings are evaluated considering existing literature on suicidality and euthanasia, with a particular focus on the humanistic-existential perspective.

METHOD

An open-ended data-gathering strategy was employed to elicit comprehensive descriptive information about the phenomenon from ten in-depth interviews, applying the method of generic descriptive-interpretative qualitative research.

RESULTS

Persons with DWUPS experience difficulties in connection with others, with themselves, with the world and with life itself. Concurrently, they indicate new possibilities for nascent connection in relation to others by receiving support and being able to share their death wish. This can result in growth in relation to themselves, in allowing hope, meaning and new engagement in life. The desire to die manifests itself in a variety of ways, including a strong and persistent death wish, an ambivalent attitude, or a temporary suspension of their death wish.

CONCLUSION

The process of exploring the death wish can assist persons with DWUPS in accessing potential ambivalence between life and death, in regulating emotional distress and in bearing existential concerns related to the life-and-death-questions.

Assisted Dying and Decision-Making Competence: Recent Developments in Austria

The Austrian law on death disposition confirms that persons willing to die have the right to assisted suicide. The Austrian parliament has provided various measures to distinguish between self-determination, the consequences of disease, and external influence, and to minimize the dangers of abuse. These include an examination of decision-making competence by specialists in psychiatry or clinical psychology as an additional expert supplement if the two physicians who first examine the individual are insufficiently certain as to whether the patient is medically competent to make decisions regarding assisted suicide. The concrete details of this examination remain undetermined by law and can only be derived from other regulations or the science itself. Moreover, studying the decision-making process provides valuable insights into the distinction between assisted suicide and suicide due to mental illness and emphasizes the necessity of mature decisions when ending one's life and self.

Views of Psychologists About Their Role in Hastened Death

Hastened death practices are legal in several countries. Psychologists are increasingly taking a more active role in end-of-life issues, but the role of psychologists in requests to hasten death is not established. This study aims to contribute guidance for psychological practice in the context of requests to hasten death. We conducted a cross-sectional and cross-cultural study with Psychologists from Portugal and Luxembourg who answer closed and open questions to provide views about their role in hastened death. Psychological assessment, psychological support to patient and family, the exploration of patient decision-making and reorientation of patients were viewed as roles for psychologists. However, these roles may differ depending whether the patient has a terminal or non-terminal illness.

Conscientious Objection and Other Motivations for Refusal to Treat in Hastened Death: A Systematic Review

BACKGROUND

Conscientious objection (CO) in the context of health care arises when a health care professional (HCP) refuses to participate in a certain procedure because it is not compatible with their ethical or moral principles. Refusal to treat in health care includes, in addition to CO, other factors that may lead the HCP not to want to participate in a certain procedure. Therefore, we can say that CO is a form of refusal of treatment based on conscience. Hastened death has become an increasingly reality around the world, being a procedure in which not all HCPs are willing to participate. There are several factors that can condition the HCPs' refusal to treat in this scenario.

METHODS

With the aim of identifying these factors, we performed a systematic review, following the PRISMA guidelines. On 1 October 2022, we searched for relevant articles on Pubmed, Web of Science and Scopus databases.

RESULTS

From an initial search of 693 articles, 12 were included in the final analysis. Several motivations that condition refusal to treat were identified, including legal, technical, social, and CO. Three main motivations for CO were also identified, namely religious, moral/secular, and emotional/psychological motivations.

CONCLUSIONS

We must adopt an understanding approach respecting the position of each HCP, avoiding judgmental and discriminatory positions, although we must ensure also that patients have access to care. The identification of these motivations may permit solutions that, while protecting the HCPS' position, may also mitigate potential problems concerning patients' access to this type of procedure.

Cultural mediation of grief: the role of esthetic experience

In Global North’s psychology, some existential experiences such as the loss of beloved persons are understood as purely individual problems. In a society of functioning individuals, the person is responsible for her own condition and for consuming the healthcare services provided to overcome the “problem” as soon as possible to go back to the fully functional role in the society. This vision raises several questions about turning “experiences” into “pathologies.” Historically, mankind made sense of death, loss, and grief as both a personal and collective experiences, mediated by heterogeneous cultural forms. I elaborate theoretically the concept of cultural mediation of grief, focusing on the esthetic and temporal dimensions of such mediation, as it is visible in art, rituals and everyday discourses. The idea is that such mediation is always present, and that psychology must be able to recognize it also in apparently secularized societies.

Eutanasia y Psicología. Algunas claves para la intervención en Procesos Adelantados de Muerte

Los países que han optado por regular los Procesos Adelantados de Muerte (PAM) van en aumento en los últimos años. Este tipo de legislaciones implican directamente a los equipos sanitarios.Los psicólogos incluidos en estos equipos están en contacto con estos procesos, por lo que se torna imprescindible dilucidar, mediante la escasa literatura existente, si los PAM presentan variables diferenciales con otros procesos de muerte, que sean necesarias tener en cuenta durante la asistencia psicológica. Esta recopilación de literatura pretende plantear las diferencias que en la actualidad están contrastadas y plantear qué opciones de intervención psicológica están a nuestra disposición para realizar el acompañamiento a estas personas, sus cuidadores y los equipos sanitarios que los asisten.

Spiritual Beliefs and Hastened Death: A Study on Medical Students

This study focuses on the impact of common spiritual beliefs regarding metaphysical questions in agreeability with the practice of hastened death. A sample of 497 Portuguese medical students was collected. Differences between genders and religions, predictors for agreeability with hastened death and the association between spiritual beliefs and opinion towards hastened death cases were assessed. Respondents were mostly favourable to the practice of hastened death. Formal religious affiliation and higher levels of religiosity significantly associated with lesser agreeability with hastened death. Statistically significant association was found between every hastened death scenario and multiple of the spiritual beliefs used. A number of spiritual beliefs were predictors of agreeability. We discuss the implications of religion and spirituality in agreeability with hastened death. Further research is required to better understand the true weight of spirituality in one's opinion towards this ethical dilemma.