Expressed Desire for Hastened Death in Seven Patients Living With Advanced Cancer: A Phenomenologic Inquiry

Nessa Coyle

Lois Sculco

ONF 2004, 31(4), 699-709. DOI: 10.1188/04.ONF.699-709

Purpose/Objectives: To explore the meanings and uses of an expressed desire for hastened death in seven patients living with advanced cancer.

Design: A phenomenologic inquiry.

Setting: Urban cancer research center.

Sample: Terminally ill patients with cancer who had expressed a desire for hastened death.

Methods: A series of in-depth semistructured interviews were audiotaped, transcribed, coded, and organized into themes.

Findings: The expression of desire for hastened death had many meanings and uses and communicated the following: (a) a manifestation of the will to live, (b) a dying process so difficult that an early death was preferred, (c) an intolerable immediate situation, even if not specifically identified by a patient, required immediate action, (d) a hastened death could extract a patient from an unendurable and specific situation, (e) manifestation of the last control the dying can exert, (f) a way of drawing attention to "me as a unique individual", (g) a gesture of altruism, (h) an attempt at manipulation of the family to avoid abandonment, and (i) a despairing cry depicting the misery of the current situation.

Conclusions: Expression of desire for hastened death has many meanings and uses and is a tool of communication.

Implications for Nursing: Listening to the patient's story will help nurses understand what is being asked for through the expression of a desire for hastened death.

Jump to a section


    Benzein, E., Norberg, A., & Saveman, B.I. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15, 117-126.

    Breitbart, W. (1987). Suicide in cancer patients. Oncology (Huntington), 1(2), 49-54.

    Breitbart, W., Rosenfeld, B., Pessin, H., Kaim, M., Funesti-Esch J., Galietta, M., et al. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA, 284, 2907-2911.

    Breitbart, W., & Rosenfeld, B.D. (1999). Physician-assisted suicide: The influence of psychologic issues. Cancer Control, 6, 146-161.

    Brown, J.H., Henteleff, P., Barakat, S., & Rowe, C.J. (1986). Is it normal for terminally ill patients to desire death? American Journal of Psychiatry, 143, 208-211.

    Chochinov, H.M. (2002). Dignity-conserving care—A new model for palliative care: Helping the patient feel valued. JAMA, 287, 2253-2260.

    Chochinov, H.M., Wilson, K.G., Enns, M., Mowchun, N., Lander, S., Levitt, M., et al. (1995). Desire for death in the terminally ill. American Journal of Psychiatry, 152, 1185-1191.

    Coyle, N. (2002). Expressed desire for hastened death in a select group of people living with advanced cancer: A phenomenologic inquiry. Dissertation Abstracts International, 63-11B, 5156.

    Coyle, N., Adelhardt, J., Foley, K.M., & Portenoy, R.K. (1990). Character of terminal illness in the advanced cancer patient: Pain and other symptoms in the last four weeks of life. Journal of Pain and Symptom Management, 5, 83-93.

    Creswell, J.W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.

    Ely, M. (1991). Doing qualitative research: Circles within circles. Washington, DC: Falmer Press.

    Emanuel, E.J., Fairclough, D.L., Daniels, E.R., & Clarridge, B.R. (1996). Euthanasia and physician-assisted suicide: Attitudes and experiences of oncology patients, oncologists, and the public. Lancet, 347, 1805-1810.

    Emanuel, E.J., Fairclough, D.L., & Emanuel, L.L. (2000). Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA, 284, 2460-2468.

    Ferrell, B., Virani, R., Grant, M., Coyne, P., & Uman, G. (2000). Beyond the Supreme Court decision: Nursing perspectives on end-of-life care. Oncology Nursing Forum, 27, 445-455.

    Filiberti, A., Ripamonti, C., Totis, A., Ventafridda, V., De Conno, F., Contiero, P., et al. (2001). Characteristics of terminal cancer patients who committed suicide during a home palliative care program. Journal of Pain and Symptom Management, 22, 544-553.

    Ganzini, L., Harvath, T.A., Jackson, A., Goy, E.R., Miller, L.L., & Delorit, M.A. (2002). Experience of Oregon nurses and social workers with hospice patients who requested assistance with suicide. New England Journal of Medicine, 347, 382-588.

    Grzybowska, P., & Finaly, I. (1997). The incidence of suicide in palliative care patients. Palliative Medicine, 11, 313-316.

    Hutchings, D. (2002). Parallels in practice: Palliative nursing practice and Parse's theory of Human Becoming. American Journal of Hospice and Palliative Care, 19, 408-414.

    Jacobson, J.A., Kasworm, E.M., Battin, M.P., Botkin, J.R., Francis, L.P., & Green, D. (1995). Decedents' reported preferences for physician-assisted death: A survey of informants listed on death certificates in Utah. Journal of Clinical Ethics, 6, 149-157.

    Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.

    Mak, Y., & Elwyn, G. (2003). Use of hermeneutic research in understanding the meaning of desire for euthanasia. Palliative Medicine, 17, 395-402.

    Matzo, M.L., & Schwarz, J.K. (2001). In their own words: Oncology nurses respond to patient requests for assisted suicide and euthanasia. Applied Nursing Research, 14(2), 64-71.

    Owen, C., Tennant, C., & Jones, M. (1992). Suicide and euthanasia: Patients attitudes in the context of cancer. Psycho-Oncology, 1(2), 79-88.

    Parse, R.R. (1981). Man-Living-Health: A theory of nursing. New York: John Wiley and Sons.

    Parse, R.R. (1992). Human Becoming: Parse's theory of nursing. Nursing Science Quarterly, 5, 35-42.

    Parse, R.R. (1998). The Human Becoming school of thought: A perspective for nurses and other professionals. Thousand Oaks, CA: Sage.

    Quill, T. (1991). Death and dignity—A case of individualized decision making. New England Journal of Medicine, 324, 691-694.

    Reinharz, S. (1983). Phenomenology as a dynamic process. Phenomenology and Pedagogy, 1(1), 77-79.

    Rosenfeld, B., Breitbart, W., Galietta, M., Kaim, M., Funesti-Esch, J., Pessin, H., et al. (2000). The schedule of attitudes toward hastened death: Measuring desire for death in terminally ill cancer patients. Cancer, 88, 2868-2875.

    Seale, C., & Addington-Hall, J. (1994). Euthanasia: Why people want to die earlier. Social Science and Medicine, 39, 647-654.

    Suarez-Almazor, M.E., Belzile, M., & Bruera, E. (1997). Euthanasia and physician-assisted suicide: A comparative survey of physicians, terminally ill cancer patients, and the general population. Journal of Clinical Oncology, 15, 418-427.

    van Manen, M. (1990). Researching lived experience: Human science for an action sensitive pedagogy. Albany, NY: State University of New York.