Table 3 Diagnoses and complaints related to the request for PAS as perceived by the interviewed GPs with exemplary quotations
Type of diagnosis and main complaints (number of interviews in which mentioned) | Quote from the qualitative data |
|---|---|
Cancer (> 10) | |
Physical weakness (partly cachexia) Immobility Increasing care requirements Loss of autonomy Loneliness Hopelessness Mental stress Fear of further suffering (e.g. pain, loss of control) Pain Shortness of breath Swallowing difficulties | “[…] And I think the wish […] of many patients when they express a desire for assisted suicide is also that they simply don’t want to suffer pain, don’t want to suffer shortness of breath, […] can’t bear loneliness. So, it’s really about overcoming this sense of hopelessness as well.” (Interview R, passage 03) |
Advanced age (min. 9) | |
Expected or experienced loneliness Senselessness Weariness with life Need for care Immobility | “And an old gentleman, same story– wife died, has nothing left, children far away, doesn’t want to live anymore– […] although in his case […] well, the problem is: he’s perfectly healthy.” (Interview C, passage 20) “[…] This is an 85-year-old gentleman. He’s been a patient since I took over the practice, so I’ve known him for 20 years. His second wife has now died. She was much younger than him. And he says he actually didn’t want to go through this again after his first wife died. And now she’s dead too, and he said– sounds silly– that he had deliberately married someone younger so he wouldn’t have to experience it again. Now it’s happened anyway. […] For him, it is definitely the expected loneliness. It doesn’t exist yet, but it’s going to happen. He also has two sons and a daughter. And they all live nearby. But of course, they live their own lives, and it’s an expected loneliness. […]” (Interview K, passages 19–23) |
Depression (min. 5) | |
Mental stress Psychosomatic pain Insomnia | “[…] Surprisingly, in my career, it’s been more patients with mental health issues. Rarely patients who belong to the oncological-palliative spectrum, but really people who just say everything is too exhausting, and they would like to go to Switzerland and ask if I could help them with that. […]” (Interview B, passage 03) |
Severe/burnt-out COPD (min. 4) | |
Shortness of breath Immobility Anxiety Pain | “Yes, well, he had severe COPD, and at first, he didn’t fit into the patient group I would have expected this from. […] I hadn’t initially perceived him that way. And the fact that someone with severe COPD would have a death wish due to this condition, I wouldn’t have thought of that before, to be honest. In his case, he was about 70 (…) and was practically out of treatment options, as they say. Already under maximum therapy, he had experienced several severe exacerbations each year, with repeated stays in intensive care and a difficult recovery afterward. He was simply short of breath, even when just making movements while sitting in a chair, and he no longer found life worth living.” (Interview P, passage 23) |
Degenerative motor neuron disease (min. 2) | |
Loss of autonomy Immobility | “[…] her radius is simply getting smaller. So, she can only walk with a walking aid and […] well, I think with her, […] the loss of autonomy is very strong. […]” (Interview S, passage 23) |
Dementia (min. 1) | |
Loss of control | “[…] it was a professor who had Alzheimer’s and noticed it. And before he had completely declined, he expressed this wish. […]” (Interview R, passage 15) |
Chronic pain syndrome (min. 1) | |
Pain Immobility Hopelessness | “[…] Well, her legs are always so overheated and aching and hot and stinging and burning and she always has a fan on her feet all day long, and packs herself full of cool packs, and then has got […] cold blisters, which then hurt even more. And she simply has no more courage to face life because […] there is simply no adequate therapy […]” (Interview G, passage 04) |
No medical diagnosis (min. 1) | |
Loneliness Financial poverty Homelessness Senselessness | “[…] a completely unsuccessful life […] without stable relationships, constantly searching, trying to buy people […] and thus totally impoverished herself […]. And when there was nothing left to get, there was no one left. […] she wanted to end that kind of life […].” (Interview N, passage 19) |