Universitat Internacional de Catalunya
Assessment and Response to the Wish to Hasten Death in Patients with Advanced Disease (8th Edition)
Other languages of instruction: English, Spanish,
Teaching staff
e-mail contact: Dra. Cristina Monforte Royo
cmonforte@uic.es
Introduction
The wish to hasten death (WTHD) is a fluctuating phenomenon that can emerge with some frequency in patients with advanced cancer or at certain critical moments in the process of other advanced diseases. It is a reactive phenomenon to suffering of multifactorial origin and a subject of concern among health professionals.
Various studies link WTHD to physical, emotional, spiritual, and social factors. It is not always an expression of a genuine desire to die, but rather a means of ending suffering.
Therefore, early identification is an opportunity to detect often hidden suffering and try to alleviate it. However, early detection and treatment are challenging given the nature of the phenomenon, the vulnerability of the population in which it occurs, and the reluctance of professionals for fear of causing harm or invading privacy. Some studies have shown that early attempts at detection and assessment are not upsetting, but are well accepted by patients, although they require professionals trained in their approach and assessment.
The WTHD also implies an ethical duty to understand and help the person expressing it; to always rule out any depressive disorder that may occur in these situations; and to alleviate the underlying suffering. In any case, before interpreting WTHD as a deliberate expression of personal autonomy, areas of present or anticipated suffering must be explored.
Otherwise, attempting to satisfy a desire expressed by the patient without a multidimensional approach could be detrimental to providing good care and could carry the serious risk of abandoning patients to a fate in which suffering is present.
Today, more than ever, with the implementation of the organic law regulating euthanasia, it is necessary to train professionals in the exploration of WTHD in order to treat it from a clinical perspective.
Pre-course requirements
Interest in training in this field.
Be a health care professional.
Objectives
Primary:
- To train students in the early detection of the desire to hasten death, as well as how to respond appropriately in a clinical context.
Secondary:
- Acquire theoretical knowledge about the underlying aspects of the emergence of the wish to hasten death.
- Acquire or improve self-confidence in complex conversations, specifically in exploring and responding to the wish to die.
- Acquire theoretical knowledge about the legislative and ethical framework surrounding the expression of the wish to hasten death.
Learning outcomes of the subject
- The participant will demonstrate knowledge in the early detection of the desire to hasten death, as well as responding in a meaningful way within a clinical context.
- The participant will demonstrate having acquired the theoretical knowledge about the underlying aspects of the emergence of the desire to hasten death.
- The participant will demonstrate having acquired and improved self-confidence in complex conversations, specifically in exploring and responding to the desire to die.
- The participant will demonstrate having acquired theoretical knowledge about the legislative and ethical framework surrounding the expression of the desire to hasten death.
Syllabus
Module 0. Presentation and introduction to the course.
Module 1. The wish to hasten death: Conceptual and epidemiological aspects.
Module 2. Clinical exploration of the wish to hasten death: Clinical context, indications and contraindications, guidelines and instruments (SAHD, DDRS, AFEDD). Clinical cases (dos and don'ts).
Module 3.1. Clinical response to the wish to hasten death (part 1).
Module 3.2. Clinical response to the wish to hasten death (part 2).
Module 4. The family faced with the wish to hasten death. Role of the family (obligations and limits), conversations with the family. Clinical cases (dos and don'ts).
Module 5. Ethical, anthropological, and legal aspects of requests to hasten death in Spain.
Module 6. Assessment using virtual OSCE (decision-making and situation management based on real cases (videos)).