Citation

Spittler JF. Nervenheilkd. 2004; 23(5): 292-296.

Copyright

(Copyright © 2004, Georg Thieme Verlag)

DOI

10.1055/s-0038-1626382

PMID

unavailable

Abstract

Three patients are presented in their development during the planning of an assisted suicide. The underlying illnesses were: a progressive motor neuron disease starting in infancy, progressive multiple sclerosis, and locked-in syndrome after an ischemic-hemorrhagic brainstem stroke. The latter, unable to perform a forceful enough hand-movement to switch the PEG-pump died from pneumonia. The other two committed suicide in Switzerland. Numerous conversations with the patients and their relatives gave insight to the reasons and motifs. Seven stages of coping can be distinguished: hoping for therapy, losing certainty, depression, setting plans in motion, spiritual re-orientation, letting-go, and for the relatives: working through the aftermath. The distinction of the stages will be qualified by variability of duration, overlap, anticipation and flashback, as well as interpersonal variations between all concerned. For a better understanding one has to keep in mind that appealing for help and taking stock exist complementarily, and that ambiguous tendencies exist in both the patient and in his/her environment. Formally the development towards an assisted suicide is marked by a threshold of anticipated increasing deterioration, as well as the dichotomy between a prognosis of an almost undiminished life-expectancy and an increasing loss of independence. This leads to the perception of an increasing rift between the desire to survive, and decreasing self-respect, autonomy and dignity. This rift demonstrates the complementary nature of freedom and dependancy involved in making this decision. If those accompanying manage to realise a careful personal encounter the one leaving can be granted comfort, consolation and a growth in understanding and development.

Language: de

Keywords

human; prognosis; survival; decision making; depression; assisted suicide; stroke; cause of death; suicidal behavior; life expectancy; locked in syndrome; review; disease course; coping behavior; Switzerland; Assisted suicide; relative; perception; multiple sclerosis; pneumonia; Accompanying; Coping stages; motor neuron disease; Presuicidal development