How can health care professionals face their terminally ill patients’ desire to die? One way of caring for patients in this state corresponds to practicing dignity in care, which involves listening, facilitating expression, understanding and accompanying the patient. Alazne Belar, a doctoral student within the ATLANTES Program of the Institute for Culture and Society, analyzed this issue during the first of a series of colloquiums on palliative care organized by the group.

The researcher distinguished between dignity as a person’s intrinsic value and social dignity, which depends on interaction with other people. "We have seen that depending on how we relate to people, the way we look at them, subjective or social dignity can be undermined," he noted.

Several studies reveal that deterioration caused by advanced disease can lead a patient to express a desire to die. Regarding this, Alazne Belar noted that wanting to die is a general desire that encompasses a range "from a general desire to a specific request to hurry up death. However, a patient may wish to die, but does not actually consider hurrying death up and so will not take any action."

Recovering the meaning of life

For Belar, the key is precisely to find what lies behind that desire: "Many times it is not a simple 'wish to die,' but rather has many implications and meanings— it can be a way of asking for help, or a patient’s way of saying that he does not want live a certain way or with pain."

In that sense, there are different ways to proceed, according to the ATLANTES PhD student. If, for example, this desire were caused by pain, it could be dealt with through medication.

However, if the desire is rooted in a loss of meaning in life, dignity therapy may help. This involves having a conversation about topics relevant to the patient that they want to share with their relatives and, from there, producing a document based on the conversations.

"Many times you do not know if what helps is the document as a legacy, the conversation... We found though that this therapy helps patients feel a sense of dignity and that many patients have accepted and recommended it," Alazne Belar concluded.ar.