Dealing with Desire to Die in Palliative Care

In the course of new legal regulations, the question of how to deal with desire to die is the focus of current professional debates. From the perspective of palliative care, a desire to die should not be thought of only as the wish for assisted suicide, but should be recognised in all its possible forms and facets. An open, respectful, and interested approach towards patient perspectives is therefore essential. Goals for dealing with desire to die are formulated within the S3 guideline "Palliative care for patients with incurable cancer". Support for the implementation of such goals is provided by trainings on the topic and a clinical guideline for the discussion of a potential desire to die. Open communication about the topic primarily helps to shift the focus from taking immediate action towards a widening of perspectives, a slowing of the process and the opening of an emotional space. Decisions regarding next steps can then be made based on a richer understanding of possible underlying concerns and expectations related to desire to die. These steps can include pain management and the treatment of depression to reduce suffering associated with a desire to die. Measures may also consist of foregoing or terminating life-prolonging measures. If patients have a serious and persistent wish for assisted suicide, the existence of such a wish should be recognized and addressed appropriately.