Feeling like a burden to others and the wish to hasten death in patients with advanced illness: A systematic review

Bioethics. 2019 May;33(4):411-420. doi: 10.1111/bioe.12562. Epub 2019 Apr 8.


Studies that have explored the wish to hasten death (WTHD) in patients with advanced illness have found that the feeling of being a burden may trigger WTHD. Research suggests that both the feeling and the wish are indicators of multidimensional suffering whose meaning may depend on the patient's biographical background. Therefore, we carried out a systematic review and meta-ethnography. Fourteen qualitative studies, reported in 16 articles, met the inclusion criteria. The analysis identified two themes: the personal and social dimensions that could help to explain the feeling of being a burden in these patients. These dimensions reveal how this feeling is linked to physical, psychological/emotional, existential and social factors. The feeling of being a burden cannot be understood without considering patients' personal interpretation of their dependency or care needs, and hence it is also necessary to understand their biographical background. Such an understanding is crucial to inform clinical policies based on the moral duty to provide all patients with humane care.

Keywords: burden to others; clinical ethics; end of life; palliative care; qualitative studies; systematic review; wish to hasten death.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Attitude to Death*
  • Caregivers*
  • Death
  • Emotions*
  • Family*
  • Humans
  • Interpersonal Relations*
  • Qualitative Research
  • Self Concept
  • Stress, Psychological*
  • Terminal Care / psychology*
  • Terminally Ill / psychology