Scientific publications

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Jan 4, 2016 | Magazine: PlOs One

Balaguer A (1), Monforte-Royo C (2), Porta-Sales J (1,3), Alonso-Babarro A (4), Altisent R (5), Aradilla-Herrero A (6), Bellido-Pérez M (2), Breitbart W (7), Centeno C (8), Cuervo MA (9), Deliens L (10), Frerich G (11), Gastmans C (12), Lichtenfeld S (13), Limonero JT (14), Maier MA (13), Materstvedt LJ (15), Nabal M (16), Rodin G (17), Rosenfeld B (18) Schroepfer T (19), Tomás-Sábado J (6), Trelis J (3), Villavicencio-Chávez C (1,3), Voltz R (11).
(1) School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
(2) Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
(3) Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
(4) Unidad de Cuidados Paliativos, Hospital Universitario La Paz, Madrid, Spain.
(5) Institute of Health Research Aragon, Cátedra de Profesionalismo y Ética Clínica, Universidad de Zaragoza, Zaragoza, Spain.
(6) Escola Universitària d'Infermeria Gimbernat, Autonomous University of Barcelona, Barcelona, Spain.
(7) Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America.
(8) ATLANTES Research Program, Institute for Culture and Society and Palliative Medicine Department, Clinica Universidad de Navarra, University of Navarra, Navarra, Spain.
(9) Complejo Hospitalario Infanta Cristina, Badajoz, Spain.
(10) End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
(11) Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.
(12) Catholic University of Leuven, Leuven, Belgium.
(13) Ludwig-Maximilians-Universität München, Munich, Germany.
(14) Faculty of Psychology, Stress and Research Group, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
(15) Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
(16) Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova, Lleida, Institut Català de la Salut, IRB, Lleida, Spain.
(17) Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry and Global Institute Psychosocial, Palliative and End-Life Care (GIPPEC), University of Toronto, Ontario, Canada.
(18) Department of Psychology, Fordham University, Bronx, New York, United States of America.
(19) School of Social Work, University of Wisconsin-Madison, Wisconsin, United States of America. 


The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD.


Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy.


All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD.


This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

CITATION  PLoS One. 2016 Jan 4;11(1):e0146184. doi: 10.1371/journal.pone.0146184. eCollection 2016.