[Facing a patient's wish to hasten death in palliative care: Professionals' experiences, practices, and interactional adjustments].

INTRODUCTION The wish to hasten death is a frequent request in palliative care settings. Addressing this wish, in a context of evolving medical practices and societal debates surrounding end-of-life care, presents significant challenges for healthcare professionals. This study aimed to explore their reactions and representations when confronted with this request.

Methods

An exploratory qualitative study was conducted with nine healthcare professionals (4 physicians, 5 nurses) working in palliative care. Semi-structured interviews were analyzed using thematic analysis, complemented by a similarity analysis (IRaMuTeQ).

Results

The expression of the wish to hasten death mobilizes four dimensions. The feeling dimension includes contrasting emotional responses (helplessness, sense of failure, discomfort, surprise, acceptance). The acting dimension refers to interventions focused on exploring the request, listening, providing explanations, and analyzing sources of suffering, as well as actions involving families and the care team. The supporting resources dimension corresponds to available resources, including the team, professional experience, training, and the legal framework. An existential (self-disclosure) dimension emerges through reflections on end-of-life care and professional posture. Representations are organized around the patient, suffering, and holistic care. No major differences were found between physicians and nurses.

Discussion

These findings highlight the fundamentally interactional and co-constructive nature of these situations: reactions, actions, and the meaning attributed to the request are shaped through exchanges between patients, relatives, and the healthcare team. Adaptation thus appears as a dynamic process, supported by collective resources and shared meaning-making in the face of clinical and ethical uncertainty.