Palliative care unit caregivers facing a euthanasia request: A qualitative pilot study

Background. - According to a French study, euthanasia requests in palliative care units are not numerous and are unstable. To understand the emergence and becoming of euthanasia requests is to consider the dynamics of relations between patient, relatives and caregivers via a multicentric, prospective study. The goal of the present pilot study was to verify its feasibility and to understand the caregivers' subjective view of euthanasia requests. Method. - Over a period of 4 months at the Jeanne-Gamier hospice in Paris, semi-structured interviews have been held with all the palliative caregivers of who received a euthanasia request, and whenever possible with patients. These interviews have been recorded, transcribed and their qualitative analysis done with the aid of STONE software. Results. - The caregivers reported nine euthanasia requests and four patients were able to be interviewed. Analysis of the caregivers' interviews indicated that four out of nine situations were actual euthanasia requests; expressions of wishes to die were heard as euthanasia requests, in particular by the doctors. Even if the caregivers unanimously assert not to be affected by these requests, they have felt powerless, their competences and the usually idealised capacities of the institution challenged. Conclusion. - For the caregivers, accepting to hear these euthanasia requests is difficult and destabilising. The importance of the interpretation of wishes to die as euthanasia requests is to be underlined. The realisation of a prospective study on the impact of the dynamic relationship concerning euthanasia requests is limited by the vulnerability of the patients. (C) 2015 Elsevier Masson SAS. All rights reserved.