Objective: better ascertain the questions and suffering leading to a request for euthanasia and thus to better adapt care attitudes and tentative responses for patients, family and caregivers. Material and methods: analysis of 65 case files of patients for whom a request for euthanasia was recorded among 1,504 patients followed by the mobile unit for palliative care at the Grenoble university hospital from 2000 to 2004. Results: the requests (69 for 65 patients) came mainly from the patients (N=31) and their families (N=29), less often from caregivers (N=9). The request arose in a context of exhaustion with loss of meaning (N=29), unbearable symptoms (N=18), unacceptable dependency (N=13), or other suffering (N=9). For the patients, the main reason was related to suffering resulting from the dependency (N=13). For the families (N=16) and caregivers (N=7), the primary reason was related to loss of meaning. The request was abandoned in most cases (N=59) with readajustment of the therapy and supportive care. Ten requests persisted. Six patients died following changes in treatment which we have considered excessive (question about the intention), raising the question of masked euthanasia. Four of these patients presented major impairment of consciousness. Conclusion: these requests were exceptional, particularly when considering only those which persisted. This underlines the importance of therapeutic modifications and supportive care, as is emphasized by the current French legislation. However, the possibility of six cases of masked euthanasia recall the vulnerability of these patients and of the caregivers faced with loss of meaning. Support and training are needed.
