Intentions in wishes to die: analysis and a typology - A report of 30 qualitative case studies of terminally ill cancer patients in palliative care

Objective: To investigate the variations in and intentions of wishes to die (WTD) of palliative care cancer patients. Methods: Thirty terminally ill cancer patients, their caregivers and relatives in a hospice, an oncology palliative care ward of a general hospital, and an outpatient palliative care service. 116 semistructured qualitative interviews analyzed by a combined approach using Grounded Theory and Interpretive Phenomenological Analysis. Results: A WTD is dynamic and interactive. Its subjective phenomenology can be described by three aspects: intentions, motivations, and interactions. In this article, we present a typology of the possible intentions. We identified nine different (ideal) types of intentions that WTD statements might have, other than wishing to live and accepting death. Many WTD statements do not imply a desire to hasten death. The intentions of statements differ according to whether a WTD is related to as imaginary or as an action. Often WTD statements contain several partial wishes, which can be in tension with each other and form a dynamic, sometimes unstable equilibrium. Conclusions: Terminally ill persons' WTD statements differ in their intention, and deeper knowledge about these differences is ethically relevant. (C) 2014 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd.