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Positive emotion
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Satisfaction with overall caregiving; patient’s serenity with own condition [45, 46, 49, 55,56,57,58]
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Events that align with patient’s wishes [15, 17]
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Distress
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Patient decline, conflict between exhaustion and increasing patient needs, social isolation, breaking a promise to the patient, family conflict [27, 29, 30, 36, 37, 42, 45,46,47,48,49,50,51, 53, 56, 57, 60, 61, 63]
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Complicated dying, moral distress about patient choice to die [15, 17,18,19,20, 67,68,69,70,71]
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“The ‘I-killed-my-mom thing’ is big, still. Because it’s the truth—how do I come to some resolution around that?” (Starks et al, p117)
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“There’s a point where you’ve done, you’ve gone overboard. You hear the 110% effort stuff; well I think it’s probably 180% effort…. You just, you become a basket case.” (Sinding, p.157)
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Positive reappraisal
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Caring provides opportunity for growth, respect, closeness, or strengthening family ties. Death allows patient to escape suffering. Escalating need for care results in more clinical resources [26, 36,37,38, 44, 46, 48, 51, 53,54,55,56,57, 60,61,62,63, 65].
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Clinicians who would not facilitate hastened death but were supportive in other ways; in retrospect, hastened death seen as right choice [15, 16, 18, 19, 70]
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“I mean it’s so wonderful that you can give someone yourself. I mean that’s a real thing to do. And that they’ll let you.” (Sinding, p. 157)
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Revised goals
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Reducing hopes for patient’s future, deciding to encourage the patient to “let go” to avoid further suffering, admitting patient needs institution-based care [27, 28, 30, 32,33,34, 37, 38, 45, 46, 48, 53, 56, 59,60,61,62,63]
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Putting own grief or ambivalence on hold to focus on patient’s wishes, reconciling to idea of hastened death as better option than disease trajectory or unassisted suicide [15, 18, 19]
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‘I had to realize that this person was no [longer] capable mentally or physically, and I had to take over the role of [parent] just like you do, first it was like a 6 year old and then a 5 year old.’ (Clukey 2008, p312)
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Spiritual beliefs
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Taking comfort in a larger force to supply strength or determine patient’s fate, taking comfort in an afterlife [27, 32, 33, 36, 40, 56, 58, 59, 61]
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Spiritual or ritual elements, during or after death, add to closure [16, 18, 19, 68]
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Positive events
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Events that eased suffering, allowed for closure, or provided humor [26, 32, 33, 36, 50, 55]
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In U.S. and Canadian studies, deaths were described as joyful, sacred, or peaceful, with patients’ wishes achieved [16, 68, 70, 71].
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