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Cited by 310Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics and bioethics in healthcare

Will to live in the terminally ill

Chochinov, Harvey Max, Tataryn, Douglas, Clinch, Jennifer J, Dudgeon, Deborah·1999·The Lancet
DOI 10.1016/s0140-6736(99)80011-7
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Abstract

Background Complex biomedical and psychosocial considerations figure prominently in the debate about euthanasia and assisted suicide. No study to date, however, has examined the extent to which a dying patient's will to live fluctuates as death approaches.Methods This study examined patients with cancer in palliative care. Will to live was measured twice daily throughout the hospital stay on a self-report 100 mm visual analogue scale. This scale was incorporated into the Edmonton symptom assessment system, a series of visual analogue scales measuring pain, nausea, shortness of breath, appetite, drowsiness, depression, sense of well-being, anxiety, and activity. Maximum and median fluctuations in will-to-live ratings, separated by 12 h, 24 h, 7 days, and 30 days, were calculated for each patient.Findings Of 585 patients admitted to palliative care during the study period (November, 1993, to May, 1995), 168 (29%; aged 31-89 years) met criteria of cognitive and physical fitness and agreed to take part. The pattern of median changes in will-to-live score suggested that will to live was stable (median changes <10 mm on 100 mm scale for all time intervals). By contrast, the average maximum changes in will-to-live score were substantial (12 h 33.1 mm, 24 h 35.8 mm, 7 days 48.8 mm, 30 days 68.0 mm). In a series of stepwise regression models carried out at 12 h, 24 h, and 1-4 weeks after admission, the four main predictor variables of will to live were depression, anxiety, shortness of breath, and sense of well-being, with the prominence of these variables changing over time.Interpretation Among dying patients, will to live shows substantial fluctuation, with the explanation for these changes shifting as death approaches.

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Authors
Chochinov, H. M., Tataryn, D., Clinch, J. J., & Dudgeon, D.
Affiliations
  • University of Manitoba (CA)
  • St. Boniface Hospital (CA)
  • Queen's University (CA)
Corresponding author
Chochinov, Harvey Max
ORCID
Chochinov, Harvey Max
Venue
The Lancet
Publisher
Elsevier BV
Published
1999-09
Volume
354
Issue
9181
Pages
816-819
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(99)80011-7
OpenAlex
W2122367099
Cited by
310
References
16
Citations by year
2026: 6 · 2025: 11 · 2024: 8 · 2023: 8 · 2022: 7 · 2021: 9 · 2020: 11 · 2019: 6 · 2018: 44 · 2017: 8 · 2016: 5 · 2015: 3 · 2014: 7 · 2013: 4 · 2012: 7
FWCI
17.40
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
will to live, dying patients, cancer, palliative care, depression, anxiety, dyspnea, sense of well-being, Edmonton Symptom Assessment System, visual analogue scale, euthanasia, assisted suicide
MeSH terms
Aged, Attitude to Death, Euthanasia, Female, Humans, Male, Mental Status Schedule, Neoplasms, Palliative Care, Suicide, Assisted, Terminally Ill, Euthanasia, Active, Voluntary

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