Table 6 Appraisal

Benign

The patient is content and comfortable [26, 32, 36, 45, 53]

The patient receives services that facilitate their goal of hastened death. The death is peaceful [17, 18, 71].

Challenge

Coping with escalating number and intensity of caregiving tasks, patient’s decline, disruption in routine. Demands consistent with caregiver’s sense of duty and commitment, but achievable [26, 30, 37, 38, 45, 47, 48, 53,54,55,56,57,58, 60, 64].

Planning and preparation, reconciling one’s own beliefs to help the patient [15, 16, 68, 70]

Threat

Events that could affect the patient’s well-being, either internal (caregiver’s own preparedness and resources) or external (availability of services). Events that affect caregiver’s effectiveness, such as fatigue. Realisation of potential for death [27, 33, 36, 37, 42, 45,46,47,48,49,50,51, 57, 58, 60,61,62,63,64, 66].

Patient denied access to hastened death; risk of incomplete ingestion, difficult or prolonged death, legal repercussions after death, social stigma [15, 16, 18,19,20, 68,69,70,71,72]

“He started taking it and apparently it tastes awful, and so started gagging a little bit, and wanted to stop halfway. And we had discussed before, once you start it, you have to do the whole thing. So then we gave him alcohol. Ah, it was terrible...” (Buchbinder et al., p. 5)

“And then you weren’t really sleeping because every few seconds you’re waking up and going ‘is she still breathing, is she still there?’”’ (Totman et al, p500)

Harm

Disease progression, insufficient professional help, potential to harm patient by being honest about prognosis [27, 29, 33, 36, 37, 41, 45,46,47,48,49,50,51, 56, 57, 61, 62]

Burden of secrecy about cause of death (Switzerland), inadequate support from providers resulting in more difficult death (U.S., Canada, Netherlands) [16, 19, 20, 68, 70]