[Psychosocial and Emotional Distress Among Relatives in Assisted Dying Contexts: Insights from Specialized Counseling].

Abstract

Following the ruling of the Federal Constitutional Court, the number of assisted suicides in Germany has been increasing. However, the psychological and psychosocial burden experienced by relatives in this context remains insufficiently explored. This study aims to examine specific stress factors and the motivations for seeking support from a specialized counseling center for relatives of individuals who are considering or have undergone assisted suicide.This cross-sectional study analyzes baseline data from relatives (N=23). In addition to sociodemographic characteristics, the study examines psychological stress factors, decision-making processes, and concerns of the relatives, as well as the illnesses and motives for assisted suicide of the individuals seeking to end their lives. Depressive symptoms were assessed using the Patient Health Questionnaire. Data were collected through structured questionnaires and qualitative free-text responses, which were analyzed using qualitative content analysis.The majority of relatives (83%) sought support during the period preceding the assisted suicide, particularly when a fixed date for the death had already been set. Among the participants, 30.4% exhibited moderate depressive symptoms, while 47.8% showed mild depressive symptoms. Key stress factors included ambivalent feelings between offering support and maintaining distance, moral conflicts, uncertainty about one's own role, anticipatory grief, and navigating the planning process leading up to the assisted suicide, including the day of death. Additionally, relatives reported experiencing social stigmatization and difficulties discussing assisted suicide with others. The most commonly cited reasons for assisted suicide among the individuals seeking to end their lives were the desire for control over their own death, fear of dying in an undignified manner, and loss of autonomy.The results showed that family members of individuals who choose assisted suicide are exposed to significant emotional distress. In particular, anticipatory grief and the awareness of a predetermined time of death led to a complex emotional experience marked by feelings of guilt and helplessness. Moreover, there is a high need for counseling, especially regarding emotional processing, legal uncertainties, and social support after the loss.These findings highlight the considerable emotional burden experienced by those close to individuals who undergo assisted suicide and emphasize the need for targeted psychosocial support. Future research should further explore effective counseling approaches to address anticipatory grief, moral conflicts, and social stigmatization in this context.