Dear editor,
We have read with delight the article entitled “Patient altruism at the end of life: A scoping review” (Sterie et al. Reference Sterie, Borasio and Deml2024), especially in subtheme (ii), that altruism is explained as the desire and decision to delay treatment or actively hasten death. It was further explained that patients express altruism through the desire or decision to delay treatment or even actively hasten death, in addition altruism is displayed by requests to limit or refuse life-prolonging treatments, and finally altruism is expressed through the patient’s request to commit suicide with the help of a doctor. This discussion is interesting to discuss further, because it turns out that altruism itself has unexpected impacts. We will review several things that were not included in the article, which we feel are important as constructive criticism.
It can be said that altruism is basically the principle and practice of caring for the welfare and/or happiness of other humans above oneself (Krebs Reference Krebs1970). Although the objects of altruistic concern vary, it is an important moral value in many cultures and religions (Batson Reference Batson2010). It may be considered a synonym for selflessness, the opposite of egoism (Mangone Reference Mangone2020). Based on this definition, in a palliative context, someone who has the principle of altruism in their life may choose to postpone treatment or actively hasten death and commit suicide by asking for help from a doctor. Rather than bothering his/hers family and other people for longer because they have to care for him/her and spend quite a lot of money on him/her.
If analyzed further, this decision can actually be said to be an “irrational belief” (Situmorang Reference Situmorang2022). The theory of Rational Emotive Behavior Therapy (REBT) explained that there were 11 “irrational beliefs” that caused them to have problems in their lives (Ellis Reference Ellis1994). In the context above, it is very related to irrational belief number 5, namely “I must control events and people because they control how I feel.” This means that someone who chooses to end their life early is actually experiencing this condition, that they feel guilty and have harmed many people because of their illness. They only focus on this, without paying attention to other people’s feelings, that the decisions they make may actually make other people sad, not happy.
Currently, the number of cases among people with altruism who choose to end their lives is increasing (Lavazza, A., & Garasic, Reference Lavazza and Garasic2022; Schroeder Reference Schroeder2005; Sterie et al. Reference Sterie, Borasio and Deml2024). There are quite a number of life problems behind this, one of which is not wanting to bother other people (Gunderson and Mayo Reference Gunderson and Mayo1993). Usually the feelings that arise when experiencing this problem are despair, depression, and suicidal thoughts (Abed Reference Abed1997). If it is not addressed immediately, it will of course lead to their decision to commit suicide (Hewitt and Edwards Reference Hewitt and Edwards2006).
In the broader context of palliative care (Forcén et al. Reference Forcén, Marengo and Behn2023), the problems faced by people with this case today such as depression, mental illness, and suicide are considered as terminal ones, so they must immediately treat and given appropriate intervention. Care is needed in providing the right intervention for them, of course an intervention that is suitable for their characteristics. Based on their character, they are in quite fragile situations and easily despair (Jonasson et al. Reference Jonasson, Lindö and Lindh2019; Krikorian et al. Reference Krikorian, Limonero and Maté2012). But on the other hand, they are people with altruism who still have a passion for seeing other people happy (Gysels et al. Reference Gysels, Shipman and Higginson2008; Post Reference Post2014; Schwartz Reference Schwartz2009). So, in this case, there needs to be a match between what they need and what the intervention provides.
Furthermore, in this letter, we would like to provide recommendations for considering the right type of intervention for some people who experience this problem so as to help them have healthier altruism and avoid “irrational beliefs.” It is hoped that future follow-up research can make a significant contribution to the development of science, especially in dealing with various problems in the field of palliative and supportive care. Apart from that, of course, future research will answer the challenge of “Positive psychology and palliative care: A call for an integrative approach” (Bernard and Arantzamendi Reference Bernard and Arantzamendi2024; Situmorang Reference Situmorang2022), and as a concrete effort to realize “Creating your soul in every moment: Meaning, creativity, and attitudes” (Breitbart Reference Breitbart2015; Breitbart et al. Reference Breitbart, Lichtenthal and Applebaum2022).
Acknowledgments
The authors wish to express their gratitude to the Creative Counseling Center Indonesia for supporting this manuscript.
Funding
The authors declared no funding was received for this paper.
Competing interests
The authors declare no conflict of interest.
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