Prevalence and characteristics of older adults with a persistent death wish without severe illness: a large cross-sectional survey

Abstract

Background Some older persons develop a persistent death wish without being severely ill, often referred to as “completed life” or “tiredness of life”. In the Netherlands and Belgium, the question whether these persons should have legal options for euthanasia or physician-assisted suicide (EAS) is intensely debated. Our main aim was to investigate the prevalence and characteristics of older adults with a persistent death wish without severe illness, as the lack of this knowledge is a crucial problem in de debate. Methods We conducted a survey among a representative sample of 32,477 Dutch citizens aged 55+, comprising questions about health, existential issues and the nature of the death wish. Descriptive statistics were used to describe the group with a persistent death wish and no severe illness (PDW-NSI) and several subgroups. Results A total of 21,294 respondents completed the questionnaire (response rate 65.6%). We identified 267 respondents (1.25%) as having a persistent death wish and no severe illness (PDW-NSI). PDW-NSI did not only occur among the oldest old. Although qualifying themselves as “not severely ill”, those with PDW-NSI reported considerable health problems. A substantial minority of the PDW-NSI-group reported having had a death wish their whole lives. Within the group PDW-NSI 155 (0.73%) respondents had an active death wish, of which 36 (0.17% of the total response) reported a wish to actually end their lives. Thus, a death wish did not always equal a wish to actually end one’s life. Moreover, the death wishes were often ambiguous. For example, almost half of the PDW-NSI-group (49.1%) indicated finding life worthwhile at this moment. Conclusions The identified characteristics challenge the dominant “completed life” or “tiredness of life” image of healthy persons over the age of 75 who, overseeing their lives, reasonably decide they would prefer to die. The results also show that death wishes without severe illness are often ambiguous and do not necessarily signify a wish to end one’s life. It is of great importance to acknowledge these nuances and variety in the debate and in clinical practice, to be able to adequately recognize the persons involved and tailor to their needs.

The Darker Side of Ageing: Towards an Ethics of Suffering that Emphasises the Primacy of Witnessing

“…Although most people would suffer from similar conditions more or less, presumably a majority would treat it more lightly and not develop a wish to die. The same goes for fears: most participants were horrified by all kinds of anticipated fears regarding the future, including but not limited to (further) development of certain illnesses, unwanted side-effects of possible treatment options, total dependence on others, and forced relocation (van Wijngaarden et al, 2015;van Wijngaarden et al, 2016;Hartog et al, 2020). Most people in a somewhat similar situation will recognise the concerns, but supposedly not become paralysed by such concerns and rather find ways to cope with them.…”

“…What does it mean to live with a deep sense that life is no longer worth living? Over the years, I have conducted several studies in which I explored the lifeworld of people like Michael (van Wijngaarden et al, 2015;van Wijngaarden et al, 2016;Hartog et al, 2020). Analysing these stories brought into view several central meanings.…”

“…People who 'suffer from life in old age' often intensely suffer from a pile of different conditions such as ill-health; age-related losses; bereavement; loneliness; isolation; traumas; burdensomeness; having a low social status associated with retirement; poor economic situation due to a limited pension; lack of available meaningful projects; and/or uncertainty about the adequacy of welfare services and care arrangements (van Wijngaarden et al, 2015;Hartog et al, 2020). These different conditions lead to distinct, often intertwined dimensions of suffering.…”

“…(based on the documentary Full Stop, 2020 1 ) Although most older adults succeed in finding meaning in life, even in deep old age (van Campen, 2020;van Campen & Verbeek-Oudijk, 2017), there is a minority of older adults who feel that life no longer makes sense (van Wijngaarden et al, 2015) As reflected in Michael's case, those people may suffer from the consequences of old age, explicated in feelings of loneliness, social isolation and disconnectedness, and fears for (further) decline and dependency. Consequently, some older adults may develop a wish to die (McCue & Balasubramaniam, 2017;Richards, 2017) + (van Wijngaarden et al, 2016;Hartog et al, 2020). Both in Belgium and the Netherlands, multiple geriatric syndromes in combination with old-age vulnerabilities are, in some cases, evaluated as 'unbearable and incurable suffering' and in such instances the people concerned may possibly be eligible for euthanasia or physician assisted suicide (Van Den Noortgate & Van Humbeeck, 2020) + (van den Berg et al, 2020).…”

From Reciprocity to Autonomy in Physician-Assisted Death: An Ethical Analysis of the Dutch Supreme Court Ruling in the Albert Heringa Case

“…With regard to their age, 2.2% of 65-year-old Dutch persons may have had a wish to die (Rurup et al 2011), while another study among the European general population demonstrated that passive death wishes increases with age (of those 50-65 years of age, 5% have a passive death wish) (Ayalon and Shiovitz-Ezra 2011). Nonetheless, recently, a study among a representative sample of Dutch citizens aged 55 years and older (n ¼ 32,477), demonstrated no significant overall difference in age distribution between those having a persistent death wish without severe illness (n ¼ 267, 1.25%) and those without (Hartog et al 2020). As such, an ongoing debate in The Netherlands remains centered around the question of whether the Dutch government should allow legal support for selfdetermination, that is increased patient autonomy within the Euthanasia Act and its practice.…”