Abstract
BackgroundSome 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.MethodsWe 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.ResultsA 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.ConclusionsThe 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.
Highlights
Some older persons develop a persistent death wish without being severely ill, often referred to as “completed life” or “tiredness of life”
Our study shows that 1.25% of a representative sample of adults aged 55 and older report having a persistent death wish without being severely ill, based on their own perception of health assessed with validated self-report health measures
The lack of robust knowledge on the prevalence of older adults with a persistent death wish without severe illness and on their characteristics, existential issues and the nature of their death wishes has been an obstacle for decision making on the issue
Summary
Some older persons develop a persistent death wish without being severely ill, often referred to as “completed life” or “tiredness of life”. Even though the issue seems to get less attention in countries without legal options for euthanasia or physician-assisted suicide (EAS), the occurrence of persistent death wishes without severe illness seems to be a universal phenomenon. 75 were slightly higher for the PDW-NSI group than for the group who gave a negative answer to the differentiation question, there was no significant overall difference in age distribution. Half of the PDW-NSI group (52.1%) lived alone and 27.2% had no children, both higher proportions as compared to the group with a negative answer to the differentiation question (25.2 and 16.3% respectively). No significant differences between the subgroups were found for the other background characteristics
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