"Completed life": Older adults who have a death wish without being severely ill

Abstract

This dissertation is about older adults who have a death wish without being severely ill. Some older adults may come to the conclusion that even though they are not severely ill, the quality and the meaning of their life has deteriorated to such extent that they do no longer see a future for themselves and prefer death over life, leading to a death wish and sometimes also to a wish for a self-directed death. One commonly used expression for this experience is “completed life”.

In the beginning of 2019 when the work for this dissertation started, there was an ongoing public and political debate about “completed life”. The debate centered around the question whether older adults with “completed life” who are not eligible for EAS but wish for a self-directed death should have legal options for assisted dying. At the same time, due to the limited empirical knowledge that was available, arguments for and against offering such legal options were mainly ideological and theoretical in nature. For well-informed policymaking on how the death wish of older adults with “completed life” can be appropriately responded to, more empirical knowledge was required. There was insufficient empirical knowledge on how many older adults have a death wish without being severely ill, who these older adults are, what the background of their death wishes is, and how their requests for EAS are handled by medical professionals. This dissertation aimed to address this knowledge gap by answering the following research questions:

1. What is the prevalence of older adults with a death wish without severe illness? 2. How can older adults with a death wish without severe illness be described in terms of characteristics and circumstances? 3. What is the background of the death wish of older adults without severe illness considering the nature of the death wish, motivations and needs behind the death wish, and communication about the death wish? 4. How are requests for euthanasia and assisted suicide (EAS) of older adults with a death wish without severe illness decided upon by Euthanasia Expertise Center (EEC) and assessed by the Regional Euthanasia Review Committees (RTEs)? 5. In what ways can be appropriately responded to the death wish of older adults without severe illness in light of empirical findings?