What does a good death look like when you're really old and ready to go?

May 25, 2018 by Naomi Richards, The Conversation

Hawaii recently joined the growing number of states and countries where doctor-assisted dying is legal. In these jurisdictions, help to die is rarely extended to those who don't have a terminal illness. Yet, increasingly, very old people, without a terminal illness, who feel that they have lived too long, are arguing that they also have a right to such assistance.

Media coverage of David Goodall, the 104-year-old Australian scientist who travelled to Switzerland for assisted dying, demonstrates the level of public interest in at the extremities of life. Goodall wanted to die because he no longer enjoyed . Shortly before his , he told reporters that he spends most of his day just sitting. "What's the use of that?" he asked.

Research shows that life can be a constant struggle for the very old, with hard to sustain and health increasingly fragile. Studies looking specifically at the motivation for assisted dying among the very old show that many feel a deep sense of loneliness, tiredness, an inability to express their individuality by taking part in activities that are important to them, and a hatred of dependency.

Of the jurisdictions where assisted dying is legal, some make suffering the determinant (Canada, for example). Others require a prognosis of six months (California, for example). Mainly, though, the focus is on people who have a terminal illness because it is seen as less of an ethical problem to hasten the death of someone who is already dying than someone who is simply tired of life.

Why give precedence to physical suffering?

Assisted dying for people with psychological or existential reasons for wanting to end their life is unlikely to be supported by doctors because it is not objectively verifiable and also potentially remediable. In the Netherlands, despite the legal power to offer assistance where there is no life-limiting illness, doctors are seldom convinced of the unbearable nature of non-physical suffering, and so will rarely administer a lethal dose in such cases.

David Goodall died listening to Beethoven’s Ode to Joy.

Although doctors may look to a physical diagnosis to give them confidence in their decision to hasten a patient's death, physical symptoms are often not mentioned by the people they are assisting. Instead, the most common reason given by those who have received help to die is loss of autonomy. Other common reasons are to avoid burdening others and not being able to enjoy one's life – the exact same reason given by Goodall. This suggests that requests from people with terminal , and from those who are just very old and ready to go, are not as different as both the law – and doctors' interpretation of the law – claim them to be.

Sympathetic coverage

It seems that the general public does not draw a clear distinction either. Most of the of Goodall's journey to Switzerland was sympathetic, to the dismay of opponents of assisted dying.

Media reports about ageing celebrities endorsing assisted dying in cases of both and very old age, blur the distinction still further.

One of the reasons for this categorical confusion is that, at root, this debate is about what a good death looks like, and this doesn't rely on prognosis; it relies on personality. And, it's worth remembering, the personalities of the very old are as diverse as those of the very young.

Discussion of assisted suicide often focuses on concerns that some may be exposed to coercion by carers or family members. But older people also play another role in this debate. They make up the rank and file activists of the global right-to-die movement. In this conflict of rights, protectionist impulses conflict with these older activists' demands to die on their own terms and at a time of their own choosing.

In light of the unprecedented ageing of the world's population and increasing longevity, it is important to think about what a good death looks like in deep old age. In an era when more jurisdictions are passing laws to permit doctor-assisted dying, the choreographed death of a 104-year-old, who died listening to Ode to Joy after enjoying a last fish supper, starts to look like a socially approved good death.

Explore further: 'Suicide tourism' and understanding the Swiss model of the right to die

Related Stories

'Suicide tourism' and understanding the Swiss model of the right to die

May 24, 2018
Two weeks ago, the 104-year-old Australian scientist David Goodall flew from his home in Western Australia to Switzerland to access assisted suicide with the help of lifecircle and Exit International, two right-to-die societies.

Australian centenarian commits assisted suicide in Switzerland

May 10, 2018
A 104-year-old Australian scientist on Thursday committed assisted suicide in Switzerland where he went to die after his home country denied him the right to seek help in taking his own life.

Australia scientist, 104, heads to Switzerland for assisted dying

April 30, 2018
Australia's oldest scientist, who caused a stir when his university tried to vacate his office aged 102, will fly to Switzerland in early May to end his life, reigniting a national euthanasia debate.

Case for assisted dying 'stronger than ever' says The BMJ

February 7, 2018
A series of articles published by The BMJ today, explore the debate around assisted dying, in which, subject to safeguards, terminally ill people who are near to death, suffering, and of sound mind, could ask for drugs that ...

People with Huntington's want more openness around assisted dying

December 7, 2017
Research has shown that better communication around assisted dying is needed between clinician and patients diagnosed with Huntington's Disease.

Australia's oldest scientist heads to Switzerland to end life

May 3, 2018
Australia's oldest scientist, wearing a top labelled "ageing disgracefully", has left the country for Switzerland to end his life at the age of 104, saying he is resentful that he must go overseas to die.

Recommended for you

Students more likely to eat school breakfast when given extra time, new study finds

August 18, 2018
Primary school students are more likely to eat a nutritional breakfast when given 10 extra minutes to do so, according to a new study by researchers at Virginia Tech and Georgia Southern University.

Like shark attack and the lottery, unconscious bias influences cancer screening

August 17, 2018
What do shark attack, the lottery and ovarian cancer screening having in common? It turns out our judgments about these things are all influenced by unconscious bias.

Phantom odors: One American in 15 smells odors that aren't there, study finds

August 16, 2018
Imagine the foul smell of an ash tray or burning hair. Now imagine if these kinds of smells were present in your life, but without a source. A new study finds that 1 in 15 Americans (or 6.5 percent) over the age of 40 experiences ...

US drug overdose deaths surge amid fentanyl scourge

August 16, 2018
US drug overdose deaths surged to nearly 72,000 last year, as addicts increasingly turn to extremely powerful synthetic opioid fentanyl as the supply of prescription painkillers has tightened.

Parental life span predicts daughters living to 90 without chronic disease or disability

August 15, 2018
Researchers at the University of California San Diego School of Medicine report that women whose mothers lived to at least age 90 were more likely to also live to 90, free of serious diseases and disabilities.

Eating breakfast burns more carbs during exercise and accelerates metabolism for next meal

August 15, 2018
Eating breakfast before exercise may "prime" the body to burn carbohydrates during exercise and more rapidly digest food after working out, University of Bath researchers have found.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

rpavellas
not rated yet May 26, 2018
I am age 81, in good health. I project that, barring accident, I could live to 95 or 100. Imagining myself beyond that age is difficult. I have 'joked' with my wife (younger by 17 years) and other relatives that when I no longer feel useful to myself and others, I'll take a (metaphorical?) walk in the woods. This is not a strong notion, but a notion nonetheless. My father, who lived to 87, had a similar notion but clung to life until a painful and widespread cancer took him. My maternal aunt suffered many years of physical and existential pain, voicing the desire to die, but, as with my father, clung to life even more tenaciously than my father. I conclude that no matter what my perspective may be, currently, I may have a different outlook at age 100, or beyond...?

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.