Some psychologists/psychiatrists are just beginning to discuss the idea of rational suicide. That a person forced to live an intolerable life — with absolutely no chance of improvement — might rationally wish to end it. Journal articles are being written, and there’s even an academic book – Rational Suicide in the Elderly — Clinical, Ethical, and Sociocultural Aspects published in 2017.
However… this idea is far from being accepted. In fact, just voicing to your physician that you might consider suicide in the future — even if you state you are not considering it now — could be enough to find yourself involuntarily committed to a mental ward. At the very least, you are likely to be referred for psychiatric evaluation. And once you’ve been evaluated, that will become a permanent part of your medical record — which could color how hospitals/physicians see future actions of yours.
Medical/health professionals are trained to view suicide as something to be prevented at all costs. But this training developed primarily in response to young people taking their lives. Young people who believe their suffering will never end — despite the very real chances their suffering will end in the future.
Suicide in the elderly needs a different response.
Elderly considering suicide are irrational(?)
The most frightening part of the Rational Suicide book mentioned in the first paragraph is the “orthodox” view of psychiatrists and psychologists. They believe a desire for suicide in the non-terminal is by definition proof the person needs to be locked up and treated for mental disturbance.
In fact, the latest editions of the two most used diagnostic manuals for psychiatrists support the conclusion that “suicidal desire, behavior, and [thoughts] are products of mental Illness.” Further, “Because mental illnesses are conditions that require treatment, desires of patients with these illnesses are typically not viewed as rational.”
In other words, what you want doesn’t matter because you are mentally ill. And you are by definition mentally ill if you are considering suicide. Which means you are risking your freedom if you raise this idea with anyone in the health care field.
An ideal death
First, let’s agree that nobody starts out wanting to suicide. We’d all love to be active and healthy until a REALLY old age, then die in our sleep. Or have a very short time in bed — just enough for the family to gather around so we can say our goodbyes — and then die peacefully with no pain.
Unfortunately, life doesn’t guarantee us this kind of end.
Elderly are most afraid about how they die
This finding came from a recent study of 40 English people aged 80-89 who lived alone. Their prevalent fear was not dying, but how they would die. They feared developing a chronic, debilitating illness and being a burden to others. “It was important for them to have a choice about when and where to die.” (Lloyd-Williams, Kennedy, Sixsmith & Sixsmith — Journal of Pain Symptom Management)
“It can be neither irrational nor immoral to want to die in order to shorten a condition that lessens the self and carries unacceptable debility, dependency, and futile suffering.” (Prado in International Journal of Law Psychiatry)
Intolerable living with Alzheimers
For one example of intolerable life — you could cite the last two years of my father’s life. His Alzheimers caused him confusion that was frustrating, maddening, and even terrifying. While he had his moments of peace, he would also scream in terror. He was convinced people were conspiring against him and trying to hurt him. He felt absolute agony at some point every single day. Even in his moments of “peace,” he knew his brain was gone and it terrified him. He kept trying to pin down facts so he wouldn’t feel so desperate. I wanted so badly for him to die — to end his suffering. And I know he would also have preferred to be dead.
I know Alzheimers isn’t always this way. The husband of a friend is happy and calm as long as nothing changes in his environment. It’s hell on my friend, but her husband is happy.
Unfortunately, with Alzheimers, by the time you realize how bad it is, you are no longer capable of figuring out how to suicide.
Forced (intolerable) living
My aunt Ethel also had intolerable final months — but in a manner very different from my dad. Ethel, like the women in my family, was very independent. She moved to senior housing as she got more infirm in her 80s. But she had her own apartment and ran her own life and she was content. Then a physical problem put her in the hospital and she had to move to a nursing home to live. She had to have a roommate. The place had the TV on 24/7 and most of the women parked in front of it all day. And they talked to her. And talked. And kept talking.
This was as intolerable to Ethel, as it would be to me. She begged me to get her out of there. She cried and screamed in the night. She lasted there about six months before dying — and she hated every second of it.
I know many people would find that nursing home scenario to be no problem. Maybe even pleasant. To me it would be a living hell. My mother made me promise her something that resonated so strongly with me I’ve put it in my own Living Will. “If you must choose between putting me in a nursing home and dumping me by the side of the road — you are to dump me by the side of the road.”
We’re all different!
We’re all different in our needs. I had a boyfriend once who couldn’t stand to be alone. Ever. If he had two hours alone facing him — he’d go see a friend. Or an acquaintance. Even someone he didn’t know would be better than being alone. He might do well in a nursing home.
I need lots of alone time. The idea of being dependent on someone — anyone! — makes my skin crawl. The idea that someone else could control what I do with my day — this would be a living hell for me. If I can’t live in my own space, with my dogs, and control what I do and when I do it — that would be a fate much, much worse than death to me. After all, I know I will die and I know I’m getting closer to it. This thought is unpleasant — but it doesn’t terrify me. Living under the control of others does terrify me.
How about you? Is there a scenario in old age you would find worse than death?
Marlene Jensen is a 71-year-old full-time marketing professor. Previously she was a VP at CBS and ABC and spent decades as an entrepreneur and pricing author/consultant. Sadly, none of these prepared her for the onslaught of marketers who now think her daily interests/needs consist solely of hearing aids, wheel chairs, adult diapers, medi-alert buttons, medications, and bath tubs you walk into.