Questioning the value of present life: The lived experience of older people who see no future for themselves.

OBJECTIVES: To describe the lived experience of older people who see no future for oneself in the context of aging and the possible development of a wish to die. METHODS: Data were collected from 34 interviews with people of 55-92 years. A phenomenological hermeneutical analysis was performed using crafted stories as an analytical device. RESULTS: Four intertwined constituents together with the essence of the phenomenon provide a layered description of what it means to see no future for oneself. In all constituents: 1) not sharing everyday life, 2) looking for new commitments, 3) facing present losses and future fears and 4) imagining not waking up in the morning, the essence losing zest for life seeped through their daily experiences. CONCLUSIONS: As their horizon of future possibilities is shrinking, older people in our study experience a loss of zest for life and start to questioning the value of their present lives. And although a certain languishing mood can be discovered, the phenomenon 'seeing no future for oneself' does not entail a wish to die.

Turning grey is not a black-and-white experience: A phenomenological study on the lived experience of old age among Dutch Franciscan friars.

The lack of constructive cultural narratives of old age impedes older people from giving meaning to any difficult circumstances related to aging in which they might find themselves. In this study, we attempted to shed a different light on experiences of meaning in older age to contribute to sources for constructive counter narratives by gaining insight into (the experience of) meaning in old age of Dutch Franciscan friars. The research was a phenomenological in-depth interview study among twelve friars (mean age 80.6 years) following a reflective lifeworld design. The three main themes that emerged from the analysis were (i) 'brotherhood', illustrating a strong, axiomatic sense of connectedness, (ii) 'finitude', illustrating individual and relational confrontations with daily and existential finitude, and (iii) 'dynamic', illustrating opportunities for new possibilities, personal growth and being able to be receptive of the 'good' in daily life. Our findings showed that aging is a multidimensional process that is not exclusively characterized by decline and loss, but also offers substantial opportunities to experience (new) meaning. Occasionally, meaning seemed to arise as a result of (physical) decline. Our results illustrated that under circumstances of connectedness and togetherness, frailty and dependency do not necessarily form a threat to one's autonomy. Connectedness also showed itself to be a source for authenticity, which reinforced the Franciscans as autonomous moral agents.

Requests for euthanasia or assisted suicide of people without (severe) illness.

BACKGROUND: Some people request euthanasia or assisted suicide (EAS) even though they are not (severely) ill. In the Netherlands the presence of sufficient medical ground for the suffering is a strict prerequisite for EAS. The desirability of this 'medical ground'-boundary is currently questioned. Legislation has been proposed to facilitate EAS for older persons with "completed life" or "tiredness of life" in the absence of (severe) illness. OBJECTIVES: To describe the characteristics and motivations of persons whose requests for EAS in the absence of (severe) illness did not result in EAS and the decision-making process of medical professionals in these types of requests. METHODS: Analysis of 237 applicant records of the Dutch Euthanasia Expertise Center. We studied both the perspectives of applicants and medical professionals. FINDINGS: The majority of the applicants were women (73%) aged 75 years and older (79%). Applicants most often indicated physical suffering as element of suffering and reason for the request. Medical professionals indicated in 40% of the cases no or insufficient medical ground for the suffering. CONCLUSIONS: Physical suffering plays an important role in requests for EAS even for persons who are not (severely) ill. From the presence of physical suffering it does not necessarily follow that for medical professionals there is sufficient medical ground to comply with the 'medical ground'-boundary.

Older Adults Who Experience Their Lives to Be Completed and No Longer Worth Living: A Systematic Mini-Review Into Used Terminology, Definitions, and Interpretations.

In the Netherlands and in Belgium, a political debate emerged regarding the possibility of euthanasia and assisted suicide (EAS) for older adults who experience their lives as completed and no longer worth living, despite being relatively healthy. This mini-review aimed to (1) present an overview of the terms used to denote this phenomenon as well as their definitions and to (2) explore how the underlying experiences are interpreted by the study authors. A systematic search was performed in Web of Science, MEDLINE, PsycINFO, and CINAHL, yielding 35 articles meeting the selection criteria. We selected empirical, English-language articles published in peer-reviewed journals. Participants had to have a first-person experience of the phenomenon or be assessed for it, or have a third-person experience of the phenomenon. Results show that the terms tiredness of life (ToL) and weariness of life (WoL) were used most frequently, also in the broader literature on suicidal expressions across the life span. Many studies mentioned operational definitions or synonyms rather than theoretical definitions. Moreover, inside the EAS debate, the term ToL was more common, its definition incorporated death wishes, and it was regularly framed existentially. Outside of this debate, the phenomenon was generally considered as a part of suicidal ideation distinct from death wishes, and its experience was often associated with underlying psychopathology. We discuss the need to establish consensus definitions and conclude that only a multidimensional view may be suitable to capture the complex nature of the phenomenon.

Till Death Do Us Part: The Lived Experience of an Elderly Couple Who Chose to End Their Lives by Spousal Self-euthanasia.

PURPOSE: This article provides the first qualitative account of spousal self-euthanasia in older people, a previously unexplored phenomenon. It investigates the lived experience of a Dutch elderly couple who strongly wished-and chose-to die together at a self-directed moment, despite not suffering from a life-threatening disease or severe depression. It describes their subjective experiences and considerations prior to their self-chosen death. METHODS: The case study focuses on the particular experience of one elderly couple (aged above 70) by presenting two personal accounts from an insider perspective. These were analyzed using a thematic existential phenomenological method. RESULTS: Spousal self-euthanasia-which in the literature is associated with self-deliverance, self-determination, and a reasonable wish to die-is presented here as related to alienation from one's body and identity, the growing emptiness of life due to loss of activities, and an inability to reconcile oneself with one's changed "being-in-the-world." Their decision to end life is largely based on the anticipatory fear of further deterioration, further losing control, and not being able to control time and manner of death in the future. The couple's agreement to end their lives together, however, held both in an impasse, as their concerns, sense of time and logic differed significantly. In this case, a close relation between having a death wish and severe depression is questioned. IMPLICATIONS: This article concludes by outlining the practical implications for professionals working in gerontology and recommends further research on the relation between self-euthanasia and depression in elderly people.