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Choosing to die in anticipation of age-related deterioration: reflections on a complex debate

Across the whole Western world, there is increasing public debate about the exercise of individual control over the timing and manner of death. More and more people, especially in old age, seem to be trying to take control over the way in which they die, as we see in practices such as advance directives, living wills, do-not-resuscitate medallions and – in a few countries – requests for assisted dying.

Recently, the BBC broadcast an intriguing documentary made by the British reporter Louis Theroux called ‘Choosing Death’. The programme has Theroux going to California, one of the few states in the US that offer people the option of ending their lives with a prescribed cocktail of drugs, provided that they are certified as being terminally ill, of sound mind, and strong enough to administer their own prescribed dose.

The documentary tells us the story of Debra, a woman who is living with the physical limitations and health problems resulting from a car crash, combined with what she assumes to be the first symptoms of early dementia. But, as Theroux states, she still makes a “vibrant, attractive and humorous” impression; a person who seems to have lots to live for. But Debra does not agree, arguing that: “I’m losing everything that makes life worth living. To me, my brain is what made life everything. And it’s no longer working like it used to.” We see Debra looking at a home-video of her younger self which shows her delivering a speech fluently. We also get to see a glance of a radiant wedding photo of her and her husband, who recently died, which left her heartbroken.

Afraid of what the future will bring her, and having a strongly defined ethos of autonomy, Debra wants to die on her own terms, at a time of her choosing. Since she does not meet the legal criteria for assisted suicide (not terminally ill), she is planning to end her life with assistance of the Final Exit Network, long before what would appear to be her natural time, a co-called pre-emptive death. As a viewer, I find myself torn, pondering over complex questions about how much control we should have over our own deaths.

Being a Dutch researcher and ethicist, I am trying to make sense of this worldwide tendency to control death, with a special focus on my own country. In the Netherlands, for years now, there has been an ongoing debate about whether we should broaden the current euthanasia law and allowing those who ‘tired of living’ or feel that their life is ‘complete’ to ask for euthanasia. Despite the absence of a serious medical disease, people want to have the option to choose death in anticipation of age-related deterioration and expected suffering. What should we make of this? How to respond in an ethical way?

In my research, my main focus is twofold. First, I try to understand the lifeworld of people like Debra; Why do these older people prefer life over death while not being terminally ill? What is at stake in their lives so that they come to consider their lives to be ‘completed’ and no longer worth living and prefer an anticipated, self-chosen death? Second, I also try to get a better grasp of the contextual drivers of such a wish to die. What is happening in our society that might incline people so readily to reach the conclusion that their life is no longer worth living? What is it that they increasingly wish to avoid ‘foreseen demeaning decline and suffering’ by a pre-emptive death?

In her book, The Coming of Age, the French philosopher Simone de Beauvoir reminds us that our image of ageing is always constructed within a community. The way that ageing and age-related decline are perceived depends a great deal on the personal goals that are socially validated as worthwhile. This means that a sense of worthiness – or the loss of it – can never be understood simply by reference to the circumstances and beliefs of a human being in isolation from a wider normative context. It’s never just ‘my choice, my decision’. Rather, the categories with which such an ultimate choice is articulated are always socially constructed. So if we really want to understand the motives of older people that lead them to choose death, and to make sense of this choice, it is thus of utmost importance that we should also examine the social, political and ideological structures in which these choices are embedded. For scholars in ageing studies, this is a challenging and worthwhile task.

About the Author

Els van Wijngaarden was an Academic Visitor at the Oxford Institute of Population Ageing in Feb-March 2018. She is based in Utrecht, The Netherlands, where she works as an assistant professor in Care Ethics at the University of Humanistic Studies.

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