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Kremeike K, Boström K, Preiser C, Dojan T, Voltz R. Desire to Die: How Does the Patients' Chorus Sound? OMEGA-JOURNAL OF DEATH AND DYING 2024; 90:318-335. [PMID: 35594497 DOI: 10.1177/00302228221103393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients receiving palliative care often express a desire to die. Forms and backgrounds of these expressions can be diverse. To contribute to a better understanding of this phenomenon, we analyzed patients' desire to die expressions reported by palliative care providers participating in 11 communication trainings on desire to die. The 102 participants were asked to reproduce related patients' statements from their everyday practice. The 165 reported statements could be assigned to the four topics: "Putting an end to life by …," "Social death," "Death images," as well as "Specific and unspecific references to life, death and dying." Across these topics, phrasing differs particularly regarding sentence type (interrogative, declarative, propositional, exclamatory), explicitness and (the way of) referencing others (e.g. attribution of power). The compilation of statements reflects a chorus of expressions, which the palliative care providers might hear throughout their professional career as well as during a patient's process(ing) of disease.
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Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Kathleen Boström
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Christine Preiser
- Faculty of Medicine, Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
- Centre for Public Health and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Appel JE, van Wijngaarden E, Dezutter J. Tiredness of Life - Conceptualizing a Complex Phenomenon. Psychol Rep 2024:332941241268815. [PMID: 39054766 DOI: 10.1177/00332941241268815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
A phenomenon referred to as 'tiredness of life' or 'weariness of life' appears in current discussions on the legitimacy of euthanasia for relatively healthy older adults as well as in research on suicidality more broadly. However, a consensus conceptualization of the phenomenon is lacking. In the current paper, we offer such a conceptualization by reviewing and integrating knowledge from terminology, available descriptions, and first qualitative findings. Boredom with life, aversion towards life, meaninglessness, and fatigue are identified as central components of the phenomenon. Per component, we describe how the component was identified, our definition of the component and its foundation in descriptions in the literature, and empirical studies on how the component relates to euthanasia requests and suicidality. Moreover, hypotheses on the structure of the phenomenon are outlined, such as on interactions among and the importance of the different components.
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Affiliation(s)
- Judith E Appel
- Meaning Research Late Life Lab, Faculty of Psychology and Educational Science, University of Leuven, KU Leuven, Leuven, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Els van Wijngaarden
- Meanings of Ageing and Dying Lab, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Jessie Dezutter
- Meaning Research Late Life Lab, Faculty of Psychology and Educational Science, University of Leuven, KU Leuven, Leuven, Belgium
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Satalkar P, van der Geest S. Divergent Views and Experiences Regarding 'Completed Life' and Euthanasia in the Netherlands. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1628-1646. [PMID: 34962847 PMCID: PMC10838475 DOI: 10.1177/00302228211066681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A small proportion of older people in the Netherlands want to end their lives because they feel their lives to be 'completed' and no longer worth living. Currently, there is heated debate over whether or not these people should have the right to euthanasia. Drawing on previous research, we conduct a heuristic analysis of views and experiences of three different 'parties' involved in this debate, namely, the older people, their relatives and friends and medical professionals. The views of these three groups tend to be divergent and conflicting, posing a difficult dilemma to decision-makers.
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Affiliation(s)
- Priya Satalkar
- Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Sjaak van der Geest
- Department of Medical Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Hafford-Letchfield T, Hanna JR, Ellmers TJ, Rasmussen S, Cogan N, Gleeson H, Goodman J, Martin S, Walker P, Quaife M. Talking really does matter: Lay perspectives from older people on talking about suicide in later life. Front Psychol 2022; 13:1009503. [PMID: 36467190 PMCID: PMC9709258 DOI: 10.3389/fpsyg.2022.1009503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/06/2022] [Indexed: 09/19/2023] Open
Abstract
Background The cumulative body of research on suicidality in later life describes its unique and complex features in older people when compared with that in other population groups. Yet significant gaps exist in how research informs the further development of suitable interventions. The perspectives of older people are also limited in research findings. Aims Therefore, this exploratory study aimed to (1) identify potential barriers and enablers in discussing suicidal thoughts and their expression in later life from the perspectives of lay older people and (2) explore where opportunities might occur in approach, place, relationships, and language with older people to discuss suicidal thoughts and their expression. Method We conducted in-depth qualitative individual interviews with 15 people aged 70-89 years. This method helped explore older peoples' own lay perspectives on suicidal thoughts in later life and how these are expressed, and their understanding of where and how people might seek support. Results A total of three themes were generated from the dataset: (1) intergenerational and socio-cultural differences in suicide expression, (2) the normalization of suicidal thoughts in later life, and (3) the importance and difficulties of everyday discussion and opportunities to express suicidal thoughts. Conclusion Suicidal thoughts and their expression appear commonly and are normalized in later life yet remain taboo and hidden. The participants revealed how such thoughts and behaviors are typically expressed through colloquial or "off-hand" remarks and comments and the importance of authentic listening. The findings highlight the importance of more informal discussions around these topics and how care professionals, practitioners, and providers might frame opportunities for dialogue with people who may want to access support. Further engagement with community-informed participatory research methods in which older people provide their own perspectives and experiences is important in addressing these gaps. There is a need for co-designing in developing screening, assessment, and signposting outside of clinical settings that can be used in everyday caring relationships with people in later life.
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Affiliation(s)
- Trish Hafford-Letchfield
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Jeffrey R. Hanna
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Toby J. Ellmers
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Susan Rasmussen
- School of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Nicola Cogan
- School of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Helen Gleeson
- School of Mental Health and Social Work, School of Education, Middlesex University, London, United Kingdom
| | | | - Sophie Martin
- School of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Patrick Walker
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Matthew Quaife
- School of Mental Health and Social Work, School of Education, Middlesex University, London, United Kingdom
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A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
As the body of research on suicide in later life has developed, so has its vocabulary. This has generated a high level of overlap in concepts and terminology used to articulate suicide and how it might present, as well as ‘grey area’ behavioural terms that are both specific to older adults and less well-defined (e.g. ‘hastening of death’ or ‘completed life’). A better understanding of individual experiences and pathways to suicide can help to inform assessment and interventions, and increase the potential to relate any theoretical concepts to the implementation of such. Here, we adopted a scoping review to search systematically literature on specific presentation, features, circumstances and outcomes of these grey areas of suicide in later life. Fifty-three articles (quantitative, qualitative and theoretical) were reviewed. A narrative approach was used to merge and translate this body of knowledge into a new conceptual framework based on four key themes: (a) a sense of completed life or existential loneliness; (b) death thoughts, wishes and ideation; (c) death-hastening behaviour and advanced directives; and (d) self-destructive or self-injurious behaviour. We discuss the importance of integrating this understanding into current knowledge and suicide prevention strategies for older adults. Recommendations are made for unifying research with policy themes on healthy ageing, person-centredness within service provision and citizen participation.
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Florijn BW. From Reciprocity to Autonomy in Physician-Assisted Death: An Ethical Analysis of the Dutch Supreme Court Ruling in the Albert Heringa Case. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:51-58. [PMID: 33355524 DOI: 10.1080/15265161.2020.1863510] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In 2002, the Dutch Euthanasia Act was put in place to regulate the ending of one's life, permitting a physician to provide assistance in dying to a patient whose suffering the physician assesses as unbearable. Currently, a debate in the Netherlands concerns whether healthy (older) people who value their life as completed should have access to assistance in dying based on their autonomous decision making. Although in European law a right to self-determination ensues from everyone's right to private life, the Dutch Supreme Court recently adopted a position on whether the Dutch Euthanasia Act lacks adequate attention to a patient's autonomous decision making. Specifically, in the Albert Heringa case, the Court ruled that the patient-physician relationship as understood in the Dutch Euthanasia Act limits this plea for more self-determination. This ethical analysis of the Heringa case examines how the Supreme Court's understanding of the Euthanasia Act defines patient autonomy within a reciprocal patient-physician relationship.
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Rupprecht FS, Martin K, Lang FR. Aging-related fears and their associations with ideal life expectancy. Eur J Ageing 2021; 19:587-597. [PMID: 34840544 PMCID: PMC8607224 DOI: 10.1007/s10433-021-00661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
Fears regarding various aspects tend to stimulate individuals to escape or to avoid the sources of the threat. We concluded that fears associated with the future aging process, like the fear of aging-related diseases, the fear of loneliness in old age, and the fear of death, would stimulate patterns of avoidance when it comes to ideal life expectancy. We expected fear of aging-related diseases and fear of loneliness in old age to be related to lower ideal life expectancies. We expected fear of death to be related to higher ideal life expectancies. In two adult lifespan samples [N1 = 1065 and N2 = 591; ages ranging from 18 to 95 years, M (SD)1 = 58.1 (17.2) years, M (SD)2 = 52.6 (18.1) years], we were able to support our hypothesis regarding fear of death. We furthermore found significant interactions among the fears, indicating that individuals fearing diseases or loneliness but being unafraid of death opted for the shortest lives. Our results indicate that fears regarding life in very old age might be associated with the wish to avoid this age period; the fear of death was however associated with the wish for particularly long lives, and thus, with distancing oneself from the dreaded event of death. We conclude that fears seem to be associated with how individuals approach old age and with what they wish for in their own future as aged people.
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Affiliation(s)
- Fiona S Rupprecht
- Institute of Psychogerontology, Friedrich-Alexander University of Erlangen-Nuremberg, Kobergerstr. 62, 90408 Nuremberg, Germany
| | - Kristina Martin
- Institute of Psychogerontology, Friedrich-Alexander University of Erlangen-Nuremberg, Kobergerstr. 62, 90408 Nuremberg, Germany
| | - Frieder R Lang
- Institute of Psychogerontology, Friedrich-Alexander University of Erlangen-Nuremberg, Kobergerstr. 62, 90408 Nuremberg, Germany
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van Wijngaarden E, Goossensen A, Leget C. The social-political challenges behind the wish to die in older people who consider their lives to be completed and no longer worth living. JOURNAL OF EUROPEAN SOCIAL POLICY 2018; 28:419-429. [PMID: 30443106 PMCID: PMC6196347 DOI: 10.1177/0958928717735064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the Netherlands, physician-assisted dying has been legalized since 2002. Currently, an increasing number of Dutch citizens are in favour of a more relaxed interpretation of the law. Based on an ethos of self-determination and autonomy, there is a strong political lobby for the legal right to assisted dying when life is considered to be completed and no longer worth living. Building on previous empirical research, this article provides a critical ethical reflection upon this social issue. In the first part, we discuss the following question: what is the lived experience of older people who consider their lives to be completed and no longer worth living? We describe the reported loss of a sense of autonomy, dignity and independence in the lives of these older people. In the second part, from an ethics of care stance, we analyse the emerging social and political challenges behind the wish to die. Empirically grounded, the authors argue that the debate on 'completed life in old age' should primarily focus not on the question of whether or not to legitimize a self-directed death but on how to build an inclusive society where people may feel less unneeded, useless and marginalized.
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Affiliation(s)
| | | | - Carlo Leget
- University of Humanistic Studies, The Netherlands
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