The social–political challenges behind the wish to die in older people who consider their lives to be completed and no longer worth living (original) (raw)
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Autonomy and dying: Notes about decision-making and “completed life” euthanasia in the Netherlands
Death Studies
Euthanasia in the Netherlands is based on the notion that the person seeking assistance to die is able to make an autonomous decision. The objective of this study is to explore this notion, in particular, in the case of "tiredness of life." The article is mainly based on two qualitative researches and two selected case histories that provide an in-depth insight into the complex process of (not) reaching a clear decision. We found three obstacles that cast doubt over autonomous decision-making in the face of death: (1) Doctorsnot patientshave the final say in "measuring" the "amount" of pain and suffering that entitles a person to be granted euthanasia.
2017
Based on an ethnographic fieldwork done at the Dutch "right to die" organisation in the Netherlands, I explore and discuss the Western perception on autonomy, identity, and independency in relation to old age. After about thirty years of debate, the Netherlands legalised assisted dying in 2002. The law was first and foremost for those who were terminally ill or had a chronic illness. The Dutch "right to die" organisation, NVVE, had an essential role in the legalisation of assisted dying in the Netherlands. With influence within politics and frequently having a place in the Medias spotlight, NVVE has grown to be an organisation that expands all over Netherland. are an essential part of this thesis. To be able to receive assisted dying, one needs to fulfil the due care criteria. Several groups within the Dutch society feels discriminated because of the criterions. By making the law available for those who experience unbearable suffering, the people diagnosed with dementia, individuals with a mental illness or those who are tired of life, are not able to request and receive assisted dying. The baby boom generation will be and are responsible for the biggest group of elders in our time. Their ideals concerning independency, identity, and autonomy tends to influence the way we think about our health and becoming old. What happens when these factors are threatened by old age? The fear of dying without autonomy, control, and identity has led to a new conception death. The fact that many Dutch citizens cannot reives assisted dying has led the NVVE to invent a new legitimised concept-the autonomous route. This method is especially relevant for elders in the fourth age. Consequently, the society could lose some of its diversity were the elders or people diagnosed with dementia will be ones who suffer. To be in control and keep autonomy are important factors when dying a good and dignified death. However, the need to state what is considered a "good" or a "bad" death has led the organisation to push boundaries.
2016
This PhD-thesis is about older people who consider their lives to be ‘completed’, who suffer from the prospect of having to live on and therefore prefer a self-chosen death. This is not a new issue. What is relatively new, though, is the current Dutch debate about whether we should legalize, facilitate and institutionalize assisted dying in such cases. Should older people who come to a well-considered conclusion that life is over have the right to assisted dying? In order to develop a careful and morally responsible policy, it is a prerequisite to first gain deeper understanding of this phenomenon. Essential questions should be addressed, such as: What exactly does it mean that life is considered to be completed? What are the underlying motivations and experiences? Remarkably very little empirical research has been done into this specific phenomenon of completed life in old age. Therefore, we performed the first empirical study worldwide into the lived experiences of older people who consider their lives to be completed and want to terminate their lives at a self-directed moment, without being severely physically or mentally ill. The central research questions were: 1. What is the lived experience of older people who consider their lives to be completed and no longer worth living (without evidence of a life-threatening disease or a psychiatric disorder)? 2. What does it mean to live in-between the intention to end life at a self-directed moment and actually performing a self-directed death (or not)? 3. How can the gained empirical insights (resulting from research questions 1 and 2) be connected with the ethical debate on completed life in old age and what considerations can be developed from a care-ethical understanding of emerging social dilemmas?
Divergent Views and Experiences Regarding ‘Completed Life’ and Euthanasia in the Netherlands
OMEGA - Journal of Death and Dying, 2021
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.
Social Science & Medicine, 2015
In the Netherlands, there has been much debate on the question whether elderly people over 70 who are tired of life and who consider their life to be completed, should have legal options to ask for assisted dying. So far there has been little research into the experiences of these elderly people. In order to develop deliberate policy and care that targets this group of elderly people, it is necessary to understand their lifeworld. The aim of this paper is to describe the phenomenon 'life is completed and no longer worth living' from a lifeworld perspective, as it is lived and experienced by elderly people. Between April to December 2013, we conducted 25 in-depth interviews. A reflective lifeworld research design, drawing on the phenomenological tradition, was used during the data gathering and data analysis. The essential meaning of the phenomenon is understood as 'a tangle of inability and unwillingness to connect to one's actual life', characterized by a permanently lived tension: daily experiences seem incompatible with people's expectations of life and their idea of whom they are. While feeling more and more disconnected to life, a yearning desire to end life is strengthened. The experience is further explicated in its five constituents: 1) a sense of aching loneliness; 2) the pain of not mattering; 3) the inability to express oneself; 4) multidimensional tiredness; and 5) a sense of aversion towards feared dependence. This article provides evocative and empathic lifeworld descriptions contributing to a deeper understanding of these elderly people and raises questions about a close association between death wishes and depression in this sample.
Being a burden to others and wishes to die: The importance of the sociopolitical context
Bioethics, 2019
May 2019's special issue of Bioethics stated, a highly complex as well as extremely relevant issue with regard to end-of-life care practices and ethics. 1 All contributions to the special issue offer new and very valuable insights. Nevertheless, we think that the influence of the sociopolitical context on both the phenomenon "being a burden" in relation to wishes to die and the empirical study of this phenomenon deserve more attention. Our view follows from the theoretical background of care ethics, which focuses on care as both a social and political practice, and from our experiences with research on physician-assisted dying in the Netherlands. The sociopolitical context includes the informal and formal norms as found in institutions or society as a whole and that can be, but do not have to be, laid down in laws, regulations and policies. The authors of the special issue already briefly touch on elements of the sociopolitical context that could impinge on the experience of being a burden, such as cultural factors, 2 gender norms 3 and attitudes of healthcare staff. 4 They discuss the possible influence of
Anthropology & Aging, 2021
In this reflective essay, we explore the concept of generativity and propose it as a more positive interpretation of the experience of ‘completed life’ and its bearing on the wish to die. In 2010, more than 100,000 people in the Netherlands signed a petition requesting an extension of the existing euthanasia legislation. They asked the government to grant euthanasia to older persons who feel tired of life and who regard their lives as complete, in the absence of physical or psychic sickness. Debates about ‘completed life’ euthanasia have continued since then, but the various factions in these debates have been unable to reach consensus or conclusion. In this paper, we analyse the concept of generativity and use this to interpret statements by supporters of ‘completed life’ euthanasia. Next, we disentangle common idioms that people use when they grow older and feel that death is approaching yet still out of reach. The aim of this article is to invite readers to reflect on the wish fo...
“Old age is cruel”: The right to die as an ethics for living
The Australian Journal of Anthropology, 2018
In debates over medically assisted dying right to die activists are often accused of embracing anunbridled neoliberal individualistic ethics that devalue life and reject notions of community andcare. Through an ethnographic study of activists in North America and Australia, this articleaims to complicate this point of view by showing how they are deeply invested in what it meansto act morally in the world vis-a-vis their relationships with others and how they envisage thisissue within an ethics of care. Although activists are often accused by opponents of delegitimis-ing the ageing process and relying on atomised individual values, in depth interviews with rightto die activists reveal complex, ambiguous and contradictory reflections on the ageing processas a dominant source of suffering while defending an ethics of care and life. In the end, this arti-cle argues that the right to die paradoxically constitutes an ethics for living.
European Journal of Health Law, 2011
Two matters that have a significant presence in the contemporary Dutch assisted dying debate, are the nature of the suffering required for an assisted death to be lawful, and the issue of who can lawfully assist. This article explores whether the lawful medical assisted dying model is too restrictive in failing to recognise existential suffering, considering selected case studies involving such suffering and lay assisted death. It addresses the question whether the Netherlands would take a trip down a slippery slope if the lawful model of assisted death were extended to cases where individuals are ‘tired of life’.
Journal of Moral Philosophy, 2020
Several Dutch politicians have recently argued that medical voluntary euthanasia laws should be extended to include healthy elderly citizens who suffer from non-medical ‘existential suffering’ (‘life fatigue’ or ‘completed life’). In response, some seek to show that cases of medical euthanasia are morally permissible in ways that completed life euthanasia cases are not. I provide a different, societal perspective. I argue against assessing the permissibility of individual euthanasia cases in separation of their societal context and history. An appropriate justification of euthanasia needs to be embedded in a wider solidaristic response to the causes of suffering. By classifying some suffering as ‘medical’ and some as ‘non-medical’, most societies currently respond to medical conditions in importantly different ways than they do to non-medical suffering. In medical cases, countries like the Netherlands have a health care, health research and public health system to systematically assign responsibilities to address causes of medical suffering. We lack such a system for non-medical suffering among elderly citizens, which makes completed life euthanasia importantly different from euthanasia in medical cases. Because of this moral ‘responsibility gap’, focusing on the permissibility of completed life euthanasia in separation of wider societal duties to attend to possible causes is societally inappropriate. To spell out this objection in more philosophical terms, I introduce the concept of acts that are morally permissible but contextually problematic.