1
|
Kraak-Steenken FWM, Renckens SC, Pasman HRW, Bosma F, van der Heide A, Onwuteaka-Philipsen BD. Euthanasia and Physician-Assisted Suicide in People With an Accumulation of Health Problems Related to Old Age: A Cross-Sectional Questionnaire Study Among Physicians in the Netherlands. Int J Public Health 2024; 69:1606962. [PMID: 38698912 PMCID: PMC11064696 DOI: 10.3389/ijph.2024.1606962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives: We explored characteristics of people with an accumulation of health problems related to old age requesting euthanasia or physician-assisted suicide (EAS) and identified characteristics associated with granting EAS requests. Methods: We conducted a cross-sectional questionnaire study among Dutch physicians on characteristics of these people requesting EAS (n = 123). Associations between characteristics and granting a request were assessed using logistic regression analyses. Results: People requesting EAS were predominantly >80 years old (82.4%), female (70.0%), widow/widower (71.7%), (partially) care-dependent (76.7%), and had a life expectancy >12 months (68.6%). The most prevalent health problems were osteoarthritis (70.4%) and impaired vision and hearing (53.0% and 40.9%). The most cited reasons to request EAS were physical deterioration (68.6%) and dependence (61.2%). 44.7% of requests were granted. Granting a request was positively associated with care dependence, disability/immobility, impaired vision, osteoporosis, loss of control, suffering without prospect of improvement and a treatment relationship with the physician >12 months. Conclusion: Enhanced understanding of people with an accumulation of health problems related to old age requesting EAS can contribute to the ongoing debate on the permissibility of EAS in people without life-threatening conditions.
Collapse
Affiliation(s)
- Frédérique W. M. Kraak-Steenken
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Sophie C. Renckens
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Fenne Bosma
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| |
Collapse
|
2
|
De Groote M, De Raedt S, Van Humbeeck L, Van Hoeyweghen R, Nobels A, Van Den Noortgate N, Piers R. How strong is the will-to-live in frail older persons? A survey study in acute geriatric wards and nursing homes in Belgium. Aging Ment Health 2024; 28:302-306. [PMID: 37534457 DOI: 10.1080/13607863.2023.2242302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Will-to-live is defined as the psychological expression of one's commitment to life and the desire to continue living. It is an important indicator of subjective wellbeing. This study aimed to assess the will-to-live in frail older hospitalized patients and nursing home residents as well as to evaluate its association with physical frailty, tiredness of life, depression and wish-to-die. METHODS Between March and September 2021, we interviewed 186 older adults in six nursing homes and two acute geriatric wards across Belgium. Will-to-live was assessed using a single-item numeric rating scale from 0 to 5. A linear regression analysis was performed to assess the association between will-to-live and frailty (Clinical Frailty Scale) with adjustment for age, gender and setting. Mann-Whitney U test was used to evaluate the association between will-to-live and depression, tiredness of life and wish-to-die. RESULTS Mean age was 85 (± 6.2) years. Mean score on the Clinical Frailty Scale was five (± 1.5) and four on the will-to-live (± 1.3). No statistical significant association was found between will-to-live and age (p = 0.991), gender (p = 0.272), setting (p = 0.627) and frailty (p = 0.629). Multiple linear regression showed no significant association with Clinical Frailty Scale (p = 0.660), after adjustment for age, gender and setting. Will-to-live was negatively associated with tiredness of life (p = 0.020) and wish-to-die (p < 0.001), but not with depression (p = 0.186). DISCUSSION Both nursing home residents and older hospitalized patients expressed a strong or very strong will-to-live. Will-to-live was not associated with physical frailty as measured by the Clinical Frailty Scale. Nursing home residents with a weak will-to-live were more likely to have depressive symptoms. Most nursing home residents with a wish-to-die had also a low will-to-live, although some residents had both a high will-to-live and wish-to-die.
Collapse
Affiliation(s)
- Marie De Groote
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Soetkin De Raedt
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | | | | | - Anne Nobels
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
3
|
van den Berg VE, Thölking TW, Leget CJW, Hartog ID, Zomers ML, van Delden JJM, van Wijngaarden EJ. Questioning the value of present life: The lived experience of older people who see no future for themselves. Aging Ment Health 2023; 27:2457-2465. [PMID: 37036420 PMCID: PMC10578650 DOI: 10.1080/13607863.2023.2197850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/20/2023] [Indexed: 04/11/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Thessa W. Thölking
- Department of Anesthesiology, Pain and Palliative Medicine, Contemporary Meanings of Ageing and Dying, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Carlo J. W. Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, the Netherlands
| | - Iris D. Hartog
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- Comprehensive Cancer Organisation Utrecht, Utrecht, the Netherlands
| | - Margot L. Zomers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes J. M. van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Els J. van Wijngaarden
- Department of Anesthesiology, Pain and Palliative Medicine, Contemporary Meanings of Ageing and Dying, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| |
Collapse
|
4
|
Rubli Truchard E, Monod S, Bula CJ, Dürst AV, Levorato A, Mazzocato C, Münzer T, Pasquier J, Quadri P, Rochat E, Spencer B, von Gunten A, Jox RJ. Wish to Die Among Residents of Swiss Long-Term Care Facilities: A Multisite Cross-Sectional Study. J Am Med Dir Assoc 2022; 23:1935-1941. [PMID: 36202218 DOI: 10.1016/j.jamda.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The wish to die (WTD) in persons near the end of life is a clinically important, ethically and practically complex phenomenon as demonstrated by the intense debates on assisted dying legislation around the world. Despite global aging and increasing institutionalization in old age, WTD among residents of long-term care facilities (LTCF) is underexplored. We aimed to assess the prevalence of WTD and identify its predictors in older LTCF residents. DESIGN Multisite cross-sectional observational study. SETTING AND PARTICIPANTS 31 LTCF in the 3 major linguistic regions of Switzerland, including residents 75 years or older, admitted to the LTCF 4 to 10 months before the study, without severe cognitive impairment. METHODS Between February 2013 and June 2017, trained research staff interviewed residents to assess WTD using 2 validated instruments and collected information on potential predictors, including depressive symptoms, anxiety, demoralization, feeling to be a burden, spiritual distress, symptom burden, multimorbidity, and drug use. Demographic data were obtained by chart review. Descriptive statistics as well as univariate and multivariate regression analyses were performed. RESULTS From 427 eligible residents, 101 were excluded, 46 refused, and 280 were included in the study (acceptance rate 85.9%). In general, residents readily and openly addressed the topic of WTD. The prevalence of WTD was 16.0% and 16.2% according to the 2 instruments, with all but 1 of the residents expressing a passive WTD. The strongest independent predictors for a WTD were depressive symptoms (OR 7.45 and 5.77 for the 2 WTD assessment instruments) and demoralization (OR 2.62 and 3.66). CONCLUSIONS AND IMPLICATIONS The WTD is a relevant concern affecting approximately 1 in 6 LTCF residents. Further research is needed to investigate which interventions could best address the potentially modifiable factors that were associated with the WTD in this specific setting and population.
Collapse
Affiliation(s)
- Eve Rubli Truchard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéfanie Monod
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Véronique Dürst
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandro Levorato
- Servizio di Geriatria dell'Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Claudia Mazzocato
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Pierluigi Quadri
- Servizio di Geriatria dell'Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Etienne Rochat
- Institute for Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brenda Spencer
- Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Pilly, Switzerland
| | - Ralf J Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute for Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
5
|
Elzinga E, Zomers M, van der Burg K, van Veen S, Schweren L, van Thiel G, van Wijngaarden E. Lifelong versus not lifelong death wishes in older adults without severe illness: a cross-sectional survey. BMC Geriatr 2022; 22:885. [PMID: 36411442 PMCID: PMC9680128 DOI: 10.1186/s12877-022-03592-5] [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: 03/11/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some older adults with a persistent death wish without being severely ill report having had a death wish their whole lives (lifelong persistent death wish; L-PDW). Differentiating them from older adults without severe illness who developed a death wish later in life (persistent death wish, not lifelong; NL-PDW) can be relevant for the provision of adequate help and support. This study aims to gain insight into the characteristics, experiences, and needs of older adults with a L-PDW versus older adults with a NL-PDW and into the nature of their death wishes. METHODS In the Netherlands, in April 2019, a cross-sectional survey study was conducted among a large representative sample of 32,477 citizens aged 55 years and older. Respondents with a L-PDW (N = 50) were compared with respondents with a NL-PDW (N = 217) using descriptive statistics, Kruskal-Wallis tests, and Fisher's exact tests. RESULTS Respondents with a L-PDW were relatively younger and less often had (step)children. They less often looked back on a good and satisfying life with many good memories and more often reported trauma. Older adults with a NL-PDW more often reported loss and bereavement. Overall, the groups showed a lot of similarities. Both groups reported a death wish diverse in nature, numerous health problems, and a variety of needs for help and support. CONCLUSIONS Some of the differences we found between the groups might be particularly relevant for the provision of adequate help and support to older adults with a L-PDW (i.e., their past and trauma) and to older adults with a NL-PDW (i.e., their loss and bereavement). The heterogeneity of both groups and the diverse nature of their death wish indicate that careful assessment of the death wish, its background, and underlying needs is required to provide personalized help and support to older adults with a death wish.
Collapse
Affiliation(s)
- Elke Elzinga
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Margot Zomers
- grid.7692.a0000000090126352Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX Utrecht, the Netherlands
| | - Kiki van der Burg
- grid.7692.a0000000090126352Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sisco van Veen
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Psychiatry & Department of Ethics, Law and Humanities, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Lizanne Schweren
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands
| | - Ghislaine van Thiel
- grid.7692.a0000000090126352Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX Utrecht, the Netherlands
| | - Els van Wijngaarden
- grid.10417.330000 0004 0444 9382Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| |
Collapse
|
6
|
Hagens M, Pasman HRW, van der Heide A, Onwuteaka-Philipsen BD. Intentionally ending one's own life in the presence or absence of a medical condition: A nationwide mortality follow-back study. SSM Popul Health 2021; 15:100871. [PMID: 34337130 PMCID: PMC8318894 DOI: 10.1016/j.ssmph.2021.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
Abstract
In the Netherlands, people who wish to intentionally end their own life can request for physician assistance in dying (PAD). Having a classifiable medical condition is a prerequisite to receive PAD. Some people, either in the presence or absence of a medical condition, choose to end life without assistance from a physician. This study estimates the frequency of people who intentionally ended their own life, and describes their demographic and medical characteristics through a nationwide mortality follow-back study based on questionnaires from certifying physicians of a stratified sample of death certificates of people drawn from the central death registry of Statistics Netherlands (n = 7277). In 1.85% of all deaths in 2015 people intentionally ended their own life; of which 0.50% by voluntarily stopping eating and drinking, 0.20% by self-ingesting self-collected medication, and 1.15% using other methods. Estimating the frequency of suicide is influenced by definitions and the information sources. The great majority of people who ended life by voluntarily stopping eating and drinking were over 80 years old and suffered from an accumulation of health problems related to old age, somatic problems, and/or dementia. People who ended their own life through other methods were mostly under 65 years old and primarily suffered from psychiatric, psychosocial and existential problems. Few people who intentionally ended their own life requested PAD, especially those who suffered from solely psychiatric diseases and those without a medical condition. PAD in the Netherlands is embedded in the medical domain as it is currently understood by Dutch law. This raises the question how to address the desire to die from people whose wish to intentionally end their own life is not rooted in a medical condition and therefore fall outside this medical framework of assistance in dying. In the Netherlands, in 1.85% of all deaths people intentionally ended their own life. Death by voluntarily stopping eating and drinking accounts for 0.50% of all deaths. The majority of people who intentionally ended their own life had medical conditions. Few people who intentionally ended their life requested physician assistance in dying.
Collapse
Affiliation(s)
- Martijn Hagens
- Amsterdam Public Health Research Institute (APH), Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Office A-325, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Amsterdam Public Health Research Institute (APH), Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam Public Health Research Institute (APH), Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| |
Collapse
|