How is Planned Suicide Different Than Dying with Dignity?

Q. My neighbor, Sam, is a ninety-year-old widower who has lived alone in his home for several years. His health has deteriorated over the past few months and he frequently comments about how much he misses his wife. His daughter lives far away and only visits on holidays and special occasions. Sam barely manages to do his own cooking and cleaning. I try to help by providing transportation and running errands, but I’m not always available. Before his wife died, they were proponents of death with dignity, but I hadn’t heard anything mentioned since. However, he seems very depressed and withdrawn these days, and it scares me. What is the difference between death with dignity and planned suicide? What are things I can do as his friend to help him get over his depression and what should I do if he is in fact, suicidal?

A. This week, September 8 – 14, is National Suicide Prevention Week (and September is Suicide Prevention Month). It’s a time to share what we can do to prevent tragedies occurring with the ones we love and others around us.

Suicide is More Common for Seniors

According to the U.S. Centers for Disease Control, senior citizens are twice as likely to commit suicide as teenagers, and six times more likely to succeed in a suicide attempt. In the United States, a senior commits suicide every 66 minutes. That’s 21.7 senior suicides per day and 7,912 per year among those ages 65 and older. Though older adults make up only 15% of the population, they represent 18% of all deaths by suicide. Double suicides of spouses or partners are most prevalent among the aged.

Why Do Older Adults Commit Suicide?

There are several reasons that older adults wish to prematurely end their lives, and things you can do to help them. They include the following:

Depression: Depression is a common problem among older adults, but it is NOT a normal part of aging. Important life changes that happen as we get older may cause feelings of uneasiness, stress, and sadness. For instance, the death of a loved one, moving from work into retirement, or dealing with a serious illness can leave people feeling sad or anxious. After a period of adjustment, many older adults can regain their emotional balance, but others do not and may develop depression.

Depression causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, and working. Although depression is a common mood disorder, it can be serious and treatment is likely necessary.

What you can do to help: If a senior you care about is depressed, you can make a difference by offering emotional support. Listen to him or her with patience and compassion. Don’t criticize feelings expressed but point out realities and offer hope. You can also help by seeing that your loved one gets help from a doctor or therapist, an accurate diagnosis, and appropriate treatment. Help your loved ones find good doctors, accompany them to appointments if you can, and offer moral support. If your loved one mentions or attempts suicide, call 9-1-1 without delay!

Isolation/loneliness: 43% of seniors surveyed by the University of California in San Francisco said they feel lonely even if they don’t live alone. Research has found that when feelings of loneliness set in, it can increase the risk of depression, anxiety, overeating, malnutrition, alcohol abuse, and other mental and social health issues.
Unfortunately, many seniors today are lonely or isolated as more and more adult children and family members are moving away from their senior parents. This can often leave seniors completely alone and in a state of social isolation. A lack of social contact and low proximity to friends and family all breed more isolation, which often leads to depression.

What you can do to help: Isolation/loneliness is less likely when people’s bodies and minds remain active. Visit with your friend or invite him for an outing. Suggest activities to do together that your friend used to enjoy such as walks, an art class, a trip to the movies—anything that provides mental or physical stimulation. Group outings, visits from friends and family members, or trips to the local senior or community center can also help combat isolation and loneliness. Talk to your friend’s loved ones and set him up on Skype, if they are interested in connecting that way. Be gently insistent if your plans are refused.

Feeling like a burden: Many of us resist the idea of being dependent on others. We like being able to find our own way and make decisions ourselves. That pattern becomes even more prevalent as people age. More than that, we don’t want to burden the people around us.

What you can do to help: The idea of being a burden doesn’t sit well with most people. Yet, this thought pattern often makes things more difficult for families and for caregivers – especially those who want to offer support. Explain to your friend that his accepting help is actually easier and less stressful for those who care about him.

Loss of meaning or purpose: It’s also common for older adults to feel “useless” during retirement. After working for decades, many struggle with just relaxing and enjoying their free time. They feel the need to contribute to society in a meaningful way but are unsure or unable to achieve this goal.

What you can do to help: Experts advise that people seeking a sense of meaning or purpose consider spending more time on activities they enjoy or using work skills in a new way. For instance, if your loved one used to enjoy photography, you can help him to see joy in it once more. Also, people can get a sense of meaning or purpose from very simple things such as taking care of a pet, working in the garden, or even simply being kind to a neighbor.

Health problems: Illness and disability, chronic or severe pain, cognitive decline, damage to body image due to surgery or sickness can all be contributors to depression.

What you can do to help: Perhaps your neighbor needs a home health aide to come in and help. An aide can monitor pain, offer companionship, and provide more independence by helping the older adult remain at home. Or, maybe a more permanent solution such as assisted living or nursing home care, depending on how much assistance is needed. Talk to his daughter so she can help figure these things out and plan for them.

What Makes Suicide Different than Death with Dignity?

Most of us want to extend our lives for as long as possible. The self-preservation instinct is so strong that we hardly question it. But with some older adults, wanting to die is not uncommon, whether through suicide or the desire to die with dignity. These two things may seem similar, but there is a major difference between suicide and dying with dignity, as well as the motivations behind each.

• Suicide often involves people who are severely depressed and no longer want to live. Those considering suicide see no hope and do not recognize that their problems are treatable.

• Dying with dignity (medical aid in dying), in contrast, is refusing medical treatment when faced with a terminal or chronic illness — usually an illness accompanied by severe pain. People who seek medical aid in dying are suffering life-ending illnesses and understand that their condition is no longer treatable—there is no hope for a better outcome.

Choosing how to live one’s life is at the fundamental core of a person’s independence. This includes how to die as well as when, where, under what circumstances, by what method, and who will be there. Just as older adults want to have autonomy in life, most want to retain it until the end. To learn more about Death with Dignity and the states where it’s legal, please read my recent article, Would You Choose Death on Your Own Terms if You Had a Terminal Illness? In Ten States, it’s Legal.

Do You Have a Loved One who is Lonely or Depressed?

If have a loved one who is lonely and/or feeling isolated or depressed, spend some time together (and make sure he or she gets professional help, if needed). The feelings you create by showing you care can change how he or she interacts with others and improve his or her mood. Remember, the benefit of your visit (or a call, if you cannot visit) will likely last, so call and visit senior loved ones whenever you can.

If you or your loved ones don’t have your estate planning, incapacity planning, or long-term care planning in order, as always, please contact us for an appointment for a no-cost introductory consultation:

Elder Law Fairfax: 703-691-1888
Elder Law Fredericksburg: 540-479-1435
Elder Law Rockville: 301-519-8041
Elder Law DC: 202-587-2797

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