Is Suicide a “Rational” Option for Seniors?

Robert Shoots was a retired house painter who was happily remarried and enjoyed good health. He went fishing and played golf often, showing no signs of depression or other mental illness. Yet, Shoots took his own life, and he planned for it for a while.

According to Shoots’ daughter, “All the people he knew were dying in hospitals, full of tubes, lying there for weeks, and he was just horrified by it. He was determined to avoid that kind of death.” So, one March morning, Shoots ran a tube from the tailpipe of his beloved old Chrysler to the front seat, where he sat with a bottle of Wild Turkey. He was 80.

Shoots’ daughter was not surprised about his suicide when she found him dead in his garage. He suffered from chronic illnesses and pain and, years earlier, he had told her of his intentions. He was certain of his decision, so she wouldn’t have even tried to dissuade him against it. She just wished that he had mentioned that he was going to do it that day, so should could’ve said a satisfying goodbye to him.

Is Suicide by Older Adults Ever a “Rational” Choice? 

The term “rational suicide” was first used in an article by David J. Mayo, PhD, that was published in the Journal of Medicine and Philosophy in 1986. Since then, the concept has been written about frequently. Currently, the term is used with regard to a person with free choice, sound decision-making skills, and what they consider an unremitting, “hopeless” physical condition.

The topic of rational suicide in older adults is one that many older people discuss among themselves and sometimes with others — and is one that physicians increasingly encounter, too. Yet most physicians have scant training or experience in how to respond, said Dr. Meera Balasubramaniam, a geriatric psychiatrist at the New York University School of Medicine.

According to Dr. Balasubramaniam, “I found myself coming across individuals who were very old, doing well, and shared that they wanted to end their lives at some point. So many of our patients are confronting this in their heads.” Some of the reasons she and others have for seniors contemplating suicide include:

  • concerns over overly aggressive care at the end of life and of unrelenting suffering;
  • negative perceptions toward aging and dependency (i.e. not wanting to be a burden on family members);
  • a diagnosis of a debilitating disease (i.e. dementia, Parkinson’s etc.);
  • chronic illness and pain;
  • social isolation, loneliness, and depression;
  • increasing access to drugs;
  • loneliness from having loved ones die or move far away;
  • greater need for autonomy; and
  • the desire to end their lives on their own terms.

Unfortunately, many people see aggressive medical interventions, unrelieved suffering, and the other reasons listed above at the end of life as avoidable only through premature self-inflicted death. Luckily, there are ways to help seniors mitigate the desire for suicide, as we will explore later in this article.

The Growing Acceptance of “Rational Suicide” with the Assistance of a Physician

Attempted suicide is technically illegal — though rarely prosecuted. However, the growing aceptance of Physician Assisted Death (PAD) plays an important role in changing attitudes towards “rational suicide.” Many right-to-die supporters hold the view that we must all die at some point, and the vast majority of us will die in old age. Some people would like to exercise control over when and under what circumstances their death occurs, while others don’t think doing so (with or without the help of a physician) is ethical.

You may be wondering if PAD is legal. Currently, PAD is strictly prohibited in Virginia, as it is in most other states. At this time, California, Colorado, District of Columbia, Oregon, Vermont, and Washington have Death with Dignity statutes allowing physician-assisted suicide for terminally ill or otherwise suffering individuals who wish to end their lives, although the DC law could be overturned by the federal government. There is currently no legislative activity around Death with Dignity in Virginia. Individuals are working to raise the profile of aid in dying in Virginia through news stories, petitions, and other individual advocacy, but no group is on the ground organizing for physician-assisted dying.

In Maryland, a Death with Dignity law was considered in 2017, but was not passed, supposedly due to lack of public support.

In DC, PAD is legal, but patients must be older than 18 with less than six months to live to be eligible. Please see our article on the subject for more details.

Mitigating the Desire for “Rational Suicide”

Those contemplating “rational suicide” need to know that there are other options. In order to mitigate the desire for rational suicide in older adults, it is important that primary care physicians, geriatric care providers, family, and friends develop more of an awareness of this issue.

What Doctors Can Do

Doctors need to play a bigger role in helping patients to alleviate loneliness and social isolation by assisting them in finding programs that provide community and human contact with other people. Expanded options for dealing with chronic pain would also be helpful. Meaning-centered psychotherapy, dignity therapy (which stresses improving quality of life and connection to family), social work for increased resources, and spiritual options could also be helpful for seniors that could be contemplating suicide.

What Loved Ones and Community Members Can Do

As loved ones, we can start with our own family members, friends, and neighbors. Look for ways to assist an older person that he or she might not have considered or be too embarrassed to ask about. Spend some time with loved ones and lonely community members (and make sure they get professional help, if needed.) Teaching seniors how to use technology could also be a way for them to better connect with friends and family members who live far away. If you or a loved one is considering harming himself or herself, or is having other dark thoughts, call 911, go to the nearest emergency room, contact a private mental health provider, or contact the National Suicide Prevention Lifeline at 800-273-TALK (8255), text “help” to the Crisis Text Line at 741-741 or go to suicidepreventionlifeline.org.

Now is the Time to Get Your Advance Directive and Other Documents in Place

No one can precisely predict the exact life changes that’ll occur during the course of your life. And no one can predict the type of health care setting he or she will need or how quickly the disease will progress. That’s why planning in advance is so important. Once you have taken the step of speaking with your loved ones about your wishes, it is important to develop incapacity planning documents, including an Advance Medical Directive (including our proprietary Long-term Care Directive, which is an essential part of our Advance Medical Directive and something you will only find at our firm, as I have spent the last 20 years developing this document), to make your wishes known. If you or a loved one has not done Incapacity Planning, Long-Term Care Planning, or Estate Planning (or had your Planning documents reviewed in the past several years), now is a good time to plan and get prepared. Call us to make an appointment for a no-cost initial consultation:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-143
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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