‘Couldn’t care less:' What older people who are ‘tired of life’ can tell us about assisted dying

I can totally relate to tiredness of life. Guess what? I saw a beautiful sunrise yesterday morning, acknowledged it, and couldn’t care less if I saw another one.

Nina* is a 72-year-old woman in reasonably good health. She talked to one of us (Sam) recently about her life – and in particular, the sense that she had grown tired of being alive and was ready for the exit.

Nina wasn’t feeling suicidal or filled with anxiety and depression, but she was certain that she was ready to die. Living, she said, had become a burden. In Nina’s case, not only did this mean that she felt like a burden to society, but also that life felt a burden to her.

You know, other people [family and friends] don’t get it. But I believe this is actually a positive thing, because it means I am less and less attached to Earthly things – to being alive.

In our interviews with older people over the past 15 years, some have described the phenomenon of “tiredness of life” in this matter-of-fact way – as though they are talking about the weather. The condition is not, as some might imagine, always accompanied by a flurry of distress, anxiety or panic.

The debate around assisted dying in the UK has intensified because of the terminally ill adults (end of life) bill, which cleared its second reading in the House of Commons on November 29. (This bill applies to England and Wales. A separate bill is due before the Scottish parliament, but the Scottish government has indicated the bill could not be brought into force without the co-operation of the UK government.)

A concern expressed by many opponents of the bill is that it could encourage the idea that people who feel as though they are a burden – or simply that life itself is a burden – should consider ending their life, putting particular pressure on the more vulnerable in society, including disabled people.

A number of countries, including the Netherlands, Belgium, Switzerland, and Canada, have already legalised various forms of assisted dying, whereby patients self-administer life-ending medication, and euthanasia, where a doctor administers it directly. If the UK parliament bill is passed into law – and there are still many stages to go – then irremediable suffering from a terminal medical condition would be a strict legal criterion for someone to have the legal right to end their life. But critics of the bill have also raised concerns about the potential for this legal definition to be extended in the future.

In the Netherlands, there has been a significant recent rise in euthanasia cases granted for psychological suffering, highlighting how non-terminal conditions – including profound existential distress, such as tiredness of life – are increasingly being considered there. In Belgium, around 20% of 3,423 reported cases of euthanasia between January 2022 and December 2023 did not involve people with a terminal condition.

Our interest in this issue stems from discussions with older people in many European countries about their day-to-day experiences of the late stages of life. We are not advocating for either side of the UK parliament bill, but believe the fact that some people grow tired of life – a condition that has been repeatedly and very lucidly expressed to us – should be discussed openly and thoughtfully as part of the debate, and to inform how best to support countries’ growing populations of older people.

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Research spanning the past 30 years shows this condition has often been described in academic literature under terms such as “completed life”, “finished with life”, or “existential suffering” in older people. Its core characteristics have tended to be a sense of existential loneliness, a wish to hasten death, and a demoralisation with being alive.

In 2000, a Dutch court examined the landmark case of 86-year-old former politician Edward Brongersma, who had requested euthanasia from his doctor, Philip Sutorius, due to his longheld belief that life had become meaningless after the death of his friends and family. Sutorius ultimately complied with his patient’s request, providing him with a lethal cocktail of drugs which the patient self-administered.

Sutorius was subsequently put on trial because Brongersma’s tiredness of life was not deemed to meet the legal requirement of “hopeless and unbearable suffering”. In the end, the court cleared the GP of wrongdoing, acknowledging the patient’s deep suffering. An appeal court reversed this decision but imposed no punishment, recognising Sutorius had “acted out of concern for his patient”.

This case exemplifies how existential suffering can challenge legal and ethical boundaries in euthanasia law. Our work in the Understanding Tiredness of Life in Older People network – a European consortium we set up in 2022 to coordinate and promote research efforts around the experience – seeks to contribute to this complex and often polarised debate.

We believe it is important to air the thoughts and experiences of people like Nina, who was living alone following a divorce in her 60s when she was interviewed. She reflected:

There is an increasing sense of suffering that I try to live with. It’s connected to a feeling that being alive is less and less appealing than the alternative … I feel I have lived my life as fully as was humanly possible. Now I want to drop my body at any time.

‘Maybe we are tired of living this way?’

After introducing the concept of tiredness of life in a 2023 Conversation article, I (Sam) received letters and emails from people around the world who recognised the concept in themselves, their family or friends. One, Ray, wrote to say he was “very happy that people are seeing the problem” – and that, “while no solutions are being presented … at least it is being talked about now”. He went on to explain his own life situation:

I am 67 and retired. I feel most of the time that society in general wants to push me to the back burner, or maybe just wants me to disappear. My list of friends is dwindling now, as some have gone through or are starting to go through an end-of-life situation. Several have lost their spouses to dementia or cancer, and without their lifelong spouse, they just slowly fade. Eventually, they stop answering phone calls or showing up for weekly lunches.

Illustration of an older man with a cap holding his face and looking sad

NCStock/Shutterstock

Ray’s reflections, like those of many we’ve encountered in our research, appear to stem from a sense of existential exhaustion that is not necessarily tied to clinical depression or a psychiatric condition, but rather to the accumulation of losses that come with ageing. This is something that stands alone and, in our view, deserves acknowledgement – and medical, psychological and societal support.

In his letter, Ray added: “I’m not sure most people have the slightest idea about the existential realities of being an older person in the modern world … Maybe we just want to feel needed again, and are tired of living this way?”

Our network’s research suggests common byproducts of ageing include a loss of meaning and identity as well as health and fitness, a profound sense of boredom, and sometimes an “aversion to life”. In 2015, Greta, aged 87 and living in a nursing home, explained to me (Els) how this feeling came about in her:

I am treated as a person … but for myself, I see nothing – nothing but blackness. You cannot care for people any more. You lose so much that you are no longer human. That’s how I feel about myself.

What some older people say about their inner life can be hard to hear, and difficult to accept – especially if they are a close relative experiencing such profound suffering. Greta said she always had a passion for art, and her room in the nursing home was full of expressive pictures she had painted over her lifetime. But due to a deterioration in her eyesight, she now felt a deep sadness at the loss of the “colourful world” she had loved so much:

When I was 58, I retired [and] said: ‘I am going to paint.’ Everyone laughed at me, but I used to draw when I was little. In a way, it has always been my talent. In spring, it’s so beautiful out here – that little pond with those trees and the daffodils all in bloom. It’s such a rustic spot. The delicate green of the weeping willows … But now, it’s all black.

Tiredness of life often seems connected to a feeling that it is no longer possible to “be yourself” while alive, making death a more desirable option. But estimating how many older people reach this state of mind is hard, given the condition’s many different manifestations – and, indeed, an ongoing debate about whether it should be recognised within the medical community.

Our aim is not to lobby for or against a particular stance, but to foster an honest conversation about what some older people – including those who may think about assisted dying – are experiencing in their day-to-day lives. Unlike those who are actively suicidal, people who are tired of life may express a more passive weariness, or a sense of “completeness”, rather than an urgent desire to end their life abruptly.

In his book, Being Mortal, the American surgeon Atul Gawande argues that advances in medicine have turned ageing into a “long, slow fade”, with an emphasis on biological survival rather than quality of life. Tiredness of life could be viewed as a byproduct of this focus. For example, Gawande describes the experience of his wife’s grandmother in a nursing home after suffering a fall:

She woke when they told her, bathed and dressed when they told her, ate when they told her. She lived with whomever they said she had to … She felt incarcerated, like she was in prison for being old.

‘I had ceased to be a sexual being’

In Sweden, care professor Helena Larsson has written about a gradual “turning out of the lights” in old age. While Gawande critiques modern medicine’s role in extending life at the expense of quality, Larsson suggests that gradual disengagement from life is a natural, perhaps inevitable, process in old age. From this perspective, it is possible to think about tiredness of life as part of a long-term process of “letting go”.

A counterpoint is provided by Susan Pickard, director of the Centre for Ageing and the Life Course at the University of Liverpool, who suggests we are in danger of losing sight of the fact that people can and do “continue to grow” even very far into old age. In a 2024 paper published in The Gerontologist, Pickard argues that the positive aspects of ageing are often overlooked, and asks whether we have become blind to the gifts that ageing has to offer.

Pickard highlights the memoirs of Diana Athill, an English literary editor born in 1917 who “really shot into the sky” aged 90 by writing about her experiences of “deep old age”. In her memoirs, Athill described feeling a profound sense of loss at knowing she’d never again walk a puppy or live to see her tree fern grow. Yet, she also discovered unexpected gains, including the joy of platonic friendships and a newfound interest in life beyond sexuality.

Indeed, Athill said she considered “the possibility of friendship with men without sexuality” to be one of the greatest privileges of her old age:

I might not look or even feel all that old, but I had ceased to be a sexual being – a condition which had gone through several stages and had not always been a happy one, but which had always seemed central to my existence … An important aspect of the ebbing of sex was that other things became more interesting.

While we have spoken to many older people dealing with the sorts of losses described by Athill – who died in January 2019, aged 101 – we have not encountered much of the ambiguity reflected in her memoirs. This suggests she was something of an outlier, and that the reality for most older people is that their life feels less open to new opportunities – narrowing down rather than opening up.

The 19th-century German philosopher Friedrich Nietzsche wrote: “If we have our own ‘why’ of life, we shall get along with almost any ‘how’.” Developing a better understanding of the mindsets of people as they approach the final stages of their life should help us, as a society, offer them a clearer sense of purpose – a “why” that helps them find meaning to life, even as they face the inevitable losses of age.

Tiredness of life and assisted dying

Tiredness of life adds a complex layer to the ongoing debate about assisted dying, one that the media and academic research continue to grapple with in many countries. Assisted dying laws across 18 different jurisdictions vary widely in terms of minimum age, waiting periods, health conditions and consultation requirements, according to a 2021 study I (Kenneth) conducted with colleagues at the University of Ghent.

In some places, such as the Netherlands, people experiencing tiredness of life may be more likely to meet the criteria for assisted dying, while in others including Canada, they are not. In Belgium, an 85-year-old person experiencing gradual blindness and mobility issues may be legally eligible for assisted dying, but the same person might not qualify in countries with stricter terminal illness criteria.

Generally, a person requesting assisted dying needs to have an incurable or terminal illness with limited life expectancy, be suffering unbearably without meaningful prospects for improvement, and be of sound mind – free of pressure from people around them. It has been argued that people who are tired of life meet the latter two conditions, even if they do not have an incurable or terminal illness.

Drawing of an older woman in a hat and coat, sitting and thinking.

Makar/Shutterstock

Nonetheless, tiredness of life is a particularly complex issue in light of the eligibility criteria for euthanasia. When a person feels their life is “completed” but does not have an incurable illness or organ failure, it is always going to be more difficult for physicians to confirm the person’s request for assisted dying.

In countries such as Belgium and the Netherlands, where assisted dying legislation is broadest, a minority of people request euthanasia on the grounds they are tired of life, according to research by palliative care physician Eva Bolt and colleagues. In the Netherlands, where eligibility for assisted dying has been considered for people who are not necessarily terminally ill or even close to dying, around 3% of euthanasia requests are thought to involve people who are tired of life.

However, the research also identified that a very low percentage of physicians feel comfortable fulfilling such requests – hesitation compounded both by legal uncertainties they may yet face, and by ethical discomfort when dealing with a patient request that does not align with clear-cut medical conditions.

An older person requesting assisted death may have some degree of age-related ill health, such as reduced mobility, hearing loss or blindness – but these may not limit life expectancy in any obvious sense. For many physicians responsible for assessing a request for assisted dying (and those providing the peer consultation that is mandatory under law), there can be professional, moral and emotional reluctance to grant the request.

Even when a physician feels a person suffering from tiredness of life is eligible for assisted dying and should be “allowed to die,” they may be inclined not to approve the request for fear of disciplinary repercussions.

In most countries with assisted dying laws, they mandate “a posteriori” case reviews, looking back on a case to determine cause and culpability in the aftermath of death. This is important because it is clearly impossible for doctors to “prove” that a person would have continued to feel tired of life indefinitely.

And doctors must also take into account the reaction of a person’s family when they assess an assisted dying request. Families often have difficulties understanding and accepting the choice of a loved one, particularly if the cause of their suffering is not visible and obvious.

A wish to die can be changeable, affected by shifts in physical, relational and social circumstances. There can be a degree of ambivalence: people may live with mixed feelings, even wishing to die and wishing to live simultaneously. This points to the fact that there may be a letting go process, and that people may reach a place of certainty about wishing to die after a period of psychological, emotional and spiritual tension.

Impact on family, friends and healthcare staff

I have two sons. My youngest son, who is quite close, keeping an eye on me, is very dear to me … And I also have a partner with whom I have a very good LAT [living apart together] relationship. But for me, it’s no longer a reason to go on living. I feel like a sawn-off tree.

We have also explored how tiredness of life in older people such as Brian, who was 94 when he talked to us, can affect the family and friends around them – and also healthcare professionals. While family connections were generally described positively, participants often expressed an intense desire not to be a burden.

Illustration of an older man, sitting and thinking.

NCstock/Shutterstock

This reluctance to openly discuss their suffering, despite the emotional closeness, reflects a broader struggle in family dynamics. Feelings of guilt, fear of burdening loved ones, and emotional unpreparedness frequently shape these conversations, making them much more complex than it might first appear.

In the US, research by social anthropologist Miriam Moss and colleagues, explored conversations between residents of nursing homes who had expressed a wish to die, and their family members. These revealed that responses involving “avoidance and invalidation” were common from family members. An interview with the adult daughter of a recently deceased 81-year-old man was particularly revealing:

Interviewer: Did you ever talk about death and dying with your Dad?
Daughter: I didn’t want to discuss it. Every time he brought it up, I didn’t want to hear it [so] we never really discussed it.
Interviewer: How do you feel about that?
Daughter: I wouldn’t bring it up, just because I would be devastated.
Interviewer: Would it be hard for him?
Daughter: I don’t know … I don’t want any reason to discuss it, to be honest with you … He did tell me they were going to take him to a psychologist because someone came in, and he must have been having a bad day.

This conversation points to the broader emotional journey that family members undertake when faced with a loved one’s statement that they are tired of life. Avoidance of such conversations can stem from a deep-seated emotional defence mechanism.

Even outside cases of assisted dying, family members often grapple with overwhelming sadness, helplessness and guilt regarding loved ones who are struggling with day-to-day life. And this can also be true for carers supporting old people in clear distress.

In a 2015 study, geriatrician Liesbeth Van Humbeeck and colleagues revealed the emotional burden that nurses face when supporting older people who express tiredness of life in community nursing homes in Flanders, Belgium. Feelings of powerlessness and uncertainty were common among these nurses, who said they were unsure how best to provide care or relate to the older person.

The study also identified that this sense of helplessness can contribute to emotional burnout, particularly when healthcare professionals and carers feel they lack the proper tools or guidance to address such deep, complex existential issues. The nurses often found themselves navigating both professional frustration and moral distress as they struggled to offer meaningful support:

When you enter the room of such a person, it can be hard mentally. Because actually, we are there to help the resident – but we have the feeling then that we are powerless, that we cannot help him.

Another nurse highlighted the difficulty in identifying tiredness of life, saying: “I sometimes do not know whether it is tiredness of life or depression. I think we are quicker to diagnose depression than acknowledge tiredness of life.”

This distinction is important. Misdiagnosis can lead to inappropriate treatments, such as prescribing antidepressants to someone whose condition is not rooted in clinical depression. Without understanding the existential concerns behind tiredness of life, it is possible that healthcare providers and carers risk treating patients less effectively, overlooking the deeper emotional and psychological issues at play.

Van Humbeeck and colleagues argued that it is crucial for managers to recognise the feelings of uncertainty and powerlessness among nurses and carers as a clinical reality in the support of patients suffering from tiredness of life. We agree they need psychological support and guidance to help deal with the emotional toll they face in their work. They would also benefit from specialist communication training to help them navigate conversations with old people about feeling tired of life.

Strategies like these could help alleviate feelings of powerlessness among nurses, boosting their emotional resilience and enabling them to provide better care for their patients. As one nurse put it:

You have to take into account [each patient’s] personality. There are people who very quickly will say they are tired of life, but who do not mean that seriously. From these people you have to hear it often. But you also have very serious people, and when you ask them further questions, they can give you very apt answers.

A need for greater understanding

Opponents of broadening assisted dying to include people who say they are tired of life, rather than terminally ill, caution that this approach could allow healthcare workers, carers, policymakers and society as a whole to neglect their duties towards older people. They raise important arguments, such as the idea that legalising assisted dying and euthanasia may take us further away from grappling with how best to support older people who are suffering – risking endorsing the sense that some people’s lives have diminished value.

Concerns about attitudes towards the value of older people’s lives were visible during the COVID pandemic, as discussions emerged around whether older people were being disproportionately “sacrificed” in medical triage decisions, raising ethical questions about whose lives were prioritised when resources were limited.

Illustration of an older man sitting on his own on a park bench.

MaKars/Shutterstock

Proponents of assisted dying emphasise the importance of personal autonomy, arguing that people should have the right to decide the course of their own lives – and deaths. They caution against ageist biases, noting that even when older people are of sound mind, their requests for assisted dying are sometimes dismissed based on stereotypes and assumptions about diminished capacity.

To navigate these complex ethical debates and support informed decision-making, we need robust, evidence-based research on the phenomenon of tiredness of life. Such knowledge will empower healthcare professionals to better understand this experience and respond with appropriate care, balancing empathy with ethical considerations. And it will help policymakers develop frameworks that are sensitive to the needs of older individuals while safeguarding their rights.

This need for greater understanding underpinned the creation of our research network in 2022. Comprising 15 academics from Belgium, the Netherlands, Switzerland and the UK, we are exploring the nuances of older people’s experiences, and developing a clearer understanding of its impact on them, their family and friends, and society more broadly – providing insights that inform both clinical practices and public policy.

Our initial review of 33 academic studies revealed that people experiencing tiredness of life often face a range of age-related struggles, including unpredictable life changes, fear of dependency, and a sense of social redundancy. These experiences can lead to severe consequences including euthanasia requests, refusal to eat or drink and, in some cases, suicide.

We are also exploring how tiredness of life overlaps with other phenomena such as demoralisation, depression, existential anxiety, loneliness, social death, and the concept of a “completed life”. Understanding these interconnections is, we believe, crucial for developing comprehensive care strategies that address the emotional and existential challenges faced by many older people.

As we continue to research tiredness of life, it becomes clear that this growing phenomenon is complex, deeply personal, and demands thoughtful consideration from healthcare professionals and policymakers alike. How society chooses to respond will shape not only the future of end-of-life care, but also how we understand the ageing process itself.

*All interviewees in this article have been given pseudonyms to protect their identity

_This article has been updated to clarify the assisted dying bill applies directly to England and Wales and indirectly to Scotland, where a separate bill is due to be debated. It was further updated to note the bill cleared its second reading in the House of Commons on November 29.

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Sam Carr, Reader in Education with Psychology and Centre for Death and Society, University of Bath; Els van Wijngaarden, Associate Professor in Contemporary Meanings of Ageing and Dying, Radboud University, and Kenneth Chambaere, Professor in Public Health, Sociology and Ethics of the End of Life, Ghent University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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