We were on the top floor of a concrete building somewhere in Ghent University Hospital. It was the second meeting of a European network convened to better understand and explore the concept of 'tiredness of life' in older people.

As a group of geriatricians, psychiatrists, social scientists, psychologists, and death scholars from Belgium, Switzerland, the Netherlands, and the UK, we were trying to get a better handle on 'tiredness of life.' What exactly is it? What sets it apart from simple depression in old age? Is it an inevitable byproduct of ageing? And should older people who are genuinely 'tired of life' be permitted to die?

Cumulative losses

Anecdotally, examples abound of people in the latter stages of life who have been reduced to a husk. Professor of Death Studies, Tony Walter, wrote of a friend who claimed that "much of the time I feel I'm just a body to be fed, watered, and toileted."

Old age and losses [Source: Forbes]

He suggested that "the end of a person's social life and social identity may precede the end of his or her physical life; sociologists term this "social death." In my work on people's experiences of ageing, I have witnessed the myriad of losses that accumulate in old age, and contribute to the gradual loss of a meaningful life and identity.

As Philip Roth noted, "old age is not a battle, old age is a massacre." Eventually, if we live long enough, we lose our youthful bodies and physical capabilities, our health, our spouses, partners, friends, careers, and identities. Without them, we can feel as though our lives have been stripped of meaning, and in the extreme we are reduced to bodies that are fed, watered, and toileted.

Tiredness of life

Somewhere in this gradual process, people can get tired of being alive. There is a sense that the losses are irreversible, that life stripped of meaning is pointless, that the physical and social means through which one might reengage with the world or rebuild a sense of purpose are gone. Life feels 'completed' and the future is neither hopeful nor desirable.

Early research by Dr Els van Wijngaarden and her colleagues at the University of Humanistic Studies in The Netherlands has qualitatively explored tiredness of life. The researchers listened to a group of older people who were not seriously ill, yet felt increasingly disconnected to life, and had a yearning desire to end their lives.

The key ingredients they identified were: (1) a sense of aching loneliness; (2) the pain of not mattering; (3) an inability to express oneself; (4) mental, physical, social, and existential tiredness; and (5) a fear of being reduced to a completely dependent state.

As one man of 92 told the researchers:

You have no effect on anything, you know. The ship sets sail and everyone has a job, but you just sail along. I am cargo to them. That's not easy. That's not me! No, no, no, no, no! Humiliation is too strong a word, but it is bordering on it. I simply feel ignored, completely marginalized.

Or as another man, living in a private apartment connected to a nursing home, said:

Look at the condition of those old ladies in the building opposite. Gaunt and half dead, pointlessly driven around in a wheelchair, it is simply horrible… In my eyes, it has nothing to do with being human anymore. They don't even know it, they just go through the process, and then suddenly ‘the black car’ arrives again. It is a stage of life I simply don't want to go through

Euthanasia and death

Euthanasia for tiredness of life? [ethics.org.au]

Advocates of 'tiredness of life' as a bona fide concept in older people have argued that it frequently reflects people who are both suffering and living against their will. This has led to a lively debate about whether such older people reflect a category of persons to which the right to euthanasia should be extended.

Australian bioethicist, Dr Greg Pike, has argued that euthanasia is typically understood as a 'mercy killing,' aimed at ending intolerable suffering. In his opinion, 'tiredness of life' may be more closely related to autonomy than to suffering. He goes as far as to suggest that:

A society which endorses someone’s choice that it is legitimate, rational and acceptable to intentionally end life, even when there is no more compelling reason than being ‘tired of life’, is a society which will see the early exit of the weak and frail first.

These arguments deserve careful consideration. However, my experience of listening first hand to the suffering of older people who feel genuinely 'tired of life' leads me in no doubt that their suffering is profound.

Such 'existential' suffering is difficult to understand and appreciate if one has not walked in the shoes of those burdened by it. Furthermore, the older people I've talked to who genuinely seem to fit the bill for being 'tired of life' are some of the strongest human beings I've encountered.

‘Tiredness of life’ deserves serious attention and respect. If we live long enough, we may all encounter it eventually.