Rational Suicide in Elderly Adults: A Clinician's Perspective

Meera Balasubramaniam, MD, MPH


J Am Geriatr Soc. 2018;66(5):998-1001. 

In This Article

Mr. A and Contemporary Society

The French historian Philippe Aries traced the shift in western attitudes toward death from the Middle Ages to contemporary times. He observed that death was originally perceived as an inevitable, collective fate of all humans, a moment that was embraced as "normal" and in the company of loved ones. He pointed out that a shift occurred around the 12th century, when death came to be observed as personal rather than collective. Following the personalization, around the 18th century, death was dramatized and feared. It changed more over the 19th and 20th centuries into something that became forbidden and shameful.[4,5] Geographical shifts accompanied the attitudinal changes such that the place of dying soon shifted from the familiarity of homes to hospitals. Over time, we as a society started to distance ourselves from death to a greater extent by moving very old adults from homes to nursing homes before death occurred.[5,6]

Pope has linked contemporary ageist attitudes to fear of death and of growing old.[5] We live in a society that glorifies youth, health, and vitality. Pope observed that older adults evoke a multitude of feelings about their own finiteness in terms of youth, fitness, and mortality. Our desire to distance ourselves emotionally from the image of our possibly frail, dependent future selves takes the shape of ageism. Ageist attitudes are widespread, ironically, even among older adults and geriatricians.[5,7] Older adults frequently express fear of being institutionalized. It is likely that the medicalized, impersonal conditions of many assisted living facilities and nursing homes contribute to this fear. Our views on aging and how we care for elderly adults as a society are inextricably tied to older adults' perceptions of whether their lives are worth living and, as an extension of that, their death wishes.[5]