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Cited by 4Palliative Care and End-of-Life IssuesSuicide and Self-Harm StudiesPalliative and Oncologic Care

In-hospital care prior to assisted and unassisted suicide in swiss older people: a state-level retrospective study

Open access
Dieudonné-Rahm, Nathalie, Burkhardt, Sandra, Pautex, Sophie·2019·BMC Geriatrics
DOI 10.1186/s12877-019-1325-6PMC PMC6833264
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Abstract

Suicide is a major public health issue, affecting all ages and is expected to grow as life expectancy increases [ 1 , 2 ]. The incidence of suicide is particularly high among older males aged 65 and older [ 3 ]. The rate of suicide in the oldest group (ages 85+) is over four times higher than overall rate of suicide in Switzerland or in the US; moreover, this age group shows an increase in suicide rates in almost all countries [ 3 , 4 ]. Elderly persons have a higher risk of completed suicide compared with younger age groups. Their frailer health status should not be considered as the main contributing factor to this excess of mortality. Elderly use more deadly methods and are less likely to be found and rescued because of the scarcity of warning signs when planning and carrying out the lethal act [ 5 ]. Whereas for the majority of the countries in the world, assisted suicide is not an option, in Switzerland, this process is permitted. In this country, assisted suicide counts for about 1% of deaths, with people 65 years and older having the highest rates of assisted suicide [ 4 , 6 , 7 ]. A person can be granted access to assisted suicide when the following two conditions are met: to have decisional capacity and to be able to perform the fatal act oneself. In addition, other persons implicated in this process should have no selfish motive. The Swiss legal framework permits right-to-die societies to assess and decide on the acceptability of a request, without restrictions regarding the source of suffering. The Swiss Academy of Medical Sciences ethical guideline for end-of-life care issued in 2013 required that the underlying disease implies that the end-of-life is expected to be near. However, since 2014, right-to-die organizations in Switzerland have considered requests for assisted suicide, in the case of unbearable suffering or age-related changes, even in the absence of terminal illness [ 8 , 9 ]. Since assisted suicide became relatively easier to access in Switzerland, we anticipated that, over the years, an increasing number of people with chronic illnesses would carry out assisted suicide to end their suffering. We additionally hypothesized that there would be a decrease in unassisted suicides with the widening of indications by right-to-die organizations in 2014. Suicide in late life is known to be complex and multifactorial. Some factors have been found to influence both types of suicides in the elderly, such as constricted social networks (loneliness, social exclusion, bereavement), mood disorders and cognitive impairment [ 10 , 11 , 12 , 13 ]. It has been found in recent systematic reviews that physical illness and functional impairment are important suicide risk factors in the elderly. Furthermore personality disorders that lead to an inability to adapt to the changes occurring in late life are more likely to be found in older adults who attempt or complete suicide than in their younger counterparts [ 14 , 15 , 16 , 17 , 18 ]. These findings suggest that the elderly who contemplate suicide would be particularly sensitive to any worsening of their quality of life. Older age suicide may have rational grounds, following a process of deliberation and holistic self-assessment of irremediable impairment of current or future ones-quality of life [ 19 ]. Indeed, elderly persons may contemplate suicide due to being tired of life or considering that their life is complete. Neoliberalism, technology, and changing attitudes related to the legalization of assisted death in some countries are sociological trends thought to influence rational suicidal thoughts [ 20 ]. However, elderly prone to unassisted and assisted suicide differ in many ways. Unassisted suicide in the elderly often follows impulsive decision-making during major depressive or mixed illness episodes [ 21 ]. Unassisted suicide is known to be strongly associated with previous suicide attempts, mood disorders (e.g. depression, bipolar disorder), vulnerability in the context of borderline or other personality disorders, presence of impulsive-aggressive traits, hopelessness and substance use [ 22 , 23 , 24 , 25 , 26 ]. Individuals with mental and behavioral disorders generally report having a poor perceived quality of life, as they are at greater risk of experiencing marginalization, poverty and stigma, and show a higher incidence of suicide than the general population [ 21 , 22 , 27 , 28 ]. On the other hand, the typical assisted suicide decedent profile has been described as a single or divorced woman with tertiary education, without religious affiliation, affected by cancer or any other chronic illness [ 29 ]. Persons who choose to opt for assisted suicide are supposed to make an informed choice about how and when to die. They are evaluated for their decisional capacity beforehand and are imposed a time for reflection before making their final decision. Thus, the decision to end one’s life via assisted suicide may become an option, especially wh

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Authors
Dieudonné-Rahm, N., Burkhardt, S., & Pautex, S.
Affiliations
University Hospital of Geneva (CH)
ORCID
Venue
BMC Geriatrics
Publisher
Springer Science and Business Media LLC
Published
2019-11-06
Volume
19
Issue
1
Pages
300-300
ISSN
1471-2318 (ISSN-L)
DOI
10.1186/s12877-019-1325-6
PMC
PMC6833264
OpenAlex
W2987843250
Cited by
4
References
55
Citations by year
2026: 2 · 2023: 1 · 2021: 1
FWCI
0.23
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Geriatrics (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Funders
Université de Genève
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
assisted suicide, older adults, inpatient care, end-of-life care, terminal illness, unbearable suffering, decision-making capacity, state-level variation, chronic disease, social networks, mood disorders, cognitive impairment, loneliness, bereavement, suicide prevention, palliative care, advance care planning
MeSH terms
Aged, Aged, 80 and over, Aging, Chronic Disease, Female, Hospitalization, Humans, Male, Mortality, Quality of Life, Retrospective Studies, Right to Die, Suicide, Switzerland, Mental Competency, Suicide, Assisted, Risk Assessment

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