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Disconnectedness from the here-and-now: a phenomenological perspective as a counteract on the medicalisation of death wishes in elderly people

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Abstract

When elderly people are ideating on manners to end their lives, because they feel life is over and no longer worth living, it is important to understand their lived experiences, thoughts and behaviour in order to appropriately align care, support and policy to the needs of these people. In the literature, the wish to die in elderly people is often understood from a medical, psychopathological paradigm, referred to as cognitive impairment, depressive disorder, pathological bereavement, and suicidality. In this paper, we evaluate this dominant paradigm by considering three serious limitations, namely: (1) the risk of epistemic transformation; (2) the risk of reduction; and (3) the risk of obscuring the social and cultural embeddedness. Drawing on insights from our empirical–phenomenological research on the issue of elderly and the self-chosen death, this paper argues for a phenomenological perspective to counteract the medicalisation of death wishes in elderly people.

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References

  • Ashworth, P. 2003. An approach to phenomenological psychology: The contingencies of the lifeworld. Journal of Phenomenological Psychology 34(2): 145–156. doi:10.1163/156916203322847119.

    Article  Google Scholar 

  • Buiting, H.M., D.J.H. Deeg, D.L. Knol, J.P. Ziegelmann, H.R.W. Pasman, G.A.M. Widdershoven, and B.D. Onwuteaka-Philipsen. 2012. Older peoples’ attitudes towards euthanasia and an end-of-life pill in The Netherlands: 2001–2009. Journal of Medical Ethics. doi:10.1136/medethics-2011-100066.

    Google Scholar 

  • Carel, H. 2011. Phenomenology and its application in medicine. Theoretical Medicine and Bioethics 32(1): 33–46. doi:10.1007/s11017-010-9161-x.

    Article  Google Scholar 

  • Carel, H. 2012. Phenomenology as a resource for patients. Journal of Medicine and Philosophy 37(2): 96–113. doi:10.1093/jmp/jhs008.

    Article  Google Scholar 

  • Cohen, S. 2011. The proto-ethical dimension of moods. In Philosophy's moods: The affective grounds of thinking, ed. Hagi Kenaan and IIit Ferber, 173–184. Netherlands: Springer.

  • Conrad, P. 2007. The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Dahlberg, K. 2006. ‘The individual in the world-the world in the individual’: Towards a human science phenomenology that includes the social world. Indo-Pacific Journal of Phenomenology: Methodology: Special Edition 6: 1–9. doi:10.1080/20797222.2006.11433932.

    Article  Google Scholar 

  • Dahlberg, K., L. Todres, and K. Galvin. 2009. Lifeworld-led healthcare is more than patient-led care: An existential view of well-being. Medicine, Health Care and Philosophy 12(3): 265–271. doi:10.1007/s11019-008-9174-7.

    Article  Google Scholar 

  • Finlay, L. 2011. Phenomenology for therapists: Researching the lived world. West Sussex: Wiley/Blackwell.

    Book  Google Scholar 

  • Fitzpatrick, M. 2001. The tyranny of health doctors and the regulation of lifestyle. London: Routledge.

    Google Scholar 

  • Forsell, Y., A.F. Jorm, and B. Winblad. 1997. Suicidal thoughts and associated factors in an elderly population. Acta Psychiatrica Scandinavica 95(2): 108–111. doi:10.1111/j.1600-0447.1997.tb00382.x.

    Article  Google Scholar 

  • Fricker, M. 2007. Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Goossensen, A., and A. Oude Egberink. 2013. Gezien of niet? Verbeeldingen in de geestelijke gezondheidszorg. Utrecht: Uitgeverij De Graaff.

    Google Scholar 

  • Harwood, D., K. Hawton, T. Hope, and R. Jacoby. 2006. Suicide in older people without psychiatric disorder. International Journal of Geriatric Psychiatry 21(4): 363–367. doi:10.1002/gps.1473.

    Article  Google Scholar 

  • Illich, I. 2003. Medical nemesis. Journal of Epidemiology and Community Health 57(12): 919–922. doi:10.1136/jech.57.12.919.

    Article  Google Scholar 

  • Jorm, A.F., A.S. Henderson, R. Scott, A.E. Korten, H. Christensen, and A.J. Mackinnon. 1995. Factors associated with the wish to die in elderly people. Age and Ageing 24(5): 389–392. doi:10.1093/ageing/24.5.389.

    Article  Google Scholar 

  • Kellehear, A. 2007. A social history of dying. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Martinsen, E.H. 2011. Care for nurses only? Medicine and the perceiving eye. Health Care Analysis 19(1): 15–27. doi:10.1007/s10728-010-0161-9.

    Article  Google Scholar 

  • Olafson, F.A. 1998. Heidegger and the ground of ethics: A study of Mitsein. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Raue, P.J., B.S. Meyers, J.L. Rowe, M. Heo, and M.L. Bruce. 2007. Suicidal ideation among elderly homecare patients. International Journal of Geriatric Psychiatry 22(1): 32–37. doi:10.1002/gps.1649.

    Article  Google Scholar 

  • Rurup, M.L., D.J. Deeg, J.L. Poppelaars, A.J. Kerkhof, and B.D. Onwuteaka-Philipsen. 2011. Wishes to die in older people: A quantitative study of prevalence and associated factors. Crisis: Journal of Crisis Intervention & Suicide 32(4): 194–203. doi:10.1027/0227-5910/a000079.

    Article  Google Scholar 

  • Rurup, M.L., M.T. Muller, B.D. Onwuteaka-Philipsen, A. Van der Heide, G. Van der Wal, and P.J. Van der Maas. 2005a. Requests for euthanasia or physician-assisted suicide from older persons who do not have a severe disease: An interview study. Psychological Medicine 35(5): 665–671. doi:10.1017/s003329170400399x.

    Article  Google Scholar 

  • Rurup, M.L., B.D. Onwuteaka-Philipsen, M.C. Jansen-van der Weide, and G. van der Wal. 2005b. When being ‘tired of living’ plays an important role in a request for euthanasia or physician-assisted suicide: Patient characteristics and the physician’s decision. Health Policy 74(2): 157–166. doi:10.1016/j.healthpol.2005.01.002.

    Article  Google Scholar 

  • Scocco, P., G. Meneghel, F. Caon, M. Dello Buono, and D. De Leo. 2001. Death ideation and its correlates: Survey of an over-65-year-old population. The Journal of Nervous and Mental Disease 189(4): 210. doi:10.1097/00005053-200104000-00002.

    Article  Google Scholar 

  • Seale, C. 1998. Constructing death: The sociology of dying and bereavement. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Seale, C. 2000. Changing patterns of death and dying. Social Science and Medicine 51(6): 917–930. doi:10.1016/s0277-9536(00)00071-x.

    Article  Google Scholar 

  • Seale, C., and S. Van Der Geest. 2004. Good and bad death: Introduction. Social Science and Medicine 58(5): 883–885. doi:10.1016/j.socscimed.2003.10.034.

    Article  Google Scholar 

  • Slatman, J. 2014. Multiple dimensions of embodiment in medical practices. Medicine, Health Care and Philosophy. doi:10.1007/s11019-014-9544-2.

    Google Scholar 

  • Svenaeus, F. 2000. The hermeneutics of medicine and the phenomenology of health: Steps towards a philosophy of medical practice. Dordrecht: Kluwer.

    Book  Google Scholar 

  • Svenaeus, F. 2011. Illness as unhomelike being-in-the-world: Heidegger and the phenomenology of medicine. Medicine, Health Care and Philosophy 14(3): 333–343. doi:10.1007/s11019-010-9301-0.

    Article  Google Scholar 

  • Todres, L. 2008. Being with that: The relevance of embodied understanding for practice. Qualitative Health Research 18(11): 1566–1573. doi:10.1177/1049732308324249.

    Article  Google Scholar 

  • Todres, L., K. Galvin, and K. Dahlberg. 2007. Lifeworld-led healthcare: Revisiting a humanising philosophy that integrates emerging trends. Medicine, Health Care and Philosophy 10(1): 53–63. doi:10.1007/s11019-006-9012-8.

    Article  Google Scholar 

  • Todres, L., K.T. Galvin, and K. Dahlberg. 2014. “Caring for insiderness”: Phenomenologically informed insights that can guide practice. International Journal of Qualitative Studies on Health and Well-Being. doi:10.3402/qhw.v9.21421.

    Google Scholar 

  • Todres, L., K.T. Galvin, and I. Holloway. 2009. The humanization of healthcare: A value framework for qualitative research. International Journal of Qualitative Studies on Health and Well-Being 4(2): 68–77. doi:10.3402/qhw.v4i2.5003.

    Article  Google Scholar 

  • Toombs, S.K. 1990. The temporality of illness: Four levels of experience. Theoretical Medicine 11(3): 227–241. doi:10.1007/bf00489832.

    Article  Google Scholar 

  • Toombs, S.K. 1993. The meaning of illness: A phenomenological account of the different perspectives of physician and patient. Dordrecht: Kluwer.

    Google Scholar 

  • Van Delden, J. J. M., A. Van der Heide, S. Van de Vathorst, H. Weyers, and D. G. Van Tol. 2011. Kennis en opvattingen van publiek en professionals over medische besluitvorming en behandeling rond het einde van het leven: Het KOPPEL-onderzoek. Retrieved from Den Haag.

  • van der Meide, H., G. Olthuis, and C. Leget. 2014a. Feeling an outsider left in uncertainty: A phenomenological study on the experiences of older hospital patients. Scandinavian Journal of Caring Sciences. doi:10.1111/scs.12187.

    Google Scholar 

  • van der Meide, H., G. Olthuis, and C. Leget. 2014b. Patient participation in hospital care: How equal is the voice of the client council? Health Care Analysis. doi:10.1007/s10728-014-0271-x.

    Google Scholar 

  • Van Manen, M. 1998. Modalities of body experience in illness and health. Qualitative Health Research 8(1): 7–24. doi:10.1177/104973239800800102.

    Article  Google Scholar 

  • van Manen, M. 2014. Phenomenology of practice: Meaning-giving methods in phenomenological research and writing. Walnut Creek, CA: Left Coast Press.

    Google Scholar 

  • van Rein, P.S. 2013. Petitioning for completed life: A thematic content analysis. Minneapolis: Walden University.

    Google Scholar 

  • van Wijngaarden, E.J., C.J.W. Leget, and A. Goossensen. 2014. Experiences and motivations underlying wishes to die in older people who are tired of living: A research area in its infancy. Omega Journal of Death and Dying 69(2): 191–216. doi:10.2190/om.69.2.f.

    Article  Google Scholar 

  • van Wijngaarden, E.J., C.J.W. Leget, and A. Goossensen. 2015. Ready to give up on life: The lived experience of elderly people who feel life is completed and no longer worth living. Social Science and Medicine. doi:10.1016/j.socscimed.2015.05.015.

    Google Scholar 

  • van Wijngaarden, E.J., C.J.W. Leget, and A. Goossensen. 2016. Caught between intending and doing: Older people ideating on a self-chosen death. BMJ Open. doi:10.1136/bmjopen-2015-009895.

    Google Scholar 

  • Wardrope, A. 2015. Medicalization and epistemic injustice. Medicine, Health Care and Philosophy 18(3): 341–352. doi:10.1007/s11019-014-9608-3.

    Article  Google Scholar 

  • Wessely, S. 2002. Pros and cons of medicalisation. BMJ 324: 912. doi:10.1136/bmj.324.7342.912.

    Article  Google Scholar 

  • Yuill, K.L. 2015. Assisted suicide: The liberal, humanist case against legalization. Bastingstoke: Palgrave Macmillan.

    Google Scholar 

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Acknowledgments

An earlier version of this article was presented at The European Conference on Philosophy of Medicine and Health Care 2015 on Medicalisation. We thank Karin Dahlberg, Fredrik Sveneaus and Hanneke van der Meide for their comments on a previous version of this paper. This study was funded by The Netherlands Organisation for Scientific Research (NWO): Grant number 023.001.035.

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  1. University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands

    Els van Wijngaarden, Carlo Leget & Anne Goossensen

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  1. Els van Wijngaarden
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  2. Carlo Leget
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  3. Anne Goossensen
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Correspondence to Els van Wijngaarden.

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Ethical standard

The Medical Ethical Review Committee UMC Utrecht evaluated this study. This committee confirmed that the Dutch Medical Research Involving Human Subject Act (WMO) did not apply, as participants were not patients but mentally competent citizens, and participants were not subjected to treatment or required to follow a certain behavioural strategy as referred to in the WMO (art.1b). Subsequently, official approval of this study was not required (protocol: 13-176/C).

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van Wijngaarden, E., Leget, C. & Goossensen, A. Disconnectedness from the here-and-now: a phenomenological perspective as a counteract on the medicalisation of death wishes in elderly people. Med Health Care and Philos 19, 265–273 (2016). https://doi.org/10.1007/s11019-016-9687-4

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