A wish to die is most often linked to loneliness and depression.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An Irish longitudinal study examined the wish to die (WTD) among 8174 patients who were over the age of 50. The study that was published in February 2021 followed the participants for 6 years and it determined that people who had a (WTD), almost three-quarters reported being lonely and 60% had clinically significant depressive symptoms. Other factors that led to a WTD was functional disability and chronic pain.

When the WTD was reassesed two year later, 72% of the people indicated that loneliness and depression had receeded, which re-affirmed previous studies that prove that a WTD fluctuates.

The study was conducted to inform legislators who were considering a bill to legalize euthanasia in Ireland. The study states:

In order to inform discussion around this complex issue (euthanasia and assisted suicide), this report examines the prevalence of WTD in a large population-representative sample of people aged ≥50 years. We specifically examine factors associated with WTD; the longitudinal course of WTD and the relationship between WTD and death.

The study found that 3.5% (279 out of 8174 participants) had indicated that they had a WTD within 30 days of the interview. Participants with a WTD were more likely to be female, separated or divorced, and were 7 times more likely to have depressive symptoms and four times more likely to have been previously diagnosed with depression than people without a WTD.

The wish to die fluctuates.

Since this is a longitudinal study, some participants were interviewed several times. 72% of the participants did not indicate a WTD two years after their first interview while 175 who did not indicate a WTD in the first interview did have a WTD two years later. A person who indicated a WTD at the first interview but then did not have a WTD two years later were much less likely to be lonely or to be experiencing depressive symptoms.

Clearly a WTD fluctuates and it is closely connected to loneliness and depressive symptoms.

The study also found that studies from other jurisdictions have similar results. A study from the Netherlands (2011) indicated that 3.4% of people aged 58 - 98, had a WTD which is nearly identical to the 3.5% in this study.

The study further examines the issues of loneliness and depression and stated:

WTD appears to be closely linked to loneliness and depressive symptoms. Almost three-quarters of participants with WTD also reported loneliness, while almost one fifth reported that they were lonely all the time. 60% of participants with WTD also had clinically significant depressive symptoms.

Importantly, only half of those with WTD and co-existing depressive symptoms report an established diagnosis of depression. Prior work has highlighted the potential burden of undiagnosed and therefore untreated population with depression within the TILDA cohort. It is not surprising therefore that less than one-sixth of those with WTD and co-existing depressive symptoms have accessed psychological or counselling services given this apparently high rate of undetected depression.

This last paragraph proves that most of the people who had a WTD and depressive symptoms that the depressive symptoms were nearly always undiagnosed and the person was not receiving treatment for their depressive symptoms.

Very few people who request euthanasia or assisted suicide are sent for a psychiatric evaluation. The Oregon 2020 report indicates that of the 370 people who received a prescription for a lethal assisted suicide drug cocktail, only three of them received a psychological or psychiatric evaluation. The Oregon 2019 report indicates that of the 290 people who received a prescription for a lethal assisted suicide drug cocktail, only one received a psychological or psychiatric evaluation.

This study proves that people with a wish to die are most often living with loneliness or experiencing depressive symptoms. The study also proves that most of the people who are experiencing depressive symptoms, that the depression is not diagnosed and the person is not receiving treatment for depression.

Finally the study re-affirms the conclusion of previous studies which proves that a wish to die fluctuates. I would encourage people who are interested in this topic to read the articles and studies by Dr Harvey Chochinov concerning Dignity Therapy and how the Wish to Die fluctuates.

Sadly many people who die by euthanasia or assisted suicide are experiencing a wish to die which is closely associated with loneliness and depression. Most of those who are experiencing depressive symptoms are not being treated for their condition and they are not sent for a psychological or psychiatric evaluation.