Medicine, Health Care and Philosophy

, Volume 19, Issue 2, pp 265–273 | Cite as

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

  • Els van Wijngaarden
  • Carlo Leget
  • Anne Goossensen
Scientific Contribution


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.


Phenomenology Human science phenomenology Wish to die Elderly people Medicalization of death and death wishes Humanisation of policy Proto-ethics 



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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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).


  1. 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.CrossRefGoogle Scholar
  2. 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
  3. Carel, H. 2011. Phenomenology and its application in medicine. Theoretical Medicine and Bioethics 32(1): 33–46. doi: 10.1007/s11017-010-9161-x.CrossRefGoogle Scholar
  4. Carel, H. 2012. Phenomenology as a resource for patients. Journal of Medicine and Philosophy 37(2): 96–113. doi: 10.1093/jmp/jhs008.CrossRefGoogle Scholar
  5. 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.Google Scholar
  6. Conrad, P. 2007. The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press.Google Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. Finlay, L. 2011. Phenomenology for therapists: Researching the lived world. West Sussex: Wiley/Blackwell.CrossRefGoogle Scholar
  10. Fitzpatrick, M. 2001. The tyranny of health doctors and the regulation of lifestyle. London: Routledge.Google Scholar
  11. 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.CrossRefGoogle Scholar
  12. Fricker, M. 2007. Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.CrossRefGoogle Scholar
  13. Goossensen, A., and A. Oude Egberink. 2013. Gezien of niet? Verbeeldingen in de geestelijke gezondheidszorg. Utrecht: Uitgeverij De Graaff.Google Scholar
  14. 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.CrossRefGoogle Scholar
  15. Illich, I. 2003. Medical nemesis. Journal of Epidemiology and Community Health 57(12): 919–922. doi: 10.1136/jech.57.12.919.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. Kellehear, A. 2007. A social history of dying. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. Olafson, F.A. 1998. Heidegger and the ground of ethics: A study of Mitsein. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. Seale, C. 1998. Constructing death: The sociology of dying and bereavement. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  26. 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.CrossRefGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. Slatman, J. 2014. Multiple dimensions of embodiment in medical practices. Medicine, Health Care and Philosophy. doi: 10.1007/s11019-014-9544-2.Google Scholar
  29. Svenaeus, F. 2000. The hermeneutics of medicine and the phenomenology of health: Steps towards a philosophy of medical practice. Dordrecht: Kluwer.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. Todres, L. 2008. Being with that: The relevance of embodied understanding for practice. Qualitative Health Research 18(11): 1566–1573. doi: 10.1177/1049732308324249.CrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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
  34. 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.CrossRefGoogle Scholar
  35. Toombs, S.K. 1990. The temporality of illness: Four levels of experience. Theoretical Medicine 11(3): 227–241. doi: 10.1007/bf00489832.CrossRefGoogle Scholar
  36. Toombs, S.K. 1993. The meaning of illness: A phenomenological account of the different perspectives of physician and patient. Dordrecht: Kluwer.Google Scholar
  37. 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.Google Scholar
  38. 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
  39. 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
  40. Van Manen, M. 1998. Modalities of body experience in illness and health. Qualitative Health Research 8(1): 7–24. doi: 10.1177/104973239800800102.CrossRefGoogle Scholar
  41. van Manen, M. 2014. Phenomenology of practice: Meaning-giving methods in phenomenological research and writing. Walnut Creek, CA: Left Coast Press.Google Scholar
  42. van Rein, P.S. 2013. Petitioning for completed life: A thematic content analysis. Minneapolis: Walden University.Google Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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
  45. 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
  46. Wardrope, A. 2015. Medicalization and epistemic injustice. Medicine, Health Care and Philosophy 18(3): 341–352. doi: 10.1007/s11019-014-9608-3.CrossRefGoogle Scholar
  47. Wessely, S. 2002. Pros and cons of medicalisation. BMJ 324: 912. doi: 10.1136/bmj.324.7342.912.CrossRefGoogle Scholar
  48. Yuill, K.L. 2015. Assisted suicide: The liberal, humanist case against legalization. Bastingstoke: Palgrave Macmillan.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Els van Wijngaarden
    • 1
  • Carlo Leget
    • 1
  • Anne Goossensen
    • 1
  1. 1.University of Humanistic StudiesUtrechtThe Netherlands

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