Ready for the Exit? Tiredness of Life and Assisted Dying

I can totally relate to tiredness of life. Guess what? I saw a beautiful sunrise yesterday morning, acknowledged it, and couldn’t care less if I saw another one.

Nina is a 72-year-old American woman in reasonably good health. She talked to me recently about her life—and the sense that she was ready for the exit. Nina wasn’t suicidal or filled with anxiety and depression, but she was certain she was ready to die. Living, she said, had become a burden.

In interviews with older people over the past 15 years, some have described the phenomenon of “tiredness of life” in this matter-of-fact way—as though they are talking about the weather. The experience is not, as some might imagine, always accompanied by distress, anxiety, or panic.

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Tiredness of life

Our work in the Understanding Tiredness of Life in Older People network—a European consortium set up in 2022—suggests common by-products of ageing include a loss of meaning and identity as well as health and fitness, a profound sense of boredom, and sometimes an “aversion to life.” Greta, aged 87 and living in a nursing home, explained this feeling:

I am treated as a person…but for myself, I see nothing—nothing but blackness. You cannot care for people any more. You lose so much that you are no longer human. That’s how I feel about myself.

Greta said she always had a passion for art, and her room in the nursing home was full of expressive pictures she had painted over her lifetime. But due to a deterioration in her eyesight, she now felt a deep sadness at the loss of the “colorful world” she had loved so much.

Tiredness of life often is connected to a sense that it is no longer possible to “be yourself” while alive, making death a more desirable option. Estimating how many older people reach this state of mind is hard, given the condition’s different manifestations—and, indeed, an ongoing debate about whether it should be recognized at all within the medical community.

Tiredness of life and assisted dying

A number of countries (e.g., the Netherlands, Belgium, Switzerland, and Canada) have already legalized forms of assisted dying, whereby patients self-administer life-ending medication, and euthanasia, where a doctor administers it directly.

In the Netherlands, there has been a significant recent rise in euthanasia cases granted for psychological suffering, highlighting how nonterminal conditions—including profound existential distress, such as tiredness of life—are increasingly being considered there.

Tiredness of life adds a complex layer to assisted dying. In some places (like the Netherlands), people experiencing tiredness of life meet the criteria for assisted dying, while in others (like Canada), they do not. Generally, a person requesting assisted dying needs to have an incurable or terminal illness with limited life expectancy, be suffering unbearably without meaningful prospects for improvement, and be of sound mind—free of pressure from people around them. It has been argued that people who are tired of life meet the latter two conditions, even if they do not have an incurable or terminal illness.

In the Netherlands, where eligibility for assisted dying has been considered for people who are not necessarily terminally ill or dying, around 3 percent of euthanasia requests are thought to involve people who are tired of life.

However, a very low percentage of physicians feel comfortable fulfilling such requests—hesitation compounded both by legal uncertainties and ethical discomfort. For many physicians responsible for assessing a request for assisted dying there can be professional, moral, and emotional reluctance to grant the request.

Doctors must also take into account the reaction of a person’s family when they assess an assisted dying request. Families often have difficulties accepting the choice of a loved one, particularly if the cause of their suffering is not visible or obvious.

A wish to die can also be changeable, affected by shifts in physical, relational, and social circumstances.

Impact on family, friends, and healthcare workers

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Feelings of guilt, fear of burdening loved ones, and emotional unpreparedness frequently shape conversations around tiredness of life.

In the U.S., research by social anthropologist Miriam Moss explored conversations between residents of nursing homes who had expressed a wish to die and their family members. An interview with the adult daughter of a recently deceased 81-year-old man was particularly revealing:

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Interviewer: Did you ever talk about death and dying with your Dad?

Daughter: I didn’t want to discuss it. Every time he brought it up, I didn’t want to hear it [so] we never really discussed it.

Interviewer: How do you feel about that?

Daughter: I wouldn’t bring it up, just because I would be devastated.

Interviewer: Would it be hard for him?

Daughter: I don’t know…I don’t want any reason to discuss it, to be honest with you.… He did tell me they were going to take him to a psychologist because someone came in, and he must have been having a bad day.

This conversation points to the broader emotional journey that family members undertake when faced with a loved one who claims they are tired of life.

Geriatrician Liesbeth Van Humbeeck also revealed the emotional burden that nurses face when supporting older people who express tiredness of life in community nursing homes in Flanders, Belgium. Feelings of powerlessness and uncertainty were common among these nurses, who said they were unsure how best to provide care or relate to the older person.

The nurses often found themselves navigating both professional frustration and moral distress as they struggled to offer meaningful support:

When you enter the room of such a person, it can be hard mentally. Because actually, we are there to help the resident—but we have the feeling then that we are powerless, that we cannot help him.

Another nurse highlighted the difficulty in identifying tiredness of life, saying: “I sometimes do not know whether it is tiredness of life or depression. I think we are quicker to diagnose depression than acknowledge tiredness of life.”

As we continue to research tiredness of life, it becomes clear that this growing phenomenon is complex and deeply personal but deserves consideration from healthcare professionals and policymakers. How society chooses to respond will shape not only the future of end-of-life care but also how we understand ageing itself.

NB: This article republishes material from an article by the author in The Conversation under a Creative Commons License.