Image by Sergei A on Unsplash.
In her book Never Say Die, Susan Jacoby tells a story that still unsettles me. A man who had lived independently all his life was forced to accept a caretaker. One day he stole the caretaker’s car keys, drove to a bridge, and jumped.
Most people would call this a tragic suicide. Jacoby saw something different. He wasn’t depressed. He simply couldn’t accept the loss of independence. He didn’t want a caretaker. For him, the choice was simple: live without dignity, or die on his own terms.
A recent NPR/Kaiser Health video shared a similar story. An outdoorsman and adventurer, after his wife’s death, was placed in long-term care by his daughter. At 89, confined indoors with limited control over his life, he jumped from a fourth-floor window.
His daughter spoke only of her grief. No one asked what his life felt like to him.
What We’re Missing
We’re drawing the wrong conclusions from these stories. Yes, suicide statistics show that about 18% of older adults take their lives compared to 12% of the general population. But statistics blur the reality: many older adults are not “depressed” in the clinical sense. They are facing permanent losses of freedom, identity, and meaning.
A 17-year-old who contemplates suicide after a breakup or school stress may find those struggles fade with time. But for an 80-year-old who cannot live alone or make choices anymore, the trajectory points only one way. Therapy may not restore what they’ve lost. Antidepressants deliver side effects and questionable value.
When we say, “They should adapt,” we aren’t making a mental-health observation—we’re making a moral judgment.
The Wrong Frame: Prevention
The NPR video estimated that one-third of long-term care residents think about suicide. The discussion focused on institutional responsibility and survivor pain—not the residents’ wishes.
What if, instead of forcing people into violent, lonely, painful deaths—jumps from bridges and windows—we offered a dignified “final exit”? Imagine a legal, supported process where someone over 75 or 80 could plan a goodbye ceremony, say farewells, and leave life peacefully. Families would grieve, yes, but without guilt, shock, or unanswered questions.
A Contrast: Sandy Bem
The New York Times once told the story of Sandy Bem, a psychologist diagnosed with early dementia. At 69, she chose to end her life before the disease erased her autonomy. She found medication, said goodbye to family, and died peacefully. She left documentation so her family knew her decision was hers alone.
But Sandy’s story also shows the cruel limits of current laws. She had to act while she was still fully rational, giving up weeks or months of potential life. If assisted dying had been legal, she could have chosen the timing without fear of losing control.
The Questions We Don’t Ask
While researching aging, I found countless studies about suicide prevention—reductions in numbers, checklists of depressive symptoms, interventions to “save lives.” What I didn’t find were outcomes that mattered to older people themselves.
Nobody asked: What makes life worth living for you? Nobody asked: What would make continued existence intolerable?
Atul Gawande, in Being Mortal, encourages families of terminally ill patients to ask: “What do you need to give your life meaning?” For some, it’s chocolate ice cream and football. For others, it’s playing with grandchildren. But what happens when those sources of meaning are gone forever?
Cancer patients, heart patients, or patients on dialysis can decline treatment and let nature take its course. People with dementia, macular degeneration, or permanent institutionalization have no such option. They’re told to adapt, medicate, or endure.
Rethinking What It Means to “Save” a Life
We spend enormous resources on counting suicides and preventing them at all costs. But prevention often serves survivors more than the people we “save.” For the elderly, survival can mean years of suffering without autonomy or joy.
Maybe the better question is not how to save every life, but how to honor the lives—and the choices—of those who feel their time has come.
