Photo by Lost Alien on Unsplash.
When I started researching a book on how aging sucks, I didn’t expect to fall into a rabbit hole about death wishes and suicide in the elderly. But there it was—article after article, all chanting the same mantra: At all costs, people must be kept alive.
The real question isn’t why people want to die—it’s why we’re so invested in making them stay.
An outdoor-loving active man is confined to a nursing home, unable to go outside or do anything that once made life worth living. He jumps off the roof and—luckily for him—dies.
From the book Never Say Die, another man is forced to live with a caretaker. One day he steals the caretaker’s keys, goes to a bridge, and jumps. Was he depressed? No, says author Susan Jacoby. He didn’t want to live with a caretaker.
A YouTube influencer asks a 101-year-old man how it feels to be 101. He answers that he’s alive only because he hasn’t figured out how to die.
Thousands of people in nursing homes feel the same way.
Whenever I comment on Washington Post or New York Times articles about aging, caretaking, or nursing homes, I mention the right to die. The response is always the same: overwhelming agreement. Read the comments yourself—many openly wish for right-to-die laws.
Katie Engelhart documents this in The Inevitable. Many people are ready to die on their own terms. Governments, armed with a Judaeo-Christian ethic, deploy laws, volunteer groups, and even police to stop them.
What the authorities don’t offer is meaningful relief from suffering.
It’s like abortion politics: people will rally to save the fetus, then show little interest in the quality of life of the child or in helping the parents.
Engelhart describes an Australian woman who stockpiled pills. Police broke down her door to confiscate them. She had backup pills hidden and used them a few days later. They didn’t fix the door. So was this about caring for her—or enforcing an outdated principle? Was she just supposed to live with a shattered door and a shattered body?
Canada’s MAID system allows people to apply for assisted dying more easily than most countries. Critics argue it sometimes steers people toward death to save the state money. One widely reported story—true or not—features a wounded female veteran denied a wheelchair ramp but informed she could apply for euthanasia.
You can die. You just can’t be helped.
In much of the U.S., the message is simpler: we won’t pay for your care, we won’t make your life more livable, and we won’t help you die either. Get used to being miserable.
Of course, some suicides make no sense. A teenager believes being dumped means they’ll never love again. That belief is false.
But realism—not confusion—is at work when an elderly person says, “I’d rather be dead than enter a nursing home.” Nursing homes routinely involve loss of privacy, isolation, indifference, and abuse rates estimated around 40%. If you deny them access to death, are you offering them a different reality than the one they fear? Usually not.
I’ve come to believe there are two camps.
One believes any life—no matter how diminished—is better than death. Prison, nursing homes, painful disease: all acceptable, as long as the heart keeps beating. Many physicians fall into this camp. Keeping people alive is the mission. Everything else is secondary.
Some people are simply naïve. They believe every disease is curable or institutions will improve—someday. When I told a younger woman I’d rather be dead than live in a nursing home, she assured me they “aren’t that bad.” She had no firsthand experience. She just couldn’t accept the idea that death might be preferable.
The other camp is growing. These people want control over the timing of their own deaths. They’re not saying you have duty to die: just a choice. They read the hundreds of books and articles about assisted dying—many of them bestsellers. They don’t think people should need lawyers, paperwork, or international flights to get permission to die.
After all, we already allow slow suicide. Smoking. Drinking. Ignoring medical advice. Refusing lifesaving surgery. All legal. Autonomy is respected—right up until it’s explicit.
Governments have always made exceptions. WWII spies carried cyanide pills. Coal miners once did too. What’s different about taking a pill to avoid life in a nursing home? Or a life stripped of everything that once made it meaningful?
Some in the “controlled death” camp insist on psychiatric screening. But psychiatry isn’t a magic wand. The psychiatrist’s values influence their decisions. Not all people wanting to die are depressed, and not all depressed people want to die.
What if you’re clinically depressed and terminally ill? Does depression disqualify you from avoiding agony? Why burden someone already suffering with psychiatric hurdles—especially when they’re elderly and facing irreversible decline?
Consent laws create another cruel incentive: die earlier than you want to. Wait too long and your mental state may not qualify—or your body may fail before you can act.
Even psychiatrists admit the line is blurry. Incurable depression. Depression followed by terminal cancer. Is it depression or a incurable disease?
These aren’t abstract problems. They belong to ordinary people.
It’s time to stop pretending there’s a clean way to distinguish clinical mental health problems from clear-eyed realism. We face a trade-off: do we risk letting some people die for the “wrong” reasons—or do we force people to live lives they find unbearable?
Right now, we’ve chosen forced survival.
And it’s considered more humane and compassionate, no matter how much pain is involved..
