Don Gillmor’s latest book is To The River: Losing My Brother.
Thirteen years ago, my brother David walked into the Yukon River, taking his own life. He was 48 years old. Since then, I have known several middle-aged men who have died by suicide. It turns out they are part of a widespread, dismaying trend: The rise in suicide rates among baby boomers.
Seven years from now, the oldest boomers will turn 80. Ours was a generation obsessed with youth, unwilling to give it up to the next generation. We held on to the idea of it even as the reality crumbled. So what will happen when we are genuinely, irrefutably old – when no amount of yoga or surgery or mindfulness exercises can disguise this fact?
One of the things we may come to is a reassessment of life. What it is, and whether it’s worth continuing. And, perhaps, a new definition of dying. Is it those few hours in the hospital bed, quietly leaving, or is it that last decade, resentfully staying? I have friends who have seen their own parents suffer and plan to buy their “death kit” (pentobarbital) at a Mexican pet store. As our quality of life deteriorates, at what point do we end it?
Many of us have a set of personal criteria, a line we don’t want to cross: when we can’t go to the bathroom by ourselves, when we can’t feed ourselves, when the pain becomes too monstrous.
For those who are suffering from “a grievous and irremediable medical condition” and are mentally competent, there is the possibility of medically assisted death. Assisted dying became legal in Canada in 2016, but MAID (medical assistance in dying) doesn’t cover dementia sufferers because they aren’t mentally competent to agree to their own death.
Currently, 76,000 new cases of dementia are reported each year in Canada, but that number will swell as the sheer number of boomers age. In the United States, the Alzheimer’s Association predicts that by 2050, there will be 28 million Americans with dementia. In Canada, the federal government projects that health-care costs for dementia will double from the 2011 figure of $8.3-billion to $16.6-billion by 2031.
The adage that old age sucks but it beats the alternative will get a workout in the coming decade. The financial pressure on the medical system may prod future governments toward including dementia victims in the MAID legislation. A report to that effect was presented to Parliament in December, although it contained no recommendations and Health Minister Ginette Petitpas Taylor said she had no plans to change the law.
The idea is that dementia victims give advance written notice for assisted death before they lose the capacity for consent. It is a complex issue. We see someone in the throes of dementia and think: I never want to get to that point. But we don’t know what it looks like through their eyes. Maybe some part of them still enjoys Handel’s Messiah, the face of a grandchild. And maybe that’s enough.
Any revised legislation will meet a generation disinclined to embrace old age and suffering with the stoicism of the aptly named Silent Generation that came before us.
Is this a good or a bad thing? If you polled the generations trailing in our annoying wake, they might say: the sooner the better.
And it may be sooner. The MAID guidelines state: “You do not need to have a fatal or terminal condition to be eligible for medical assistance in dying.”
How far can we take that concept? At the fringes of the right-to-die movement there is something called “old age rational suicide.” These are old people who don’t suffer from dementia or a debilitating disease, who aren’t physically suffering. They’ve simply had enough. After an assessment of their lives and a realistic look at their future, they’ve decided they don’t want to inhabit that landscape.
A 2017 study from the University of Glasgow – “Old age rational suicide” – stated, “Existential suffering resulting from accumulated age-related losses and from a feeling that one has ‘lived too long’ can be just as unbearable as physical suffering stemming from a diagnosable terminal illness.”
Among the symptoms of this state are “multidimensional tiredness” and “an aversion towards dependence.” Anyone with young children can relate to “multidimensional tiredness.” And who doesn’t want to be independent? But this will be the territory my generation inhabits in the coming years. Those lucky enough to avoid debilitating illness will be faced with “age-related losses”: companionship, mobility, energy. Our friends will die, and we will fade.
And we may be bored. An epic boredom that will make any current boredom look like a Rolling Stones concert. When the British actor George Sanders (the voice of Shere Khan in the original Jungle Book) killed himself in 1972 at the age of 65, he left a note that read, “Dear World, I am leaving because I am bored. I feel I have lived long enough. I am leaving you with your worries in this sweet cesspool. Good luck.” In a note to his sister, he said that he had only hastened the inevitable by a few years.
In the Netherlands, where euthanasia was legalized in 2002, the country’s largest right-to-die movement initiated a campaign called “Completed Life.” It lobbied for assisted dying for people over 70 who don’t have a diagnosable disease. Their eligibility guidelines were elastic and subjective – “loss of meaning and purpose,” “no prospects for the future” and “afraid of the future.”
But these are the reasons that many younger people kill themselves. And when they do, they leave devastated friends and family. But suicide itself changes character as we enter old age. It may still be tragic, but it isn’t the tragedy of young or middle-aged suicide. There is sadness certainly, but there isn’t the devastation that younger suicides leave. With them, we are so often left with the question: Why did they do it? But with the old, we know why they did it. We may not agree, but it is easier to understand. They didn’t leave unfulfilled potential, just a void.
Ezekiel Emanuel, an American oncologist and one of the architects of the Affordable Care Act, provocatively called for anyone over 75 to reject life-prolonging treatment on the basis that by 75, “creativity, originality, and productivity are pretty much gone for the vast, vast majority of us.” And this leads to loss of meaning in life.
But there is meaning and there is meaning.
We have a tendency to move the goal posts. When the Who sang “I hope I die before I get old” back in 1965, they were probably thinking 30 was old, or maybe 35. But then 40 became the new 30, 60 became the new 40, etc. What we thought we couldn’t live with becomes something we choose to bear. In his book Being Mortal, Atul Gawande describes a patient with severe health problems whose criteria was the ability to watch football and eat ice cream. If he could do that, then whatever suffering he experienced was worth it. That’s why we have to be able to reaffirm our desire to die immediately before any medically assisted death. We may not feel the way we thought we’d feel.
And there is the issue of our legacy. How do we wish to be remembered? A dignified exit after a vital life, or a gaunt, mute shell wheeled through the bedlam of an intensive care unit. In the next two decades, boomers will be at the forefront of this debate, and we will want to redefine dying as we attempted to redefine other aspects of life (music, fashion, sex), with similarly mixed results.