Ten people slipping away from their retirement community on a Sunday afternoon for a covert meeting at a grocery store cafe.
The seniors, who live in independent apartments at a high-end senior community near Philadelphia,
showed no obvious signs of depression. They're in their 70s and 80s and say they're not going to end their lives soon.
More seniors are weighing the possibility of suicide, experts say, as the baby boomer generation – known for
Dena Davis, a professor of bioethics at Lehigh University who defends "Rational suicide" ̵
The concept of rational suicide is highly controversial; It runs counter to many societal norms, religious and moral convictions, and the efforts of suicide prevention workers.
"The concern that I have is at a social level Yeates Conwell, a psychiatric specialist in geriatrics at the University of Rochester and a leading expert in elderly suicide, said, "It is more acceptable to do so, more common" ,
As a society, we have a responsibility to care for people as they ages, Conwell argued. Promoting rational suicide "
A Kaiser Health News investigation in April found that older Americans – a few hundred per year, at least – are killing themselves while living in or transitioning to long-term care. Many cases of KHN have been reported to be involved in depression or mental illness. Davis would call a rational choice.
Suicide prevention experts contend that while it's normal to think about death as we age, suicidal ideation is a sign that people need help.
But to Lois, the 86-year-old-woman who organizes the meeting outside Philadelphia, suicides by older Americans are not all tragedies. A widow with no children, Lois said she would rather end her own life than deteriorate slowly over seven years, as her mother did after she broke a hip at age 90. (Lois to be known to only her middle name so she would not been identified, given the sensitive topic.) In a couple of years ago, Lois has found other people who feel sick about suicide. But because of stigma, they said, the conversations are usually kept quiet.
Lois insisted her group meeting off-campus at Wegmans because of the "subversive" nature of the discussion. Supporting rational suicide, they said, clashes with the ethos of their continuing care retirement community, where seniors transition from independent homes to assisted living to a nursing home as they age.
Seniors pay six figures to move into the bucolic campus, which includes an indoor heated pool, a concert hall and many acres of wooded trails. They are guaranteed housing, medical care, companionship and comfort for the rest of their lives.
"We are saying, thank you very much, but that's not what we're looking for," Lois said of her group.  Carolyn, a 72-year-old member of the group who said she was "a lot of agency." But she and her 88-year-
A retired nurse, Carolyn said: "The husband and wife have been diagnosed with HIV / AIDS epidemic.
A stockpile of lethal drugs on a dresser or bedside table has been published in the 1990s , They would tell, "When I'm ready, that's what I'm going to do."
"I just saw so many people who were planning to have that quiet, peaceful ending when it came, and it just never came. The pills just got scattered.
Carolyn emphasizes that she and her husband do not feel suicidal, nor do they have any specific plan to die on a certain date. But she said while she was still able to afford the option for a peaceful future in the future.
"Ideally, I would have had the pill, or the liquid or the injection "She said."
New Jersey has recently been released in the dying state to allow medical aid, which permits some patients to get a doctor's prescription for lethal drugs.
Patients who are eligible for these laws would have to go to "underground practice" to get lethal said Timothy Quill, a palliative care physician at the University of Rochester School of Medicine. 45-year-old patient with leukemia sleeping pills so she could end her life. He said he has done so with only one other patient.
Quill said he considers he said: "I would probably be a classic [case] – I'm used to be in charge of my life. "He said he could not be better than others," but I'd like to make that a choice as opposed to a necessity. " Suicide could be as rational a choice as a patient's decision to end dialysis, after which they usually within two weeks, he said.
Clinicians have learned how to handle conversations about rationally Suicide, said Meera Balasubramaniam, a geriatric psychiatrist at New York University School of Medicine who has written about the topic.
"One school of thought that could not be rationally thought of as an ageist concept," she said. "It's an important point to consider.
In her discussions with patients, she said, she explores their fears about aging and dying
Conwell, the suicide prevention expert, said these conversations matter because "the balance between the wish and the wish to live is a dynamic one to moment, week to week. "
Carolyn, who has three children and four grandchildren, said conversations about suicide are often kept quiet for fear that they were implicated in a crime.
In some of the cases KHN reviewed, "nursing homes have faced federal fines of thousands of dollars for failing to prevent suicides on-site." 19659030] There's "just this hush-hush atmosphere of our culture," Carolyn said. "Not wanting to deal with judgment – of others, or offending someone because they have different beliefs.
Carolyn said when she and her neighbors met at the cafe, she felt comforted by breaking the taboo.
"The most wonderful thing about it being a table with people." that I knew where we could talk about, and realize that we're not alone, "Carolyn said.
At the meeting, many questions were practical, Lois said.  "We only get one crack at it," Lois said. "Everyone wants to know what to do."
Davis said she did not have any answers. Her expertise reads in ethics, not the means.
Public opinion research has shown disagreements among doctors and the general public about hastening death. Nationally, 72 percent of Americans believe that doctors should be allowed to end up in a terminal ill patient's life, according to a 2018 Gallup poll.
Lois said she's seeing societal attitudes begin to shift about rational suicide, which she sees as the outgrowth of a movement toward patient autonomy. Davis said, "It seems to me that there must be an awful lot of people in America who think the way I do," Davis said. "Our beliefs are not respected. Nobody says, "Okay, how do you respect and facilitate the belief in somebody who wants to commit suicide rather than having dementia?" "
If you have anybody talking about contemplating suicide, call the National Suicide Prevention Lifeline at 800-273-8255, or use the online Lifeline Crisis Chat, both available 24 hours a day, seven days a week. People 60 and older can call the Institute on Aging's 24-hour, toll-free Friendship Line at 800-971-0016. IOA also makes ongoing outreach calls to lonely older adults.
Kaiser Health News is a non-profit news service covering health issues. It is not affiliated with Kaiser Permanente.