title: Caught between intending and doing: older people ideating on a self-chosen death.
abstract: OBJECTIVE
  The aim of this paper is to provide insight into what it means to live with the intention to end life at a self-chosen moment from an insider perspective.
  
  
  METHODS
  Participants who lived independent or semidependent throughout the Netherlands.
  
  
  METHODS
  25 Dutch older citizens (mean age of 82 years) participated. They were ideating on a self-chosen death because they considered their lives to be no longer worth living. Inclusion criteria were that they: (1) considered their lives to be 'completed'; (2) suffered from the prospect of living on; (3) currently wished to die; (4) were 70 years of age or older; (5) were not terminally ill; (6) considered themselves to be mentally competent; (7) considered their death wish reasonable.
  
  
  METHODS
  In this qualitative study, in-depth interviews were carried out in the participants' everyday home environment (median lasting 1.56 h). Verbatim transcripts were analysed based on the principles of phenomenological thematic analysis.
  
  
  RESULTS
  The liminality or 'in-betweenness' of intending and actually performing self-directed death (or not) is characterised as a constant feeling of being torn explicated by the following pairs of themes: (1) detachment and attachment; (2) rational and non-rational considerations; (3) taking control and lingering uncertainty; (4) resisting interference and longing for support; (5) legitimacy and illegitimacy.
  
  
  CONCLUSIONS
  Our findings show that the in-between period emerges as a considerable, existential challenge with both rational and non-rational concerns and thoughts, rather than a calculative, coherent sum of rational considerations. Our study highlights the need to take due consideration of all ambiguities and ambivalences present after a putatively rational decision has been made in order to develop careful policy and support for this particular group of older people.
authors.affiliation: University of Humanistic Studies, Care and Well-being, Utrecht, The Netherlands.
authors.forename: Els
authors.initials: E
authors.lastname: van Wijngaarden
authors.affiliation: University of Humanistic Studies, Care and Well-being, Utrecht, The Netherlands.
authors.forename: Carlo
authors.initials: C
authors.lastname: Leget
authors.affiliation: University of Humanistic Studies, Care and Well-being, Utrecht, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Goossensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D033182:Intention; D007407:Interviews as Topic; D008297:Male; D016743:Mental Competency; D009426:Netherlands; D036301:Qualitative Research; D011788:Quality of Life; D012297:Right to Die; D059020:Suicidal Ideation; D017236:Suicide, Assisted / Q000523:psychology*
keywords: ETHICS (see Medical Ethics); MEDICAL ETHICS; MENTAL HEALTH; QUALITATIVE RESEARCH