['Tired of life': a reason to evaluate physical handicaps]

A 91-year-old woman was admitted to a nursing home because of functional deterioration: poor vision and hearing, and diminished mobility. She had been widowed for 30 years, had no children and a very small social network. She described herself as 'tired of life', and alluded to the assisted suicide of the former senator Brongersma, where this term was the trigger to the administration of assistance. The Supreme Court however ruled afterwards that a physician has no capacity in 'questions of life and death', but only in requests for help with a medically classifiable underlying disorder. The patient was not assisted in dying and her condition deteriorated further. Some time later she fell and contracted a clinical hip fracture. She refused to be brought to hospital and was given fentanyl plasters. A week later she died. The question on how to respond to the very elderly who seek help because they wish to die, is being discussed in the Netherlands. The term 'tired of life' appears to be rather confusing, as it has no medical connotation. It is recommended that elderly persons who ask for help in dying because they are 'tired of life', based on physical handicaps, are evaluated carefully to determine the severity of the handicaps and the hopelessness and unbearableness of the suffering. This could lead to the patient receiving assistance in dying.