I have resisted posting about this for a long time, but here it goes. What are your long-term plans for old age? Mine is assisted suicide (part of my retirement plan), when I feel I've had enough out of life. I know that this is extremely sensitive and controversial, hence the trigger warning. Therapy is often meant to reverse ideations Nothing has ever reversed my sense of My (beloved) dad had an awful decline in both physical and mental health before he died. I also generally think about the hardcore philosophical sense, what is the purpose of cultivating life when no longer wanted by the one lived it?

This is not meant to be a support thread for me, much more a life experience and philosophical discussion on using controlled exits of life. Were your exit plans ever influenced by therapy? Mine were not.

[atisketatasket]

Ever since watching my father die, I have planned that if I ever get sick like that, I would put a stop to the progress of the illness by putting a stop to me.

I had this plan long before starting therapy. I have never told it to a therapist. It’s not like the suicidal feelings I have now, which are far more emotional. This plan feels practical.

Same here. Including watching my father decline, both physically and mentally, at the last couple years of his life. My dad and I were very close in my adult life, I think because we had many personality similarities that manifested in palpable ways. Seeing him decline, and experiencing the decline with him (I was his only confidant for a good while, and then the authority to decide to eventually to give the DNR) just reinforced my current idea and decision about ending my own life on my own terms, when I feel it is time.

I told my last T this. Never got a response about it.

[stopdog]

Therapy had absolutely no effect on my beliefs about infirmaty/old age/final demise.
The woman asked me if anything about how my person was changed my mind about western medicine (chemo did work for a while) and the answer was always absolutely not - if anything it sealed that I will never let western medicine get its claws in me. I have memorized the final exit book and my strategy is planned out should I become terminally ill or chronically in pain etc.

I do plan to take advantage of modern western medicine in my exit strategy (don't think I need to specify what). We often discuss how psychotherapy is unnatural... Well, I do plan to apply an unnatural, designer approach to my own old age/death/exit. Of course no one can predict how we will really feel and think when the subjectively supposed time comes, but I personally like the idea of doing it according to my general personality, the way I decided and experienced many other things while alive.

Speaking of which, I also have a very intense fear of and aversion to death, which might interfere with my plans... dunno. Reminds me of my dad a bit... he was a super responsible person in his life, but pretty much very practically and strategically gave up and eliminated all of his passions, possessions, and he and I had a long-standing plan, executed, on what to do with the rest of his heritage. But I did not see him as a person easily giving up on life per se, at all. It was an awful, long process to do it with him. He was more content in the end, on his death bed, probably because he was heavily medicated/sedated. We had a seemingly wonderful and peaceful connection on his last day but, again, I really believe it was because of the medications the hospital put him on. I don't think people naturally go out peacefully, it is perhaps more akin to the kicking and screaming of birth.

Both life and death, and the desires for both, are natural. How could psychotherapy potentially tune down, or even in any way influence it? No idea.

[Amyjay]

I have nothing against choosing a planned or assisted suicide when my suffering becomes unbearable. Incidentally I saw a counsellor a few years ago and recently learned her father died by a planned suicide when his physical pain became untreatable and unbearable. My counsellor knew it was going to happen. It was very hard for her but she respected his decision and supported him. She said it was still a shock to her when it actually happened.
We care for our pets when their suffering is too great. I think human beings deserve the same compassion, especially when they can clearly and coherently decide that is what they want for themselves.

A documentary dealing with the topic:

[here today]

My late husband had cancer and hospice care and died at home. My mother had dementia and was in hospice at a nursing home. They both seemed OK with where they were and their passing. Neither was in much pain. I have 2 grown children so that is a factor for me. But my son has my POA and knows and understands my wish not to prolong anything. He lives in a state that has lenient laws where I plan to move eventually, if something sudden doesn't take me first. If I am diagnosed with Alzheimer's or another degenerative disease then I will think and look into other options then.

For me, I have both physical and mental issues, several also inherited from parental sides, as well as acquired from my own self-destructive behaviors, which make me aware of my lifespan and what might be reasonable life expectations. None of these present immediate or close danger right now, but I think I need to be realistic about my perspective, especially given that I have a large team depending on me professionally, at this point.

I often still wonder, would it be useful to have a therapist to discuss these specific things?

[here today]

I think it could be, maybe a "reality" oriented person like a social worker? The hospice social worker with my husband's hospice was terrific. I wish I could have found someone like her just for me, to help readjust after his death -- except I had the trauma issues that really needed to be addressed, not that I knew it at the time.

I thought I was the only one who heavily considers assisted suicide. I watched my family fight over my brain dead, vegetative uncle in the ICU. In my country, an adult can sign a directive to "refuse the use of any life-sustaining treatment to be used to prolong your life in the event you become terminally ill and unconscious and where death is imminent." It prohibits assisted suicide, but at least I can ensure my wishes will be respected should I end up like my uncle. If I've a terminal illness, I'd want hospice, then assisted suicide at a certain point.

[ruh roh]

I have talked to my therapist about this, but it hasn't been very helpful. She has suggested 5 wishes (I think that's what it's called) but when it comes to fears of dementia, which I dealt with in a parent's situation, she just says that must be scary. Um...eff yeah, it is.

I know a couple of people with access to the right kind of medical assistance to end things, but the problem is that for something like dementia—which is hands down the most horrible condition and insurance does not cover the cost of care for it—I have noticed that by the time it's apparent, the person is unaware or in denial. The timing is hard to get right. Anyway, these two other people and I have a pact to assist each other. I am the youngest, though, so I don't think they will be there for me if it comes to it. I wish therapy could be more helpful with this, but when it comes down to it, life really sucks and it is getting worse in this country for anyone who is not wealthy.

[awkwardlyyours]

I’ve always had a plan of just taking off somewhere in the mountainous wilds in the motherland — as preparation, I’ve picked out a couple of places (monasteries) I could move to and live in a few years earlier, when I’m still in a somewhat stable condition (physically and mentally).

But, recently, I’ve been considering making more concrete plans — actually moving there earlier and living on my own etc.

I have zero intentions of discussing any of this with current T — she remotely wouldn’t get it, although, to be fair, I know she’ll try her damnedest best to understand.

[East17]

Possible trigger:

I don't even have plans to make it to old age.

Both the counsellor and Psychologist are aware of the suicidal ideation and I think were hoping that therapy would reverse /eradicate these thoughts. If anything they've just become stronger, especially over the past 2 years.

Ideally I would like to opt for assisted suicide, but not living in a country where it's legal, means travelling to one where it is. It costs an awful lot of money and you still have to be of sound mind and in reasonable physical health in order see make it happen. So in reality I think I'll be left to my own devices. Having already 2 failed attempts, I want to ensure the third time is successful. Achieving that is the difficult part.

Yes, the timing is the most challenging part of it. One has to be able to be intact mentally to make the independent decision and to go forward with the act, which is hard is the main reason, or one of the reasons, is losing one's mental faculties. The people in the documentary I linked who went through with assisted death had progressive physical illnesses, but were mentally entirely competent. It is a trap with dementia.

I also think that often when someone is already seriously ill (even if the condition does not affect their cognition), often their outlook on the whole thing changes. Maybe fear or survival instinct, I don't know. In my mind as I imagine now, I would not want to wait as late as having to go to hospice, but who knows what I will want when in the situation? My father had both progressive physical illness and dementia, and while most of the time he was saying he no longer wanted to live and just hoped for death every day, he was somehow quite against the idea of ending it at his own will.

I do like the idea of maybe talking with a knowledgeable social worker about the practical parts of it, like here today suggested. Basically, to have information about the possibilities, how the administrative parts go exactly, etc. The emotional part - that is hard to get help with, I believe... it's not the kind of being sui due to depression, and it is a most intimate, individual choice.

I have had many similar thoughts and fantasies to what awkwardlyyours described. What I like about the official procedure though is the environment where it takes place, with full awareness and agreement of everyone around.

I actually did discuss assisted death with both of my Ts, and this was something they both handled well and seemed supportive of the possibility of such a choice. It was not discussed in the context of any personal wish I had, just as a theoretical topic and in relation to my father's illness. I don't know if any T would support a client in executing it.

Something perhaps interesting to some... I know of a bunch of researchers and research studies that focus on end of life psychotherapeutic care, sort of to try to help the anxiety of a terminal illness with focusing on spiritual, esoteric, kinda half scientific, half legal approaches. A more widely known (at least in some popular circuits) one is Rick Strassman's work, book and movie "The Spirit Molecule". I guess many people who read this thread/forum have heard of "traditional" or "shamanic" approaches, if for nothing else, from entertainment... And currently less known efforts are similar in the sense of comparing death to spiritual (or whatever they are for an individual) experiences induced by psychedelic drugs - here is a link to a past study that is no longer running, but maybe the film is interesting and whoever is interested can look up more details.
NYU Psilocybin Cancer Anxiety Study

This is a topic (yet again, even within this thread that already has a trigger warning) that I am very hesitant to discuss here... but I've just decided, why not share at least.

[Myrto]

Extremely interesting topic! I have never discussed my plans regarding my death with any therapist because it's something I have been sure for quite some time and I don't need a therapist's input into my situation. It's simply not relevant. In my country, euthanasia (is it the same as assisted suicide? I'm not sure) has been legal since 2002 but there are conditions you have to fulfill. You have to be capable (no dementia) and conscious (not in a coma), you have to be in a hopeless medical condition and you have to report suffering from physicial/psychological excrutiating pain. If I am ever diagnosed with a degenerative disease I plan to make full use of that law. I have also decided that I want my body to be cremated because I don't like the idea of my body being eaten out by worms. I've noticed that the rare times I have discussed this topic, my friends and girlfriend became very uncomfortable and tried to change the subject. I'm not suicidal in the least and I'm still young (30) but I just think it's good to be prepared. I simply don't understand the horrified expressions people have when you discuss death. It's part of life.

Yes, assisted suicide is euthanasia.

I think there is a subtle difference (but the law makes a very clear distinction in some countries/states) between deliberate euthanasia and assisted suicide. In euthanasia, the physician can administer the drug or whatever method, while in assisted suicide, the one assisting "only" gives the drug to the person and s/he has to perform the act. Euthanasia is what is more strictly controlled and less available, but if the person is supposed to be fully mentally competent, the difference is quite subtle really, maybe more just philosophical/symbolic, at least in my mind.

The availability of these things for people who suffer and want to die due to mental health issues is of course an extremely controversial area and I think it is not allowed in most places. This always makes me somewhat angry because it assumes that suffering from mental problems is not appreciated as very serious for an individual, just because there is no physical pain, organ failure, clearly predictable natural death in sight... Of course I understand why this is the case, but still. If human dignity and freedom are recognized in the context of physical capability, why is the mental part not, especially given that the freedom of choice is a very mental thing? Also, these days it's generally accepted that mental illnesses are physical in nature, and some are chronic or life long... And, with debilitating, painful, slow course physical illness, I doubt that a person maintains a very peaceful, completely healthy emotional mindset, even if cognition appears intact. The boundaries are clearly quite diffuse.

I understand why people feel uncomfortable talking about death, I think the fear and avoidance is natural. I've personally never felt uncomfortable discussing it, I also think/feel it's normal part of life, however cliche that sounds. I can't say that I have no/little fear of dying and death though - the very reason why I am doing this planning is because I am terrified of chronic serious illness (both physical and dementia) and also the whole stopping to exist someday. The latter does not make me believe in any form of afterlife per se, but I am generally agnostic simply because I have no way of knowing those things.

I have been able to talk about these topics with many friends, even my elderly father, very openly and comfortably. It's certainly not for everyone though, why I am very selective bringing it up and why also hesitated about posting a thread here - I just did because there are so many highly intelligent, thoughtful people here, as well as a lot of suffering.

As for therapists, I would have no problem bringing it up again, but I would prefer in a practical context, not asking for help to make up my mind. I mentioned before that I did bring up assisted death with both of my Ts and they were pretty good at discussing it in philosophical ways. But when I wrote an email to my last T about me planning to actually do this for myself, he never responded and never brought it up in session.

So more about why I prefer assisted death vs the good old DIY way... For me it is not much about the reliability of the method - I am a biologist with perfectly enough knowledge on how to terminate life successfully and could find the resource for it myself if necessary. It is much more related to the context and environment surrounding it, and here is another relationship to the psychedelic experiences, where context/environment is very well known to be important and greatly influence the experience. I have been a very autonomous, self-sufficient person in my whole life (actually too much and some of my challenges relate to this psychological feature) - just would not want to have my last moments/hours all alone, preparing and executing the act in secret. I have planned and done way too many things alone/secretively already, dying that way as well just does not feel like spiritual evolution for me. Of course, ultimately, it is a lonely experience, but not necessarily in context. I also assume that doing it legally, openly, with people assisting both in the process and the execution, might be a good distraction from the anxiety and fear. And I don't need to be worried about who finds me and how (even if it is away from civilization, in the wilderness) - this might not be a factor for everyone, but it is for me.

As for what happens afterward - for me whether or not I want to be cremated was never even a question. Both of my parents were also cremated, at their will, they planned it and bought the grave in advance (well, it was my dad who arranged all that). For me, I don't want to have a grave though. It is a symbolic thing in my mind - being my ashes scattered would represent the freedom and not attached/belonging to any particular place strongly in my life. I would consider this differently if I had children and if it meant something for them to have a grave, but I don't, so it's just me deciding.

So, these are pretty much my plans, right now.