With advance decisions currently being the only legal means of expressing ones wishes about the end of life in the UK, the literature revealed that the assumed benefits of having an advance decision, can be challanged. The processof discussing the choices and wishes for the end of life appeared to be considered more valuable by older people, than the outcomeof having an advance decision.With the debates about possible legalisation of euthanasia and assisted suicide ongoing in the UK, sevenolder people were interviewedto explore their position in this debate.The interviews were analysed using discourse analysis, with reference to the Foucauldian concepts of knowledge, power, subjectification and surveillance.
Three main discourses emerged: confused and conflicted, an aged death and voiceless in the debate.A patchy knowledge about the nature of the acts fed into conflicting discourses. A self-determination discourse was eroded by discoursesthat involved family and physicians in the decision-making process. The medicalisation of dying appeared endorsed at several levels, through the physicians’ knowledge, power, subjectification and surveillance processes. An alternative dying discourse emerged where healing and growth in death were considered possible. For this healing and growth to occur, family were present and the medical gaze absent.
In the aged death discourse, participants talked about the anticipated changes in their physical and mental health before their death in old age. However, they expressed concern about becoming dependent on professional others and the quality of care they might receive at the end of their life. They appeared to disappear from any ‘gaze and surveillance’ and were concerned they would be treated like ‘objects’. Euthanasia and assisted suicide were considered as options that could provide a sense of control and independence at the end of life. It is possible that the position of older people in society and their worthiness of care and attention might have been internalised by older people and hence contributed to their consideration of euthanasia and assisted suicide.
The participants reported feeling voiceless in the debate, as they experienced difficulty engaging others in a debate about euthanasia and assisted suicide, attributing vulnerabilities to debating partners (children, friends, physicians), who would normally be considered as holding powerful positions. They expressed frustration about the fact that it appeared that arguments in favour of euthanasia and assisted suicide had to meet a ‘higher standard of rationality’, than the arguments presented against euthanasia and assisted suicide. Their confused knowledge about the exact nature of euthanasia and assisted suicide might also hamper their power position in any debate. Psychologists need to remain vigilant about the impact of conflicting discourses the older person might express and critical of the impact societal discourses about ageing may have on the older person as well as the health and social care provision.