For some individuals, euthanasia or physician-assisted dying (aka PAD or EAS) presents an option to end one’s life with some control and dignity while minimizing pain and suffering. Whether they are experiencing severe chronic pain, mobility challenges, or serious illness such as cancer, these people may be intrigued by the possibility of euthanasia or physician-assisted dying.

But for the surviving spouses, facing the future without their lifelong partner can feel overwhelming, and their quality of life may plummet.

 

A major decision with ripple effects

 

This is a complex decision, impacting more than the patient themself. What if the patient pursuing EAS has a spouse or partner with a different opinion? According to a study conducted among physicians in the Netherlands, “involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support.”

Renckens SC, Onwuteaka-Philipsen BD, van der Heide A, et al. Physicians’ views on the role of relatives in euthanasia and physician-assisted suicide decision-making: a mixed-methods study among physicians in the Netherlands. BMC Med Ethics. 2024;25(1):43.

However, the researchers note, the relatives’ input is not considered decisive.

 

After a patient has died, their partner or spouse now faces new challenges of widowhood. Overwhelming feelings of loneliness and complicated grief are common among those who have lost a spouse or partner. The National Institute on Aging states: “Facing the future without a spouse or partner can be scary, especially for those who have never lived alone. Those who are both widowed and retired may feel very lonely and become depressed.”

Coping with grief and loss. National Institute on Aging. July 15, 2024.

 

 

 

Dying of a broken heart? The widowhood effect

 

Research suggests that grieving spouses may also die soon after their partner’s death, an occurrence known as the “widowhood effect.”

Elwert F, Christakis NA. (2008). The effect of widowhood on mortality by the causes of death of both spouses. Am J Public Health. 2008;98(11):2092–2098.

The National Council on Aging notes that “older adults grieving a spouse’s death have an increased risk of dying compared to those whose spouses are living.”

The widowhood effect: How to survive the loss of a spouse. National Council on Aging. May 4, 2023.

This can be due to psychological distress, declining self-care, and lack of social support. A study on the connections between grief and cardiovascular disease and death concludes that “a relationship exists between depression and inflammation among bereaved individuals.”

Fagundes CP, Brown RL, Chen MA, et al. Grief, depressive symptoms, and inflammation in the spousally bereaved. Psychoneuroendocrinology. 2019;100:190–197.

 

Following these conclusions, then, if a patient pursues euthanasia, their grieving spouse has a higher risk of death following the procedure. Factors unique to euthanasia that would impact the spouse’s experience should be considered, such as the decision-making process, input from family, and a sense of control over the patient’s death and dying experience. Nevertheless, the widowed spouse would still experience the grief and suffering associated with a partner’s death, no matter the cause. This living spouse would still be facing these challenges alone and could experience complicated grief, depression, and other health issues.

 

Living together, dying together

 

Some couples may consider pursuing euthanasia together, as demonstrated in June 2024 by Dutch couple Jan and Els.

Duo euthanasia: Why a happily married couple decided to die together. BBC. June 28, 2024.

The couple came to this decision considering the chronic pain and mobility challenges (in Jan’s case) as well as dementia (in Els’ case). After their many years together as a couple, they felt that the best way forward was to end their lives together, and their doctors granted them duo-euthanasia.

 

While euthanasia is relatively uncommon in the United States—and duo-euthanasia even less so—it holds significant appeal for some couples, especially when one or both are suffering. Israeli researchers compared older adults’ attitudes toward euthanasia use in the case of two different kinds of terminal illness: cancer and Parkinson’s disease.

Lifshitz R, Bachner YG, Carmel S. Older adults’ attitudes toward using Euthanasia at the end-of life: cancer vs. Parkinson’s disease. Front Public Health. 2024;12:1393535.

They found a more positive attitude toward euthanasia in cancer. They concluded that “it appears that fear of death and dying and self-efficacy are important psychological factors in explaining attitudes toward Euthanasia in both illnesses among older people. These findings shed light on older adults’ attitudes toward Euthanasia in debilitating illnesses.”

Lifshitz R, Bachner YG, Carmel S. Older adults’ attitudes toward using Euthanasia at the end-of life: cancer vs. Parkinson’s disease. Front Public Health. 2024;12:1393535.