I've been surprised that the question of suicide has come up only once in this blog's comments, even after the two recent posts on fear (here and here). As I write there, I think that for me life will retain too much meaning to want to leave it early.

But given the attitude of most people towards Alzheimer's, why don't more choose suicide?

Certainly many think about it.

On seeing an Alzheimer's patient (or any other person) lying terminally ill and comatose in a nursing home bed, almost everyone thinks, "I don't want to die like that!" Others will feel the same when a person can't remember family or wanders around babbling. But when they get to that point, they rarely consider suicide. Why not?

For some, of course, the first and overriding issue is that suicide is morally wrong and can't be considered.

Second, while people might want to commit suicide "before I get that bad," very few people will choose suicide while their lives still retain meaning. Some people might choose to kill themselves while they're suffering greatly, but the prospect of future suffering is not enough of a motive.

If life is worth living now, we hang on to it. We are, after all, attached to life.

Third, many people with Alzheimer's lose their ability to commit suicide before they're ready to go through with it.

The novel Still Alice depicts an intellectual college professor with early-onset Alzheimer's who decides she'll suicide when it gets "too bad." She places into the medicine chest a bottle of pills strong enough to kill her and writes herself a note with exact instructions on when and how to use the pills. As she gradually declines, she gradually loses the capacity to remember or figure out what she meant. Ultimately, she wonders who this person is who is trying to kill her by writing this note to her.

Fourth, the experience of the person with Alzheimer's may not be as bad as we—who are looking in from the outside—think it would be. When we get there, we may find no reason to suicide.

As unimpaired people or as people earlier in the disease, we project how we will feel in the future but, in fact, we have little idea what our experience will be then.

In the Comments section of this blog and in emails to me, I've read beautiful stories about the happiness of patients with very advanced disease. Maybe most of them aren't suffering much at all.

Finally, one values life differently as one gets sicker.

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I worked for many years in a home and hospice for homeless men with AIDS. Most of them were admitted when their symptoms were relatively mild; they'd see other patients about to die and vow to overdose before they got "that bad." As far as I know, none ever did or even tried to.

As we approach the end, to have a "meaningful life" requires less and less.

Human beings generally value their lives deeply. We may think that when we reach such-and-such a condition, our lives will lose that value. But, apparently, that's very seldom true.

My understanding is that the suicide rate for people with Alzheimer's is low.

I'm not surprised.

For my own part, I think I'll be just too curious about what the future holds to consider walking out.