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as it is lived and experienced by elderly people. Between April to December 2013, we conducted 25 in-depth interviews. A reflective lifeworld research design, drawing on the phenomenological tradition, was used during the data gathering and data analysis. The essential meaning of the phenomenon is understood as ‘a tangle of inability and unwillingness to connect to one's actual life’, characterized by a permanently lived tension: daily experiences seem incompatible with people's expectations of life and their idea of whom they are. While feeling more and more disconnected to life, a yearning desire to end life is strengthened.

The experience is further explicated in its five constituents: 1) a sense of aching loneliness; 2) the pain of not mattering; 3) the inability to express oneself; 4) multidimensional tiredness; and 5) a sense of aversion towards feared dependence.

This article provides evocative and empathic lifeworld descriptions contributing to a deeper understanding of these elderly people and raises questions about a close association between death wishes and depression in this sample.

Noninferiority testing in clinical trials : issues and challenges

Elderly people; Assisted suicide; Assisted dying; Existential suffering; Wish to die; Self-directed death; Qualitative phenomenological research

In recent years, there has been a growing scientific interest in elderly people wishing to die without the presence of a life-threatening disease or a severe psychiatric disorder.

Several quantitative studies have been undertaken to determine prevalence rates, characteristics and risk factors associated with the development of death ideation and death wishes in elderly people who are tired of living (Harwood et al., 2001, Jorm et al., 1995 and Rurup et al., 2011a).

In addition, some qualitative studies have been conducted to understand suicidal feelings in elderly people (Crocker et al., 2006, Harwood et al., 2006, Kjølseth et al., 2009, Kjølseth et al., 2010, Rurup et al., 2011b and Rurup et al., 2011c).

Most elderly people who wish to die “will wait until time fulfils their wish” (Rurup et al., 2005) and would probably consider suicide to be unacceptable, associated with despair and mutilation.

In order to describe the phenomenon in all its richness, an in-depth interview study based on Dahlberg's reflective lifeworld approach (Dahlberg et al., 2008) was conducted.