The father of human behaviour research, Daniel Kahneman — who famously wrote Thinking Fast, Thinking Slow — spent his life studying how we make decisions and uncovering the biases that cloud our judgment. In the end, he made an unusual final choice — to end his life. This was on March 27, 2024. A year ago.
Here’s what we know. Daniel Kahneman, at 90 years old, opted for assisted suicide in Switzerland. His decision was influenced by his declining health, including failing kidney function and increasing mental lapses. He had long held the belief that “the miseries and indignities of the last years of life are superfluous.” He wanted to avoid a prolonged decline and “go out on his own terms.” He also expressed that he had made peace with death, viewing it as “going to sleep and not waking up.”
Just 100 years ago, the average lifespan was a mere 32 years. Medical science has extended human life expectancy far beyond what was once thought possible. So when an 87-year-old with multi-organ failure arrives in the ICU or requires multiple heart procedures, should we throw every possible intervention at them? Or should we pause and ask: What is the goal? To extend life by weeks or months? To restore quality? To respect their dignity? Medicine provides an answer, but wisdom demands a deeper conversation.
Survival rate
To put things in perspective, two French studies analysing large numbers of ICU patients over 85 found that 55 per cent died in the hospital. Among those who survived, patients aged 85-89 lived an average of 10 months, while those 90 and older lived only four months.
With ageing, our bodies weaken and heal more slowly. The risks of medical interventions are magnified. In some cases, all I see is a flurry of tubes, beeping machines, and sterile rooms replacing the warmth of a home. I’ve witnessed the pain and fear in their eyes — the silent plea for a familiar face, a gentle touch. The truth is, the body’s resilience wanes. The pain is both physical and emotional. In their minds, they are torn between the hope of recovery and the despair of present suffering.
This makes me believe that the most profound healing in the very elderly does not happen in an operating room, but in the embrace of loved ones. The laughter of grandchildren, the comfort of a familiar armchair, the simple joy of a sunset — these are the moments that truly define a life well-lived. Let the final chapter be written at home, surrounded by love, not in the sterile confines of a hospital.
Kahneman’s choice
Do I understand Kahneman’s choice? Yes. Do I advocate for it? Yes, but when quality of life is significantly impacted.
Feelings about hospitals are deeply personal and can be influenced by many factors, including: the individual’s health status — what we call physiological age, not just chronological age; past experiences with hospitals; their level of independence; their personal views on medical intervention; the quality of care they receive; and the family’s commitment to recovery.
I always evaluate the above factors before advising. I have operated on patients in their late eighties and early nineties who have recovered and gone on to live many more years — with good quality of life. Daniel Kahneman made a deeply personal and well-considered decision, one that his family must have taken time to understand.
As medicine advances and lifespans lengthen, we may see more of these choices being exercised in the future. The question we must ask ourselves is not just how long we can prolong life — but at what cost, and for whose benefit?
The writer is Chairman, Asian Heart Institute
