Well-being as seen through the regrets of the dying

I recently read a Guardian article on the most common reported regrets from the dying and thought, “oh, that’s a good lead-in for a blog on subjective well-being.” However I see that Nic Marks at the New Economic Foundation beat me to the punch, so I link his insightful post. Nevertheless I’ll extend what he starts and add a development perspective…

The Guardian article summarizes the observations of a palliative care nurse in Australia concerning patients in their last weeks of life (Bronnie Ware, the nurse, subsequently wrote a book). Apparently the five most common regrets as voiced by these patients are:

(1)                I wish I’d had the courage to live a life true to myself, not the life others expected of me.

(2)                I wish I hadn’t worked so hard.

(3)                I wish I had the courage to express my feelings.

(4)                I wish I had stayed in touch with my friends.

(5)                I wish that I had let myself be happier.

I’m struck by how well all of these sentiments are captured by certain subjective well-being measures used in economic research. So a little background.

Subjective well-being is commonly assessed through a life evaluation framework, with a series of questions along the lines: “Thinking about your own life and personal circumstances, how satisfied are you with your life as a whole?” Respondents then answer on a scale of one to ten or choose coded responses such as “somewhat satisfied”.  A life evaluation exercise can comprise life in total or focus on sub-dimensions such as living standards.

It is natural to contrast the life evaluation framework with another dominant approach to subjective well-being:  affect measurement. The affect approach essentially asks about feelings or emotions at a particular point in time, such as “how happy did you feel yesterday”? The relation between affect measurement and life evaluation is not a straightforward one as a life evaluation is likely more than a simple summation over all past moments of affect, both good and bad. For one, even if a respondent attempted to count all past moments of happiness and weigh them against past moments of sadness, there are obvious problems with the accurate recall of every moment in life. And more importantly, even though life evaluation may indeed involve a recall of affect, there is likely to also be an assessment of a life’s meaning – and it is certainly possible to satisfactorily reflect on a life generally unhappy but still deemed meaningful.

Finally there is a third more structured approach to subjective well-being grouped under the term eudaimonic well-being that applies a particular school of psychological theory to posit core domains of well-being where greater attainment of each domain results in greater well-being. In the self-determination theory of Deci and Ryan, one approach to eudaimonic well-being, these core domains include autonomy and relatedness.Autonomy is defined as the ability of the self to influence the course of life both in the short run (how will I allocate my time this week, what will I eat for dinner) and the longer run (where will I live, how will I earn my livelihood). Relatedness is the maintenance and growth of sustaining interpersonal relations and the feeling of emotional connectedness to friends, family, and community.

As all of these regrets of the dying are retrospective in nature they are very much in the spirit of a life evaluation exercise and, when looking at this list of regrets above, I find it natural to interpret regrets (1) and (2) as expressions of a wish for greater autonomy while (3) and (4) are expressions of a wish for greater relatedness. Regret (5) is harder to interpret since it involves regrets about agency (“I wish I let myself be happy more”) but it certainly involves a wish for more moments of positive affect.

Since this is a development blog, you know I will ask: what will result from similar exercises conducted in other regions of the world and, in particular, in developing countries? As I wrote last week about the need to understand the interpreted meaning of life satisfaction, and how this meaning may vary across different cultures and contexts, an exercise of this nature would undoubtedly reveal these challenges and may even help to resolve them.

There are obvious interpretative difficulties with such an exercise. Remember, the article above concerns the “regrets” of people who had lived to elderly or late middle age in a rich country. Fewer people survive to older ages in low income countries and certain prevailing causes of death (i.e. communicable disease, accidents) result in sudden deaths that don’t allow for much reflection time. So the issue of mortality selection, where those dying in hospice do not represent the population as a whole, is more binding in developing countries than in Australia where relatively many people will have the opportunity to reflect on end-of-life regrets.

Another obvious difference, of course, is that incomes are generally lower in developing countries. Would life regrets be more likely to mention material challenges? Or would fewer people regret a life of “too much work” if their lives were lived closer to subsistence level?

I am also struck by the absence of any mention of family in these common regrets. I imagine that for several regions of the developing world life regrets would focus a good bit more on family and less on self.

Well these are mere speculations at the moment. Hopefully an intrepid researcher will take up this call and find answers.