Euthanasia and assisted suicide are the ultimate tools for elder abuse
In Oregon USA, requests for assisted suicide because of physical pain are rare. Cited much more commonly as reasons are ‘loss of personal autonomy’ and not wanting to ‘be a burden’. These are both related to issues of abuse in the family which may otherwise be hidden from outsiders.
- Elder abuse is a serious and growing problem in New Zealand.[1. Age Concern. Elder abuse and neglect. Retrieved from https://www.ageconcern.org.nz/ACNZPublic/Services/EANP/ACNZ_Public/Elder_Abuse_and_Neglect.aspx#involved]
- Elder abuse remains unreported most of the time. [2. Age Concern. Elder abuse and neglect. Retrieved from https://www.ageconcern.org.nz/ACNZPublic/Services/EANP/ACNZ_Public/Elder_Abuse_and_Neglect.aspx#involved]
- About 75% of cases involve psychological abuse.[3. Age Concern. Retrieved from https://www.ageconcern.org.nz/ACNZPublic/Services/EANP/ACNZ_Public/Elder_Abuse_and_Neglect.aspx#involved] Examples of such abuse may be to hint at death as a preferable option, pressure or coerce a person to request death or give the impression that an elderly person is a burden.
- Being a victim of elder abuse is associated with depressive symptoms.[4. Roepke-Buehler, S. K., Simon, M. & Dong, X. (2015). Association between depressive symptoms, multiple dimensions of depression and elder abuse: a cross-sectional, population-based analysis of older adults in urban Chicago. J Aging Health, 2015 Sep;27(6):1003-25. doi: 10.1177/0898264315571106. Epub 2015 Mar 24.]
- Even when a person has not been diagnosed with clinical depression, a person’s judgement may be coloured by mild depression and pressure from others.“The [Royal College of Psychiatrists] believes that psychiatric issues are of crucial importance when PAS is considered, and point out that, while clear diagnoses of severe depression or psychosis may occur in this group of people, more frequently, judgement may be coloured by mild depression, mild cognitive impairment and pressure from others.”[5. OnMedica (2006, April 25). Psychiatrists oppose assisted dying bill. Retrieved from http://www.onmedica.com/newsarticle.aspx?id=c4f7fbdc-4507-4f1e-9c93-9db9e262e3a1]
- There is a difference between the reason why a person is eligible for voluntary euthanasia or assisted suicide and the reasons why a person requests death.
- Some medical professionals have approved assisted suicide or voluntary euthanasia requests, despite being aware of coercion.
Responses to criticism
The Voluntary Euthanasia Society criticised our statement that euthanasia and assisted suicide are the ultimate tools for elder abuse. They wrote:
“There is absolutely no evidence to support this statement. In fact about 75% of the patients who have doctor assisted dying are less than 75 years of age. Patients have to be competent (understand what they are doing) when initially requesting assistance and they have to be assessed for that at that time. They also have to have terminal disease or unbearable irreversible suffering. They are also encouraged to seek usual treatments such as hospice and palliative care. In jurisdictions where voluntary euthanasia is allowed, the reporting is compulsory.”[4. Voluntary Euthanasia Society. Answering opponents. Retrieved from: www.ves.org.nz/assertions-answers]
We will now address the claims made by the Voluntary Euthanasia Society one at a time.
1. The Voluntary Euthanasia Society claims that “there is absolutely no evidence to support this statement.”
Euthanasia-Free NZ is not aware of any studies or reports specifically mentioning the term “elder abuse” as an influence on assisted suicide or voluntary euthanasia. However, we are aware of case studies, expert opinions and reports that mention concerns that are often associated with elder abuse.
Elder abuse can lead to requests for voluntary euthanasia or assisted suicide in several ways. Some abusers could put subtle or overt pressure on an elderly person to request death, especially if they may gain financially or emotionally from the death. Some relatives may think that the money to be spent on care and daily living could instead be inherited if a person died earlier.
Apparently elderly people who are not acutely ill are conveniently being dumped at hospital because their families are going on holiday.[5. Johnston, M. (2014, October 27). Holiday concern about ‘granny dumping’ at hospitals. NZ Herald. Retrieved from http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11348685] It’s easy to envisage some families steering their elderly relatives towards “assisted dying” as a permanent solution.
2. “In fact about 75% of the patients who have doctor assisted dying are less than 75 years of age.”
The Voluntary Euthanasia Society presents no evidence for this claim. This statistic does not disprove our point that voluntary euthanasia and assisted suicide can be tools for elder abuse. People younger than 75 can also be the victims of elder abuse.
3. “Patients have to be competent (understand what they are doing) when initially requesting assistance and they have to be assessed for that at that time.”
Incompetent people may be more vulnerable to abuse than competent people. However, competent people are not immune to elder abuse, coercion or pressure.
A person can be competent (understand what they are doing) AND be pressured or coerced into requesting death AND be reluctant to report the abuse, pressure or coercion.
A person can be competent AND determined to die, therefore telling the doctor only what he or she needs to hear to comply with the request for voluntary euthanasia or assisted suicide.
A person may own their decision at the point of formally requesting death. However, that doesn’t mean the person necessarily arrived at that decision without being pressured, coerced or abused.
4. “They also have to have terminal disease or unbearable irreversible suffering.”
There can be a difference between the reasons why a person is deemed eligible for assisted suicide or voluntary euthanasia and the reasons why the person requests it.
For example, in Oregon, the concern about being a burden doesn’t make a person eligible for legal assisted suicide. Nevertheless, 40% of people who received assisted suicide drugs cited it as a reason for their request.[6. Oregon Public Health Division (2015). Oregon’s Death with Dignity Act 2014 (p.5). Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf] Elder abuse can include stating or insinuating that a person is a burden.
In the Netherlands pressure from family doesn’t make a person eligible for legal voluntary euthanasia or assisted suicide. Nevertheless, Dr Theo Boer, a former member of a Dutch Euthanasia Review Committee, estimated that one in five patients who requested voluntary euthanasia were influenced by pressure from their family.
“The doctor doesn’t want to put it in the dossier; you have to read between the lines. Sometimes it’s the family who go to the doctor. Other times it’s the patient saying they don’t want their family to suffer. And you hear anecdotally of families saying: ‘Mum, there’s always euthanasia’.”[7. Boer, T. (2015, July 3). Pressure on patients is cause for concern: euthanasia expert. Dutch News. Retrieved from http://www.dutchnews.nl/news/archives/2015/07/pressure-on-patients-is-cause-for-concern-euthanasia-expert/]
The fact that a person is eligible doesn’t mean the person will request assisted suicide or voluntary euthanasia. A person may have an irreversible medical condition but be content to die naturally. It could be forms of elder abuse that push the person from feeling their suffering is bearable to feeling it is unbearable. A person who is reluctant to report elder abuse may blame all their suffering on their condition.
5. “They are also encouraged to seek usual treatments such as hospice and palliative care.”
Being encouraged to seek treatments and care doesn’t guarantee a patient consenting to them or accessing them.
The effects of elder abuse may cause a person to lose the will to live and influence his or her decision to refuse further treatment and care.
One form of elder abuse is neglect, including neglecting to help victims access treatment and other health care services.
6. “In jurisdictions where voluntary euthanasia is allowed, the reporting is compulsory.”
Yes, reporting is compulsory where voluntary euthanasia is allowed. However, it’s impossible to enforce this legal requirement. Studies based on anonymous surveys found that doctors failed to report euthanasia deaths in 23 % of Dutch cases [8. Onwuteaka-Philipsen, B. D. et al. (2012). Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. The Lancet, 380, 9845, 908-15. doi: 10.1016/S0140-6736(12)61034-4] and in 47 % of Belgian cases.[9. Smets, T. et al., (2010). Reporting of euthanasia in medical practice in Flanders, Belgium: cross-sectional analysis of reported and unreported cases. BMJ, 2010;341:c5174]