EUTHANASIA: by Paul RussellNews Weekly
Vigilance needed to protect the vulnerable
, June 23, 2012
I was chatting with a lawyer-friend the other day when the issue of medical powers of attorney and advanced medical care directives came up.
My friend said that he objects to patients being asked about whether or not they would want to be resuscitated should something go wrong at the time of being admitted to hospital for surgery.
He argued that patients’ understandable anxiety at the prospect of imminent surgery could make them vulnerable to making a poor decision.
I’d never thought of it that way and I’m not entirely convinced by his argument. After all, other than in an emergency, patients hopefully would have had some time to consider their options in consultation with their GP and specialist.
Ideally, with good quality care and planning, patients should have had the opportunity to discuss and decide upon various options before being admitted to hospital.
Nevertheless, it seemed to both of us that a good protocol for such decision-making would be that all of these details should be finalised prior to hospitalisation.
This brings me to consider the whole question of vulnerable patients at risk of coercion. In terms of euthanasia and assisted suicide, categories of the vulnerable include the frail aged and people living with disabilities — in other words, those who society accepts may need additional support in their pursuit of acceptance, equality and protection from harm.
And so we recognise, not by data alone, but by common sense, observation and experience, that there are “at risk” cohorts within our community. We need constantly to scrutinise our laws and our behaviour as a society, and always ask ourselves: does this or that action or law enhance or diminish the respect, protection and lives of the most vulnerable in our community?
Some euthanasia advocates reject the claim that euthanasia and assisted suicide laws put vulnerable people at risk. Their confidence stands in sharp contrast to the conclusions reached in reports such as the New York Task Force and the 1998 Tasmanian parliamentary inquiry, among others, and is contra-indicated by any number of studies and reports in recent years.
In fact, euthanasia advocates such as Australia’s Dr Philip Nitschke and the CEO of the British pro-euthanasia group Dignity in Dying, Sarah Wootton, both recently acknowledged that there are risks inherent to vulnerable people in euthanasia and assisted suicide legislation.
However, it would be a mistake to conclude that vulnerability in terms of euthanasia and assisted suicide is restricted only to identifiable cohorts within our community. This would be to ignore the reality that every one of us can find ourselves in circumstances when we could conceivably be vulnerable to negative suggestions and thoughts about the value of our very lives.
A Swiss study published in the New England Journal of Medicine in April this year found that people diagnosed with cancer were 12.6 times more likely to commit suicide than people of a similar background who were cancer-free. The stress associated with the diagnosis diminished over time, the report noted. Yet, after 12 months, the risk of suicide in this group remained 80 per cent higher than the cancer-free control group.
This confirms a 2005 study of cancer sufferers, which found that patients with a depressed mood were 4.1 times more likely to request euthanasia than patients without a depressed mood.
Most recently, in May this year, a Spanish research project looking into the reasons behind why patients might develop a “wish to hasten death” (WTHD) concluded: “The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one’s death.”
The researchers noted that this result came as something of a surprise to them; but what it actually confirmed was the common understanding that suicide attempts and requests or expressions of a wish to hasten death, more often than not, are cries for help, understanding and acknowledgement.
Of course, it is not only dire medical diagnoses or chronic or terminal illnesses that can make one vulnerable.
June 15 is World Elder Abuse Awareness day, an initiative designed to highlight a modern phenomenon that should concern us all — the abuse of the elderly. Elder abuse is the financial, psychological, sexual and/or physical abuse of elderly persons. Often perpetrated by a relative, carer or other trusted person upon elderly persons who are frail and/or socially isolated, elder abuse is already being called the “crime of the century”.
Elder abuse is significantly under-reported. In 2009 the Queensland Elder Abuse Unit estimated that, during the 2007/08 financial year in that state alone, between 13,896 and 42,757 older people experienced some form of emotional distress, physical trauma, sexual abuse, financial abuse, social abuse and/or neglect.
It should be a matter of the highest public concern, demanding vigilance on the part of people and government alike, that vulnerable people should be entitled to protection, compassion and care. After all, we are all potentially vulnerable at some point in our lives.
The question should never be how we propose to kill. Rather, the pressing question, always, should be: how do we learn to care better?
Paul Russell is director of the national network, HOPE: Preventing Euthanasia & Assisted Suicide www.noeuthanasia.org.au and vice-chairman of the Euthanasia Prevention Coalition International.