Assisted suicide a threat to safe aged care

In a submission to the Royal Commission into Aged Care Quality and Safety the Australian Care Alliance has warned that the assisted suicide law in Victoria, and similar proposed laws in Western Australia, Queensland, South Australia and Tasmania, pose grave risks to the safety of elderly persons and persons with disabilities in the aged care system.

Out of the eleven categories of wrongful deaths that have or can occur under any scheme so far proposed which legalises assisted suicide and/or euthanasia the submission identifies three categories of direct relevance to the Royal Commission:

• The wrongful death of elderly persons who are subtly or overtly coerced by family members or carers into requesting assisted suicide or euthanasia;
•  The wrongful death of persons with dementia, who are killed by euthanasia or assisted suicide while unable to give consent.
• The wrongful death of persons with disabilities who are affirmed by family members, doctors or society as being “better off dead”.

The submission warned of the risk that elderly people may be subject to subtle or even overt coercion either in requesting assisting suicide or in ingesting the lethal poison and that, under the Victorian legislation for example, there were no processes that could ensure that this did not happen:

The Voluntary Assisted Dying Act 2017 Act requires the two assessing doctors, as well as the witness to an administration request in the case of euthanasia, to certify that the person requesting assisted suicide or euthanasia is “acting voluntarily and without coercion”.

Assessing doctors are required to complete training approved by the Secretary of the Department of Health on “identifying and assessing risk factors for abuse or coercion”.

This training is part of an online module and is relatively brief and basic.  Merely completing this online training cannot guarantee that assessing doctors never miss the signs of coercion or abuse given the well-documented evidence of failure by professionals in Australia to identify elder abuse as cited above.

Furthermore, the training module actually suggests that if a patient indicates that “becoming a burden on family, friends and caregivers” is their reason for seeking assisted dying this could be the “patient’s expression of suffering experienced from the loss of autonomy”.

There is no provision for anyone to seek a review at VCAT of an assessment by the two doctors that a person is acting “voluntarily and without coercion” in requesting assisted suicide or euthanasia.

A family member or friend who becomes aware that a person is being coerced has no formal recourse under the Act at all.

For example, if one adult child becomes aware or concerned that her mother has been unduly influenced by a current partner or by another adult child (perhaps because of inheritance impatience or carer fatigue) to request assisted suicide and that this coercion has not been identified by either of the assessing doctors then there is simply no provision for the assessment that the request was voluntary to be re-examined.

The Victorian law allows both assisted suicide and euthanasia.

In the case of assisted suicide the assessment that the person requesting it is acting “voluntarily and without coercion” takes place at the start of the process. Once the final request is made there is no subsequent assessment. The person is given the lethal substance in a metal box with a key. The lethal substance is kept by the person with no time limit for its use. There is no requirement that a health care provider or indeed any other witness be present when the lethal substance is ingested.

The law, therefore, is entirely lacking in any mechanism for ensuring that when the lethal substance is actually ingested the person is acting voluntarily and without coercion.

It would be quite possible for a person to be cajoled, bullied, tricked or, indeed actually forced to ingest the lethal substance by a family member, carer or predator.

Read the full submission here