New report on elder abuse in Australia: implications for legalising euthanasia
A new report on elder abuse in Australia by L. Qu and colleagues - National Elder Abuse Prevalence Study: Final Report - released in December 2021 points to the prevalence of elder abuse and explains some of the risk factors and the common characteristics of perpetrators.
This information needs to inform any discussion of the risks to elderly people of legalising euthanasia and assistance to suicide, including risks arising from inheritance impatient adult children; psychological and physical abuse from adult children and intimate partners; social isolation and loneliness; failure to report abuse to professionals, including GPs; and the ineffective responses even when abuse is reported to professionals.
Proponents of legalised euthanasia or assistance to suicide who dismiss the risk of elder abuse in this context are naïve, disingenuous or simply so focused on demanding their “right to die” that they are prepared to ignore this risk.
As Dr Henry Marsh, a British neurosurgeon and proponent of legalising assisted suicide and euthanasia, has said "Even if a few grannies get bullied into [suicide], isn’t that the price worth paying for all the people who could die with dignity?"
Relevantly, this report found that:
The estimate for the prevalence of elder abuse among community dwelling people aged 65 and older in Australia is 14.8%, based on findings from the SOP. This estimate is based on experiences reported in the past year in the survey. The most common form of abuse is psychological abuse (11.7%). Neglect is the next most common abuse subtype at 2.9%. For the other subtypes, prevalence rates are 2.1% for financial abuse, 1.8% for physical abuse and 1% for sexual abuse. (page 2)
Each of these abuse types is relevant for assessing the safety of a law that allows a lethal poison to be prescribed and suppled to an elderly person to be used to end the person's life.
Adult children were most likely to commit financial, physical, and psychological abuse. Sons were almost twice as likely as daughters to commit financial abuse. Adult children were on par with intimate partners as perpetrators of neglect. Intimate partners also featured commonly as perpetrators of physical, psychological, and sexual abuse.
perpetrators were reported to have … and financial problems (nearly one in five). The most common problems associated with financial abuse were financial problems.
Inheritance impatience was a characteristic of 19.1% of abusers in Queensland in 2018/19. (page 2)
Elderly people prescribed and supplied with a lethal poison may be at risk from adult children and intimate partners perpetrating financial, physical and psychological abuse – including seeking to hasten the death of the person for financial benefit; bullying or nagging the person to ingest the poison; physically forcing the person to ingest the poison.
Most laws (including all such laws in Australia and the United States) permitting assistance to suicide provide no protections whatsoever once the lethal poison is prescribed and supplied.
people with poorer health were more likely than those with better health to report experiencing elder abuse. Having a disability was associated with a higher likelihood of experiencing elder abuse. Low social support and lack of social contact were associated with a higher likelihood of experiencing elder abuse (page 2)
There is a correlation between all abuse subtypes and low social support (including social isolation and loneliness). (page 61)
A low sense of social support is the highest risk factor for physical abuse (30.4%) and the second highest risk factor for financial abuse (29.8%). (page 66)
There is also a correlation between isolation and loneliness and requests for euthanasia. For example, the Sixth annual report for Quebec reported that for April 2020-March 2021, 24% of people gave as a reason for wishing to have their life ended by a lethal injection experiencing “isolation or loneliness”.
Where older people sought professional help, they were more likely to turn to the helping professions, medical professionals such as GPs and nurses … Notably, of those older people who reported taking action, substantial minorities considered these actions were ineffective. Responses indicating actions were ineffective were highest for financial abuse (over one third) (page 3)
This confirms the concern that there is no guarantee that medical practitioners assessing those who request euthanasia or assistance to suicide for "voluntariness" will adequately identify or respond to the presence of, or the risk of, financial, psychological or physical abuse playing a role in a person’s request for a lethal poison to end their life or the actual ingestion of such a poison if prescribed and supplied for self-administration.
For example, the section of the mandatory training in Victoria for participating medical practitioners dealing with assessing voluntariness, including the absence of coercion takes just over 5 minutes to complete including a 2 minute 20 second video and slides which take a further 2 minutes 50 seconds to read.
Given what this latest report on elder abuse confirms about its prevalence and the failure of professionals including GPs and other health professionals to adequately identify and respond to it there are no grounds for assuming that the provisions of any law permitting euthanasia or assistance to suicide are adequate to prevent wrongful deaths by elder abuse by pressure to request or ingest a lethal poison.
Simply chanting “choice” as a mantra does not address this real and substantive risk of lethal elder abuse.