Who are ‘the vulnerable’ in the euthanasia debate?

I was chatting semi-aimlessly with a lawyer friend the other day when the issue of medical power of attorneys and medical directions came up. My friend, often one to blurt out profundities without notice, 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 an imminent surgery and the understandable patient anxiety prior to the operation would make anyone vulnerable to making a poor decision or to being lead to a decision that they might not otherwise make.

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. It should be the case that, with good quality care and planning, that the options would have been discussed and decisions made prior to the patient attending the hospital. Nevertheless, it seems 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 vulnerability and the risk of coercion of patients. In terms of euthanasia and assisted suicide this vulnerability is often expressed in relation to those in our community whom we recognise as vulnerable in general terms. I’m thinking of people living with disabilities, the frail aged etc., in other words, those whom society accepts may need additional supports in their pursuit of acceptance, equality and protection from harm.

And so we recognise, not by data alone, but by common sense and experience, that there are ‘at risk’ cohorts within our community. Our laws and our behaviour as a society need to be constantly scrutinised, ever asking the question: does this action or law enhance or diminish the respect, protection and lives of those least able in our community?

Some euthanasia advocates reject the claim that euthanasia and assisted suicide laws put vulnerable people at risk. Such a claim stands in sharp contrast to the conclusions reached in reports such as the New York Task Force, the 1998 Tasmanian Inquiry among others and is contraindicated by any number of studies and reports in recent years. In fact, euthanasia advocates such as Dr. Nitschke and CEO of the pro-euthanasia group Dignity in Dying UK, Sarah Wooton, both recently acknowledged that there are risks inherent to vulnerable people in euthanasia and assisted suicide legislation.

However, it would be a mistake to consider that vulnerability in terms of euthanasia and assisted suicide is only restricted to identifiable cohorts within our community. This would be to ignore the reality that each and every one of us can experience circumstances and events that could conceivably render us vulnerable to negative suggestions and thoughts in respect to the value of our very lives.

A Swiss study published in the New England Journal of Medicine in April this year found that people who receive news of a diagnosis of 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 patients, which found that the risk to request euthanasia for patients with a depressed mood was 4.1 times higher than that of patients without depressed mood.

And, most recently in May of this year a Spanish research project looking into the reasons behind why patients might develop a ‘wish to hasten death’ concluded that, “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 they actually confirmed is that the common understanding of suicide and requests or expressions of a wish to hasten death as, more often than not, cries for help, understanding and acknowledgement, still holds true.

And, of course, it is not only medical diagnoses or chronic or terminal illness that can trigger vulnerability. June the 15^th is World Elder Abuse Awareness day, marking great concern for a modern phenomenon that should concern us all – abuse of the elderly. Elder Abuse is the financial, psychological, sexual and/or physical abuse of elder persons. Often perpetrated by a relative, carer, or other trusted person upon elderly persons who are frail 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 the prevalence of Elder Abuse to 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 in the 2007-08 financial year in that state alone.

It should be a matter of great concern demanding vigilance on the part of all of us as well as our governments that vulnerable people should continue to experience protection, compassion and care; after all, we’re all potentially vulnerable at some point in our lives. The question should never be how we propose to kill, rather, the pressing question, always, is how do we learn to care better?