I believe there is an unrecognised phenomenon in Australia that should be of concern. I refer to the growing incidence of rational suicide by the elderly and the terminally and hopelessly ill. This letter is being sent to all state and Territory coroners to increase awareness of this important issue.
Australia has an ageing society. While lifespans are extending, death itself is increasingly the result of debilitating degenerative disease of mind and body. Medical advances provide for dwindling life to be sustained until medicos allow death to occur. Terminal sedation, the standard response for intractable symptoms, is common and considered undignified. Some people are determined to avoid spending their final months or years as a demented patient.
More and more Australians are rejecting this period of futile suffering and exercising autonomy over their own death. While many such suicides are understandable, I contend that some of them would at least be delayed, or even not eventuate at all, if the victims were able to seek and receive assistance to die from others.
A result of being denied assistance is that many of these deaths are unnecessarily premature, lonely and violent. Premature because the individual has to act while they have the physical and mental capacity. Lonely because the individual is aware that assisting a suicide is an offence and they do not want to implicate family or friends. Violent because they must use whatever means to die they can access. There is a high level of interest in learning how to die peacefully and importing illegal substances to achieve that aim.
I suspect you regularly receive reports of deaths where evidence indicates the individual was terminally or hopelessly ill and considered their life was (or will become) unbearable. Providing the person was competent and acted without coercion from others, the event can be considered to be a rational response to their circumstances.
The number of rational suicides known to individual coroners is certain to be only a fraction of those actually taking place. ABS and other institutions acknowledge that suicide is (and has always been) under- reported for a variety of reasons. One that is particularly relevant in cases where the individual is terminally ill is that death by inhaling inert gas is undetectable if the apparatus used is removed (illegally) before the body is 'discovered'. Death is recorded as being the result of natural causes and as such, not reportable to coroners. There is anecdotal evidence that such disguised deaths occur regularly in Australia.
What we do not know is the number of unsuccessful attempts at rational suicide; cases where the individual botched the process through inadequate investigation, preparation and/or failure of equipment. Having to act alone can be fraught with difficulties.
The vast majority of rational suicide cases are known only to the immediate family.The public, policy makers and politicians are blissfully unaware of the scale of the distress, and will remain so without the official watchdogs, coroners, exposing what is happening behind closed doors.
I contend that when investigating a suicide clearly related to voluntary euthanasia, a coroner should consider and report on whether he/she believed the person was motivated to kill themselves while they maintained the capacity to do so, and that in all probability, if they believed they could lawfully receive assistance to end their life at some later point in time, the person may well have deferred their decision to die. It would seem this evaluation and conclusion could be undertaken under the 'why' heading in the list of objectives of the coroner.
Additionally, in the case of a violent suicide (e.g. firearm, hanging etc.) the coroner could also consider whether the act would likely have been less violent and thereby lessen the anguish for family and others involved in the aftermath, if the person had lawful access to a more tranquil way to take their own life.
Reports of double suicides, murder suicide or attempts at such actions are occasionally reported but may not be infrequent. Where these appear to be motivated by fear of losing control over end of life decisions a coroner could, as a matter of public importance, consider recommendations that will help prevent or reduce future deaths of a similar kind. It is surely in the public interest that violent suicides are reduced and rational suicide delayed, even if they cannot be prevented.
Rational suicide exists, it is time we acknowledged it officially, defined it and quantified it.
I appeal to you to consider establishing guidelines that would reveal the numbers of euthanasia suicides and make recommendations to reduce the adverse effects. A starting point might be the adoption of a common definition of rational suicide or euthanasia suicide. Coroners could also recommend Parliament, Government or a Law Reform Commission review the law on assisted suicide considering the reality of rational suicide.
This letter was posted on January 6, 2014. To date only one coroner has responded.
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