The Nathaniel Centre

Euthanasia – the bigger picture

Media generated discussions about euthanasia and assisted suicide are often initiated by the story of tragic individual cases. The rhetoric used invariably focuses on 'choice' and the so-called 'right' a person has to choose how and when they die. But this argument fails to recognise that people do not make their 'choices' in a vacuum, that such decisions inevitably involve and concern other people, not least the medical professionals and others who care for them and for others. The following select quotes highlight some of the bigger picture issues associated with legalising euthanasia or assisted suicide.

"The pro-euthanasia lobby talks enthusiastically about 'autonomy' and 'choice'. The truth is that when euthanasia is legalised, personal autonomy and choice are dangerously compromised. Moreover, legalising euthanasia - like capital punishment - has the power to brutalise society." Professor David Richmond.

"The killing decision in euthanasia and assisted suicide isn't really the suicidal person's 'choice': It is the killer's or helper's. In other words, life will end only if the joint venturer in the killing believes the suicidal person's life is not worth living." Wesley J. Smith.

"I've recently had quite a bit to do with one rest home village and I've had a chance to get the feel of the elderly residents and I know for a fact that if you had a voluntary euthanasia regime, the whole tone of that rest home village would be greatly altered as people came to fear the suggestion that they think might be made to them that they should seek euthanasia, that their time has come, that they've lived a long life, that they're being a burden to others, a very expensive burden in some cases, and that they'd be better off dead." Don Mathieson QC.

"Few people would seriously consider legalizing friend- or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. So the goal is to lend this act professional respectability by promoting physician-assisted suicide—or, more accurately, medically assisted suicide, since nurses also are necessarily involved when the assisted suicide occurs in a health facility or home-health situation.
As a nurse, I am willing to do anything for my patients—but I will not kill them nor help them kill themselves. In my work with the terminally ill, I have been struck by how rarely such people say anything like, "I want to end my life." I have seen the few who do express such thoughts become visibly relieved when their concerns and fears are addressed, instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide." Nancy Valko.

"The phrase 'death with dignity' is very often used to mean the deliberately procured death of an ill or disabled person, and strongly implies that vulnerable people are 'dignified' only in death.
I strongly believe that the supposed 'right to die' is a subterfuge for what is really a 'duty to die' because society prefers not to provide appropriate support to help us to live with dignity, but prefers the cheaper option of killing. Alison Davis, Disability Activist.

"Disability rights opposition [to legalising euthanasia] is based in reality. While Compassion & Choices and its media friends push policy on the back of one photogenic person's 'choice', we look at the social impact on vulnerable populations. The media repeats the falsehood that there have been no abuses in Oregon, we present evidence that shows the opposite ... When the focus is on an individual, assisted suicide can sound good -- who's against compassion or relieving suffering? But a closer look reveals that assisted suicide puts vulnerable people in mortal danger. The more people learn about the real-world implications of these bills, the more they oppose them. (Our group takes its name -- Second Thoughts -- from this fact)." John B Kelly, Disability Activist

"[The pro-euthanasia] slogan is people should be allowed to die with dignity, which suggests that they don't. I've seen hundreds of people die... it's just part and parcel of your life as chaplain and I would say in the time that I've been chaplain, which is about 35 years, I don't think I can remember a case where people didn't die with dignity." Rev David Orange

"Do assisted suicide supporters really expect us doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on our ethics or our empathy? Do they realize that this reduces the second patient's will-to-live request to a mere personal whim—perhaps, ultimately, one that society will see as selfish and too costly? How does this serve optimal health care, let alone the integrity of doctors and nurses who have to face the fact that we helped other human beings kill themselves?" Nancy Valko.

Editorial: Euthanasia-on-demand and without demand – let’s not kid ourselves

Dr Rob Jonquiere, Communications Director of the World Federation of Right to Die Societies, has recently completed a tour of New Zealand at the invitation of the New Zealand Voluntary Euthanasia Society.

Dr Jonquiere supports the 'right to die' as a 'human right' and has argued that 'if you can choose what kind of house you're going to live in' why can you not choose what death?' In a lecture given in 2013 (Fourth Annual SOARS Lecture), Dr Jonquiere has outlined how the original pro-choice campaigners in The Netherlands wanted to argue for euthanasia on the grounds of 'self-determination' (that is, on the basis of unfettered personal choice and without needing to fulfil any particular conditions such as being terminally ill) – euthanasia-on-demand.

However, because it was deemed necessary for doctors to be involved in order to gain public acceptance, and because many doctors 'were not looking forward to assist in cases that did not fit within a medical domain', the campaign focus strategically shifted to advocating for a very select group - seriously ill patients. Having achieved this goal, however, the pro-euthanasia campaigners quickly modified their goals. The debate immediately turned to including 'demented human beings with an adequate advance directive; patients with a chronic psychiatric illness who had come to the end of meaningful treatment; and, elderly people who for a variety of reasons judged their lives completed.' ^[i]

Consequently, there has been a gradual widening of the categories of those eligible for euthanasia in The Netherlands and Belgium; it is no longer necessary for patients to be suffering a 'terminal' illness; psychiatric conditions including depression qualify, and the law in both countries now allows for children to be euthanised.

These changes are not evidence of a 'slippery slope' but are an inevitable consequence of the argument that it is a human right to be able to end one's life. If certain individuals have a 'human right' to make this choice, then it is irrational to restrict this right to only some people; it should apply to anyone who considers their life not worth living and who demands it.

The stated goal of 'euthanasia-on-demand' may well explain why, despite an outward insistence on effective legal safeguards, the practice of euthanasia in The Netherlands and Belgium routinely exists outside of the law. In Belgium, nearly half of all cases are not reported ^[ii] and in The Netherlands at least 20 percent of cases are unreported [iii] (reporting is mandatory by law in both countries). In unreported cases there is a higher likelihood that legal requirements are not met, such as the need for a written request (involuntary euthanasia), consultation with palliative care physicians, and a requirement that only physicians perform euthanasia. In Flanders, Belgium, in 2007, one study found 32 percent of physician-assisted deaths were without explicit patient request ^[iv]; another study noted drugs were administered by a nurse in 41 percent of unreported cases (none for reported cases) [v].

In light of the argument that individuals should have the right to decide how and when to end their lives, evidence that the law is not being followed, along with the widening of eligible categories, is not necessarily concerning for euthanasia advocates. Indeed, it is welcomed by those who support euthanasia as a 'human right', seen as an indication that the current situation is too restrictive and as a rationale that the law be further liberalised to reflect (what is now illegal) practice.

Anyone supporting 'voluntary' euthanasia and/or assisted suicide in New Zealand needs to accept that, within a short time, euthanasia will be demanded for children, those with dementia, depression and other mental illnesses as well as for those who are simply 'tired of life' as is happening overseas. Given that these groups include persons incapable of giving consent, it is inevitable that there will be a push to move beyond strictly 'voluntary' euthanasia despite the persistent denials of pro-euthanasia advocates.

In jurisdictions where euthanasia and physician-assisted suicide are already legalised, the move from voluntary to non-voluntary euthanasia has been a very small step. In the Netherlands it has always been the case that it is doctors who make the final decisions about end of life; patients can request it but doctors must ultimately decide. In other words, it is always the doctors who determine whether a person would be 'better off dead' [vi]. When doctors are already the ones judging whether a person would be 'better off dead', there seems little reason why they could or should not make this decision for comatose or incompetent patients without the need for 'informed consent'. Hence, the small step.

Apart from those who are immediately affected, there are wider social consequences, since introducing 'voluntary' euthanasia and physician-assisted suicide will do more than allow a small number of patients who are 'suffering unbearably' to be able to end their lives or have them ended. It will introduce into some of our most important institutions – the medical profession, the nursing profession, hospitals and rest homes – the 'ethic' that it is acceptable to kill, with or without consent; an ethic that will become socially embedded – the so-called 'normalisation' of state-sanctioned killing.

Such an 'ethic' is contrary to and will irrevocably harm these institutions and the human virtues that are most treasured in in our society.

 

Endnotes

[i] Fourth Annual SOARS Lecture (London, September 20, 2013). http://www.soars.org.uk/index.php/pages

[ii] Smets, T; Bilsen, J; Cohen, J; Rurup, ML; Mortier, F; Deliens, L. "Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases". BMJ 2010: 341:c5174.

[iii] Onwuteaka-Philipsen, BD; Brinkman-Stoppeleburg, A; Penning, C; de Jong-Krul, GJF; van Delden, M; van der Heide, A. "Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey". Lancet 2012; 380: 908-15.

[iv] Chambaere, K; Bilsen, J; Cohen, J; Onwuteaka-Philipsen, BD; Mortier, F; Deliens, L. "Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey". CMAJ 2010; 182:895-901.

[v] Smets et al. (2010) ibid.

[vi] Keown, J. "Mr Marty's muddle: a superficial and selective case for euthanasia in Europe". J Med Ethics 2006; 32:29-33.

‘Be careful what you wish for.’ Euthanasia and Rob Jonquiere’s ‘ideal’ society

 

John Kleinsman

 

An uncle of mine often used to quip: 'Be careful what you wish for!' It's a reminder that things we desire often come with unforeseen and undesirable consequences. If there was ever an instance in which this applies it is in regard to euthanasia and assisted-suicide

Proponents of a law change believe the issue is fundamentally about 'choice'. Allowing those who want it to choose when and how they die would not affect those who think otherwise, it is argued. Euthanasia/assisted-suicide can seem acceptable, fair and safe when the focus is solely on individual 'hard' cases.

As someone opposed to euthanasia and assisted suicide, I am often accused of imposing my choices on others. Actually, I don't have a problem with people exercising choice. In an 'ideal' world, a world of total empathy and inclusion, a world of equitable access to health care in which the elderly were truly valued, I could live with people being given this choice. But we don't live in such a world.

A robust, informed debate about euthanasia and assisted-suicide needs to take into account a number of interacting social factors that define our current New Zealand context: the continuing rise of elder abuse; the increasing social isolation of the elderly; a growth in the overall proportion of elderly; greater pressure on families to provide care; smaller and more fragmented families; an increasing tendency to see persons from a narrow functional perspective; and increasing economic pressures on our health system and families. As one commentator bluntly put it: "I oppose introducing euthanasia in a toxic climate."

The availability of state-sanctioned 'mercy killing' in this environment will, in the first instance, create additional pathways for abuse and neglect. There has never been a more dangerous time to introduce such laws.

There are also the threats that euthanasia/assisted-suicide would pose for quality end-of-life care, our trust in doctors, its potential impact on youth suicide prevention and the inevitable extension to children and to those incapable of giving consent. Further, in the current "toxic climate", a law change will reframe the way the sick, elderly and disabled see themselves and are seen by others. As an experienced nurse recently wrote: "Do assisted-suicide supporters really expect doctors and nurses to assist in the suicide of one patient, then go care for a similar patient who wants to live, without this having an effect on our ethics or empathy? Do they realise this reduces the second patient's will-to-live request to a mere personal whim — perhaps, ultimately, one that society will see as selfish and too costly?" In other words, hey realize that this reduces the second patient's will-to-live request to a mere personal whim—perhaps, ultimately, one that society will see as selfish and too costly? How does this serve optimal health care, let alone the integrity of doctors and nurses who have to face the fact that we helped other human beings kill themselves? expanding personal freedoms to include euthanasia or assisted-suicide undermines the right to remain alive without having to justify one's existence.

As overseas and New Zealand reports show, and contrary to popular opinion, the main reasons people favour euthanasia are not related to extreme physical pain (an experienced palliative-care physician reassures me that these days no-one need die in physical pain) but to such things as loss of autonomy [i], feelings of being a burden and dependency on others [ii], decreasing ability to participate in activities that made life enjoyable, fear of losing control, and social isolation [iii].

This knowledge is not at all contentious. Pro-euthanasia doctors such as Dr Rob Jonquiere openly recognise that many concerned elderly people will choose euthanasia or assisted suicide for such reasons. As Jonquiere noted in a 2013 presentation: "The elderly have feelings of detachment ... The elderly have feelings of isolation and loss of meaning. The elderly are tired of life ... Their days are experienced as useless repetitions. The elderly have become largely dependent on the help of others, they have no control over their personal situation and the direction of their lives. Loss of personal dignity appears in many instances to be the deciding factor for the conclusion that their lives are complete". [iv] In the same presentation, Jonquiere freely and readily admits that "the problem is not so much physical, but social and emotional ..."

What is particularly frightening and distressing, however, is the fact that Jonquiere's response to this is to advocate even more vociferously for these people to have the right to die. "The conclusion that life is completed is reserved exclusively for the concerned persons themselves ... They alone can reach the consideration whether or not the quality and value of their lives are diminished to such an extent that they prefer death over life." All of which leads him to the cold-hearted and brutal conclusion that it is "never for the state, society or any social system" [v] to question or otherwise interfere in such a person's decision.

Looked at through a lens of social justice and inclusion, Jonquiere's analysis and conclusion is deeply disturbing. The intolerable situation that increasing numbers of elderly people find themselves in might be a direct result of neglect, ageism, abuse, ignorance, lack of funding for services, poor public policies or, worst of all, a lack of will to care from family and/or society. But in Jonquiere's ideal society the most moral and caring thing to do is to not interfere with people's choice to kill themselves or be killed by a doctor! In effect, this means that the state, which governs over the society in which these persons live, the very same society that will in very many cases be complicit in their intolerable condition, can assuage its conscience by assisting these people to die.

This is not just. This is not the sort of society I care to live in. Rather than appealing to the best in people, rather than calling forth the sort of commitment and care that is quintessentially human, Jonquiere's 'solution' amounts, metaphorically, to a radical 'lowering of the bar' that sets the standards for inclusion in society.

It raises the spectre of a society in which elderly people's deepest needs, their need to overcome isolation, neglect and the ignominy of feeling a burden, will be ignored in favour of making it easy for them to dispose of themselves; their real needs papered over by appeals to the principles of autonomy and compassion which are morally vacuous because the choice to die would, for such people, be a choice made out of desperation, a choice made because of a lack of real choices, a tissue-thin choice that is ultimately the product of institutionalised familial and/or societal neglect.

This is precisely what Pope Francis was referring to when he recently commented that abandoning the elderly and disabled is itself a form of euthanasia. In fact, Jonquiere's response is just as much about abandoning the foundational principles of an ethical and caring society as it is about abandoning particular individuals.

We can do better than that! We must do better than that for the sake of future generations, our children and grandchildren who, for better or worse, will inherit the legacy of the choices we make. 'What sort of a world are we shaping for them?' is a key question not often asked.

Personal dignity and respect, as well as a commitment to equality and social justice, calls for nothing less than a whole-hearted active dedication to holistic care for those who are suffering, elderly or disabled. It will require a determined and focussed effort to ensure that what makes us distinctively human – our ability to show and receive care – is reflected in our personal and societal attitudes and familial, social, political and cultural structures.

True 'death with dignity' occurs when a person's deepest physical, emotional, social, cultural and spiritual needs are met, when a person feels loved and cared for and feels included and valued no matter what. It is, I accept, not the 'easy way out'. Neither is it for the faint hearted. At this point in our history, the call to care will demand from us great resourcefulness as well as sacrifice. But then, as life teaches us over and again, the easy way out rarely pays dividends.

We must be honest about the unintended, long-term, negative consequences of euthanasia and assisted-suicide for both individuals and society. There would be a huge social price to pay for legalising state-sanctioned killing, counted in lives prematurely ended because of a sad perception by persons that they were 'past their used by date' and had become 'useless eaters'.

Be careful what you wish for!

Dr John Kleinsman is a member of The Care Alliance and director of The Nathaniel Centre

 

Endnotes

[i] See, for example, Oregon Public Health Division – 2013 DWDA Report at http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year16.pdf

[ii] See, for example, Malpas, P, K Mitchell, and M Johnson. "'I Wouldn't Want to Become a Nuisance under Any Circumstances' - a Qualitative Study of the Reasons Some Healthy Older Individuals Support Medical Practices That Hasten Death." New Zealand Medical Journal 125, no. 1358 (2012): 9-19.

[iii] See, for example, Nicole Steck, Christoph Junker, Maud Maessen, Thomas Reisch, Marcel Zwahlen, Matthias Egger, and for the Swiss National Cohort "Suicide assisted by right-to-die associations: a population based cohort study". Int. J. Epidemiol. (2014) 43 (2): 614-622 first published online February 18, 2014. doi:10.1093/ije/dyu010

[iv] Jonquiere, R. Fourth Annual Lecture to the Society for Old Age Rational Suicide, London, September 20, 2013 http://www.soars.org.uk/index.php/pages

[v] Ibid.

Valuing the elderly and keeping them socially connected

 

Staff of The Nathaniel Centre

We often read or hear the term 'grey tsunami' used to describe the large numbers of 'baby boomers' who are reaching the age of retirement, and we are increasingly warned about their negative economic impact, particularly the effects of a shrinking workforce and the increased demand for health care services. While many would challenge these assumptions, arguing for an alternative and more optimistic view based on people working past retirement and experiencing healthier years later in life due to improvements in diet and access to medical care, still it is the negative language that seems to prevail. The constant use of phrases such as 'old-age dependency ratio', 'decline in functional capacity' and 'the economic burden of an ageing population' to describe the elderly, arguably reveal more about ourselves and our attitudes to ageing than about the elderly – symptomatic of a society that fears growing old, that fears dependency and vulnerability and is willing to judge the elderly more and more in deficit terms, often through an economic filter.

The growing rates of elder abuse in New Zealand are well-documented and growing rates of social isolation amongst the elderly are further manifestations of a society in which the elderly are becoming disenfranchised and marginalised.

A recent article in the New Zealand Listener (April 4-10, 2015) describes a 'loneliness epidemic' affecting the elderly in this country. Recent New Zealand studies reveal that around 8 percent are severely lonely and up to 45 percent moderately lonely¹. Meanwhile other research shows clearly that loneliness is related to lower levels of physical and mental health.

Many elderly people, but especially those who are socially isolated, suffer from depression². The coroner's report for 2014 found that the number of suicides recorded in over-60 year olds went up from 75 in 2012-13 to 97 in 2013-14. "The rise in older people taking their own lives is something I highlighted last year, and this trend has continued, particularly for the above-80-year-old age cohort."³ We also know that in places where assisted suicide or euthanasia is available, the most common end of life concerns are not pain-related but existential, including loss of autonomy, fear of being a burden, a decreasing ability to participate in activities that made life enjoyable, fear of losing control and social isolation⁴.

The isolation of the elderly is partly explained by the fact that families are smaller, more fragmented and more likely to be geographically dispersed. Significant numbers of the elderly now live in different cities and even different countries than their children or their siblings, and even when living nearby, adult children are often 'time poor' – i.e. busy with their own children and jobs.

Where elder abuse is happening, families are very often part of the problem; 50 percent of alleged abusers are family members, usually sons and daughters. It is conservatively estimated that around 9,000 older New Zealanders suffer some sort of abuse or neglect each year,⁵ psychological abuse being the most common, followed by financial abuse. Loneliness or isolation is a known risk factor for abuse, and often the abuse is not reported due to feelings of shame.

The isolation, loneliness and abuse of the elderly are symptomatic of a culture that views the elderly as having outlived their usefulness. This has been described as 'ageism', a systematic stereotyping of people because they are old which leads to them being viewed as "lesser beings, asexual, intellectually inflexible and at the same time forgetful and unproductive."⁶ Describing this shift, Pope Francis has repeatedly criticised the fact that the elderly are ignored, or seen as a burden who do not produce and can be discarded: "Then when we become older, especially if we are poor, sick and alone, we experience the shortcomings of a society planned on efficiency, which consequently ignores the elderly." Pope Francis warns of a 'poisonous' culture where the elderly are 'abandoned in institutions' where they may suffer physical neglect or loneliness. He sees older people and children as being particularly at risk because they are not economically productive. "But this culture of 'discarding' human beings hurts our world ... How many times we discard older people with attitudes that are akin to a hidden form of euthanasia."⁷

Thankfully, there are various commentators who are challenging the utilitarian view of the elderly exemplified in a number of extremely positive and imaginative developments taking place internationally.

Atul Gawande, for example, writes of 'nursing home' managers in the United States who have questioned the rigid focus on safety and have given autonomy back to the residents in a variety of ways. He describes how in one home the new Medical Director found 'despair in every room' and identified the 'three plagues' of nursing home existence as boredom, loneliness and helplessness. The response of the new Director was to inject life back into the home in the form of animals, plants and people: "The inhabitants of Chase Memorial Nursing Home now included one hundred parakeets, four dogs, two cats, plus a colony of rabbits and a flock of laying hens. There were also hundreds of indoor plants and a thriving vegetable and flower garden. The home had on-site child care for the staff and a new after-school programme. Researchers studied the effects of this programme over two years, comparing a variety of measures for Chase's residents with those of residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half that of the control nursing home. Psycho¬tropic drugs for agitation, like Haldol, decreased in particular. The total drug costs fell to only 38 per cent of the comparison facility. Deaths fell 15 per cent. The study couldn't say why. But Thomas [the Medical Director] thought he could. 'I believe that the difference in death rates can be traced to the fundamental human need for a reason to live' ... The most important finding was that it is possible to provide them with reasons to live, period. Even residents with dementia so severe that they had lost the ability to grasp much of what was going on could experience a life with greater meaning and pleasure and satisfaction."⁸

In the Netherlands there is now a nursing home that allows students to live there for free in exchange for spending at least 30 hours a month with the home's senior citizens. "They go see the pensioners for a chat, they play games, go with them to the shopping centre, (and) do shopping for those who can't."⁹ The students also cook meals and plan activities based on their interests. For example, one student provided a group who were curious about graffiti with spray cans and cardboard to help them learn about the art form.

Meanwhile a nursing home in Seattle has pre-schoolers come in for their classes and to spend time with the elderly. The pre-schoolers come with "no assumptions, no judgement and no awkwardness – just lots of time to spend and heaps of love to give."¹⁰ Filmmaker Evan Briggs shot a film of the retirement home over the year 2012-2013; she said residents had a "complete transformation in the presence of the children. Moments before the kids came in, sometimes the people seemed half alive, sometimes asleep. It was a depressing scene. As soon as the kids walked in for art or music or making sandwiches for the homeless or whatever the project that day was, the residents came alive."¹¹ As the school describes, the program has benefits for both the children and the elderly; the elderly find a new sense of self-worth and enjoy the joy and laughter that toddlers bring to any setting. The children learn about the aging process, learn to accept people with disabilities and receive unconditional love and attention from the residents¹².

A community-based initiative closer to home, operated by St Joseph's Malvern parish in Melbourne, engages residents as volunteers or recipients for services offered by Jo Care.¹³ Theirs is a free service aimed at encouraging friendship and support within the local area. The volunteers might visit for a chat, share a book, go for a walk, or teach a new skill, but the focus of the program is to engage with socially isolated individuals.

In Limerick, Ireland, there is The Compassionate Communities Project¹⁴ which works in partnership with individuals, groups and communities to provide a range of support to people living with a serious life-threatening illness, as well as those facing loss and those experiencing bereavement. One of their groups, the Good Neighbourhood Partnership¹⁵ , has volunteers providing social and practical support to people with palliative care needs. The aim of the project is to enable people to identify their social and practical needs and have them met from within their own circle of community. The project had identified that often friends and neighbours want to help but are sometimes unsure how to. The Partnership makes links between those who need social and practical support and those living close-by who would like to offer help. Activities include "walking the dog, doing the shopping, collecting a prescription, going to the library, filling a coal bucket, lighting the fire, mowing the lawn, making a snack, tidying up or sitting with a person who needs a break."¹⁶

Developments such as these provide real and effective opportunities to challenge the growing spread of ageism; they have the potential to help us all view the elderly differently, understand better the contribution that they make to the community, allow them real value and dignity, and at the same time enrich our communities with demonstrations of care and compassion.

Staff of The Nathaniel Centre

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[1] An Auckland Council commissioned study found that 9 percent of Auckland residents aged over 50 were severely lonely and 44.5 percent moderately lonely; the New Zealand Longitudinal Study of Aging found that 3 percent of those between the ages of 48 and 90 years were very severely lonely, 7 percent were severely lonely and 41.2 percent were moderately lonely.

[2] Depression affects 15-20 percent of older people. Ministry of Health: Mental Health and Addiction Services for Older People and Dementia Services. 2011. http://www.health.govt.nz/system/files/documents/publications/mental-health-addiction-services-20jun.pdf

[3] Report of Chief Coroner 20 August 2014. http://www.justice.govt.nz/courts/coroners-court/suicide-in-new-zealand/suicide-statistics-1/2013-14-annual-suicide-stats-press-release

[4] See “‘Be Careful what you wish for.’ Euthanasia and Rob Jonquiere’s ‘ideal’ society”. The Nathaniel Report, issue 45, pp. 4-5.

[5] Age Concern reports 1500 confirmed cases of elder abuse or neglect; it is estimated that only 16% of all abuse incidents come to the attention of service agencies. https://www.ageconcern.org.nz/ACNZPublic/Services/EANP/ACNZ_Public/Elder_Abuse_and_Neglect.aspx#howmuch

[6] Families Commission: Elder Abuse and Neglect. Exploration of Risk and Protective Factors. Research Report No. 1/08, January 2008. P. 16

[7] See http://www.thetablet.co.uk/news/1224/0/pope-francis-likens-neglect-of-older-people-to-hidden-euthanasia-

[8] Gawande, Atul “Being Mortal: Illness, Medicine and What Matters in the End”. Profile Books Ltd, London. 2014.

[9] See http://thehigherlearning.com/?s=a+Dutch+nursing+home

[10] See http://www.mercatornet.com/family_edge/view/video-preschool-meets-nursing-homes/16358

[11] See https://gma.yahoo.com/seattle-preschool-nursing-home-transforms-elderly-residents-201932520--abc-news-parenting.html

[12] http://washington.providence.org/senior-care/mount-st-vincent/services/child-care/

[13] See http://stjosephsmalvern.org.au/jocare/

[14] http://www.compassionatecommunities.ie/

[15] http://www.compassionatecommunities.ie/#!good-neighbour-partnership/czul

[16] See http://www.compassionatecommunities.ie/#!good-neighbour-partnership/czul

JoCare: Caring for Neighbours

 

Kerri Anne Brussen

Australians prefer a faith that “rolls up its sleeves.¹”Recently at St Joseph’s in Melbourne an outreach program, JoCare, has been introduced to engage with older socially isolated persons within the local neighbourhoods. Drawing on a strong tradition of volunteering in Catholic parishes, the JoCare program seeks to involve volunteers from within our parish as well as our local community. Thus, for some, volunteering with JoCare is their faith in action, however, for others it may be a desire to do something for the common good – helping out a neighbour and building community.

JoCare

The main focus of JoCare is volunteers visiting socially isolated older persons in their homes on a regular basis, either weekly or fortnightly. They share an activity such as the crossword, reading a book or doing a puzzle. Others go out for a gentle walk. We also run a monthly gathering where older persons from the parish and local area come together to play games and cards or just to have a chat. Furthermore, we have a number of volunteers who either regularly or on an ad hoc basis provide transport for short local trips to go shopping or to attend medical appointments and church services. After each visit, volunteers provide a brief written report to the JoCare coordinator². Our first ‘neighbours’ ³ came from within the parish, but we are now receiving referrals from local council and other agencies who deliver in-home care to older persons.

Our volunteers undertake the visiting in pairs (where possible) to ensure the safety of all involved. It also provides continuity - if on occasions one volunteer is unavailable then the other can visit. The other benefit for JoCare is that as new volunteers become part of our program they are able to be mentored in their role by a seasoned volunteer.

 

To provide the best possible service to those who access the JoCare program we run a training day for our volunteers which involves looking at the world of volunteering and the gifts a person brings to volunteering.  We examine volunteer rights, responsibilities, and boundaries⁴. We discuss privacy and harassment laws. But more importantly we have conversations concerning the mind-set that volunteers may bring when visiting an older person. We talk of orientating ourselves to the person. We ask our volunteers to give full attention to the person they are visiting, encountering them as they are, for who they are. We discuss the limitations of a person’s “life space”⁵. We consider this day of conversation an important aspect of the JoCare program. Volunteers also undergo police checks and working with children checks⁶.

 

Thus, we at JoCare seek to act responsibly toward our volunteers just as we strive to encourage our volunteers to act responsibly. The documentation for JoCare is written within the framework of The National Standards for Volunteer Involvement⁷. While, this standard is not mandatory for Australian organisations that engage with volunteers, by establishing procedures and policies for JoCare within this framework, all involved in the program can be assured that JoCare is run in accordance with the ‘best practice’ for volunteering. We consider documentation is important for volunteers just as it is for paid workers. Volunteers are also provided with a volunteer manual.

What follows is a rationale for JoCare and its implementation.

Theology of Ageing

The Hebrew Bible has at least two hundred and fifty references to old age, embracing views of human aging as an integral part of Israelite society and a blessing from God. The God of the Old Testament is sometimes known as a liberator of the poor and marginalised. “Learn to do good; seek justice, rescue the oppressed, defend the orphan, plead for the widow,” (Is 1:17). The incarnation of Jesus authenticates the dignity and worth of human beings. As the early Christian church developed it gave considerable attention to the role and contribution of elders and widows in the faith community. They are owed respect as ageing persons and are called upon to mentor and provide spiritual guidance to other Christians (1 Tim. 5:1-3, 1 Tim. 5:9-10, Titus 2:3-5)⁸.

Christ gave two commandments. The first is to love God with all your heart, and the second is to love your neighbour as yourself (Mt. 22:36-40). This is what we seek to do at JoCare. Neighbourly love entails rising above the differences between persons and realising that each person is equal to the other; no-one has a greater value than another. A person's value and dignity belongs with who they are, not with what they can do.

Trinitarian theology offers an insightful window on relationships. The Trinity is profoundly relational with each of the three persons of the Trinity, the Father, the Son and the Holy Spirit, being unique but ultimately bonded to the other in relationship, signifying unity yet diversity. Each person of the Trinity is irreplaceable and cannot reach their potential unless in relationship with the others. This is the cornerstone of community love where our humanity is completed. God in his love takes creation into a personal relationship through the humanity of his Son and through the gift of the Spirit we become whole. Therefore, when we reach out to others in companionship our humanity is deepened by the humanity of the other⁹.

Social Isolation

Social isolation has become a major health issue for older people living independently in local communities. One of the main reasons JoCare has initially focussed on older persons is to minimise this experience of isolation and provide a sense of connectedness¹⁰. Social isolation is often used interchangeably with loneliness. It can come about when an individual experiences a sense that they do not belong or are engaged with others. Social isolation may be voluntary where an individual may withdraw from contact with others. It may also be involuntary when an older person experiences feelings of loneliness through a lack of close friends or confidants¹¹.

Social isolation in older persons and its related health implications has been the subject of much research. Contributing factors may be psychological and physical. Economic constraints, as well as environmental safety issues, also affect a person’s ability to maintain relationships with others. Increased drinking, smoking, a greater risk of suicide, re-hospitalisation, cognitive decline, mental health issues and cardiac heart disease are all factors bringing about serious health outcomes¹².

Research shows that involvement with a religious organisation aids in significant ways to maintaining social networks. Other research has focussed on attendance at church services. Frequent attendees of religious services experienced lower rates of mortality than those who were infrequent participants¹³. One of the main emphases of the JoCare transport program is assistance to those requiring access to transport to attend church services. This enhances their continuing participation in their community.

Older Persons

While many parishes run programs similar to JoCare or undertake some aspects of the JoCare program within their parish, there is considerable evidence in support of extending such programmes beyond parish boundaries as JoCare does. Demographically, in Australia between 1994 and 2014, the percentage of the population aged 65 years and over increased from 11.8% to 14.7%. Between 1994 and 2014 the percentage of the population aged 85 years and over increased by 153% while the total population growth for Australia was only 32%¹⁴. These groups are expected to grow at an even greater rate over the next decade.

 

In recent times, a number of social determinants of health have been discerned. Two of these highlight the importance of social inclusion. The first emphasises being part of a community, where a person engages with a support network of family and friends. The second is the provision of and access to affordable transport. This allows a person to access services and social supports¹⁵.

 

Further, Australia is a signatory to The Madrid International Plan of Action on Ageing which was adopted in April 2002. The key task of the plan is “building a society for all ages”. We are challenged to oppose discrimination towards the older person and to assist in creating a secure future, where the dignity of everyone regardless of age is respected¹⁶.

 

Pope Saint John Paul II in Familiaris Consortio notes "the life of the aging helps to clarify a scale of human values; it shows the continuity of generations and marvellously demonstrates the interdependence of God's people.”¹⁷

Pope Francis describes abandoning or discarding the elderly as a sin, commenting that a civilisation can be judged on its treatment of the elderly. He went further when he noted, "[t]he church cannot and does not want to conform to a mentality of intolerance, even less so one of indifference and disregard toward old age," concluding that "[w]here the elderly are not honoured there is no future for the young."¹⁸

Elizabeth MacKinlay observes that a “life without meaning is a life without hope”. Finding meaning is essential for human flourishing particularly when older persons undertake the “last great task of life”.¹⁹

Conclusion

Some have questioned the structure of JoCare and the requirements for volunteers to become part of the program. Our response is often a question. If your parent was receiving visitors in their home through a program such as JoCare, would you not feel more comfortable knowing that someone cared enough about your parent to ensure that the best possible practises had been undertaken prior to the commencement of the visiting schedule? While we agree a balance needs to be struck between regulations and care, we also need to be mindful of the contemporary world in which we live.

 

 

lrenaeus describes “the glory of God as human beings being fully alive.”²⁰ At JoCare our vision is to enhance the lives of others, encouraging them to become ‘fully alive’. While our initial focus has been to augment the lives of socially isolated older persons in our local area, we anticipate expanding the program to include all those who for a variety of reasons find themselves isolated within their communities.

 

Kerri Anne Brussen is the JoCare Coordinator at St Joseph's Parish, Malvern. JoCare is a free service supported by St Joseph's Malvern and Cabrini Health.

Submissions to the Health Select Committee Investigation into Ending One’s Life:

Submissions to the Health Select Committee from:

1. The Nathaniel Centre 

2. Caritas

3. New Zealand Catholic Bishops Conference

4. Anglican Bishops

5. Care Alliance

6. Not Dead Yet Aotearoa

7. New Zealand Medical Association

8. Dr John Kleinsman Health Select Committee Submission Download (.doc 24Kb)

9. Sue Buckley Health Select Committee Submission Download (.doc 32Kb)

Book Review: “Dear Life. On Caring for the Elderly” by Karen Hitchcock

Quarterly Essay. Issue 57, March 2015. Black Inc., Schwartz Publishing Pty. Ltd. Collingwood, Australia.

Reviewed by Sue Buckley

Karen Hitchcock is a staff physician at a large Australian city public hospital. In this Essay (short book) she describes how social attitudes towards the elderly shape the way rest-homes, hospitals, and health professionals organise and either limit or extend their care of the elderly. Hitchcock addresses a number of ethical issues – futility, over- and under-treatment, burden, euthanasia, advanced care directives – interspersing these with moving stories of real people and events. These stories are not just dramatic devices but beautifully rendered accounts of interactions she has experienced with her own family members and her patients.

The Essay as a whole challenges current pejorative views of the elderly - the ‘oncoming grey tsunami of the sick and frail’, the ‘swelling ranks of “greedy geezers”’ - but it is especially critical of the attitudes towards the elderly held by some health professionals and how these influence treatment decisions.  If you are old, with two or three organs failing, ‘can no longer negotiate your stairs to go and buy food’, then you are seen as having problems that cannot be cured. These patients, described variously as ‘crumbles’, ‘bed blockers’ or ‘gen med specials’ are not just unwanted in acute hospitals, but if they do arrive they are likely to receive different treatment from younger patients as physicians view their treatment as ‘futile’.  Hitchcock provides some captivating accounts of particular patients and how they responded to treatment when ‘futility’ was overruled.

Hitchcock bravely confronts the costs of treatment while challenging some commonly held assumptions. One that we hear often is that ‘the last year of our lives is when the most health-care dollars are spent’. Hitchcock acknowledges that increasing age and increasing health expenditure ‘go hand in hand’, but points out that this is because there is a greater chance of dying when you are old than when you are young. In fact, the same amount is spent on each death, young or old and, contrary to most commentary, hospital costs associated with the last year of life actually fall with age; data from New South Wales indicates that people aged ninety-five years and over incurred less than half the hospital costs of those who died aged 65-74 years. Responding to critiques that claim the public health system is ‘unsustainable’ and that push for a more private, US-style system, Hitchcock points out that as far as treatment of the elderly goes, ‘free markets lead to over-treatment, while publicly funded systems risk sometimes unexamined and discriminatory rationing’.  She concludes that ‘we need to shift our focus to improving care. It has been limited enough.’

The second half of the Essay deals with dying. It begins with stories of patients for whom decisions about ending treatment needed to be made. The first describes Hitchcock’s own father’s death and the burden of having to make a decision to switch off the machines keeping him alive. The second story tells of an elderly man with severe heart failure who ‘hated hospital’ and wanted to die. Hitchcock describes spending time with him, learning why he no longer wanted to live and finding ways of enabling him to be discharged from hospital to an enjoyable life. The third story describes the admission to hospital of an elderly man with mild dementia who had completed an advance care plan, possibly under the duress of a much younger wife. The wish not to be a burden was prominent in the plan and caused concerns for Hitchcock.  She questions the reliance on advanced care plans which might be made by someone in their seventies but no longer reflect their wishes as they reach their nineties. Impairments once thought of as intolerable may turn out to be bearable after all.  She quotes Thomas Nagel: ‘Does autonomy really give your past self the authority to kill off this later self?’

Hitchcock also questions the reality of the ‘good’ or ‘ideal’ death and challenges the notion that dying at home is preferable to dying in hospital. As she points out, the practicalities of dying at home are often too much for family members and besides, there may be no one at home to look after them.

The essay ends with a challenge to ‘we, the living’ to see ‘the elderly’ as the people they actually are: ‘The elderly, the frail are our society …They worked and loved and lived – and can continue to do so. … Right now we need the resources to care better for the elderly in the institutions we have imperfectly built, and we need deep social transformation so that many more people can live on in their communities and homes. We must remain aware of our ageism in every program and policy we implement.’

This moving essay is written with warmth and elegance and discusses some important ethical issues with clarity and practical wisdom. Its questioning of many current assumptions about the elderly and how they should be treated is well-timed given the upcoming challenges to our health and care systems from an aging population.

Sue Buckley is a researcher for The Nathaniel Centre

Age Discrimination

Kevin McGovern

Like The Nathaniel Centre, the Caroline Chisholm Centre for Health Ethics is a Catholic bioethics centre. We are based in Melbourne, the capital city of the Australian state of Victoria. Every year, the Chisholm Centre hosts a one-day conference which explores a significant issue in health and aged care. On 7 October 2015, our annual conference was on ageism or age discrimination.¹ This article reports some of the key insights from that conference.² It has three parts. The first explores age discrimination. It defines what age discrimination is, and surveys some of its various manifestations. The second part of this article overviews important Catholic teaching about ageing and age discrimination. As we will see, as well as critiquing age discrimination, Catholic teaching offers a positive vision of ageing and the contribution which older persons can and should make. Finally, the third part of this article considers briefly some of the challenges which come to us from this discussion.

I. Age Discrimination

What is age discrimination?

It is hard to say when a person should be classified as ‘old.’ The term ‘older person’ is used to describe someone who is 65 years or older – an age chosen because in recent times it has been regarded as the retirement age.³  Older persons are further divided into the young-old (65–74), the middle-old (75–84), and the old-old (85+).⁴ 

At the Chisholm Centre conference, Judy Gregurke, National Manager Aged Care Reform at COTA Australia, defined ageism or age discrimination as “the stereotyping or discrimination of a person or group of people because of their age.”⁵  There are positive stereotypes, but even these can be problematic. For example, elderly women should not feel pressured or compelled always to be “sweet.” That being said, in Western culture most stereotypes of older persons are overwhelmingly negative, and older persons are regarded as being dependent, frail and incompetent.⁶  These negative stereotypes are expressed both in negative attitudes about older persons and in negative behaviours towards them. Age discrimination predominately impacts upon those who are over 65, but it can also affect persons considerably younger than this.

Particularly when this is an ongoing experience, age discrimination can have a profoundly negative effect on older persons. They can internalise the ageist messages, and come to believe that they are indeed dependent, frail and incompetent. This self-deprecation, in turn, leads to poorer health, diminished wellbeing, and reduced mental ability.⁷  It can also diminish the older person’s motivation to be an active member of society. This in turn can lead to social isolation, which further diminishes the individual’s health and wellbeing.⁸

Research reported by the Australian Human Rights Commission in 2013 found that 71% of Australians felt that age discrimination was common in Australia. 35% of Australians aged 55 to 64, and 43% of Australians aged over 65 reported having experienced discrimination because of their age. This included being turned down for a position, being ignored, and being treated without respect. It also included service invisibility (as service people ignored them), relationship invisibility (as they were made to feel a burden in a relationship), and cultural invisibility (with people like them not being represented in popular culture).⁹  

Denigration, exclusion, and abandonment

There is a certain dynamic to age discrimination. It begins with the denigration that flows from negative stereotyping, whereby older persons are regarded as dependent, frail and incompetent. The logic is then that we do not need to include older persons, for such incompetent people would have little or nothing to contribute. This in turn leads to their exclusion from positions of influence, including employment (see below). However, it also includes the exclusion of older persons from important social, cultural and political decision-making processes and forums at the local, regional, national and international level. It even includes their exclusion from processes and forums which make decisions about older persons.

When older persons are excluded in this way, society as a whole is disadvantaged. Older persons have a privileged position in remembering our history. They remind us where we have come from, and therefore who we are, and where we are heading. When all this is forgotten, we can lose our way as a society. Our society suffers when this happens, and all of us are disadvantaged. Older persons are particularly disadvantaged when they are excluded from the processes and forums which consider their own care.

The ultimate outcome of the dynamic of age discrimination is the abandonment of older persons, as those who are already denigrated and excluded are denied the resources that they need to live a meaningful life. While this dynamic continues in society, any talk of legalising euthanasia and assisted suicide is particularly fraught. Might those who are already denigrated, excluded and abandoned ‘choose’ euthanasia as the only way out? Indeed, might euthanasia be the ultimate form of abandonment?

It must be stressed that there is nothing inevitable about any of this. Traditional societies usually have great respect for their elders. The negative dynamic has developed in Western societies because of choices which we have made. As our societies have become more materialistic and consumerist, a utilitarian calculus has taken over. This calculus places great value almost exclusively on economic contribution, devaluing all the other ways that people contribute to society. We need to remember that this utilitarian culture has arisen because of choices which we have made, and it can therefore be reversed if we make other choices.

Workplace discrimination

One place in which age discrimination occurs is the workplace. Older workers are generally experienced and productive, hard-working and reliable. However, persistent negative stereotypes lead to discrimination against them. A 2013 Australian report found that 1 in 10 business respondents had an age above which they did not recruit, with the average age being 50 years. Further, 29% of business decision-makers believed that older employees had difficulty adapting to change; 36% believed that older employees were less likely to be promoted; and 50% agreed that older employees were at higher risk of being made redundant.¹⁰

25% of Australian workers over the age of 50 report that they have experienced workplace discrimination. More than 80,000 Australians over the age of 50 are unemployed, and workplace discrimination is a significant factor in this. If only 5% more people over the age of 55 had jobs, the Australian economy would be $A48 billion better off.¹¹ 

In New Zealand, a 2014 Human Rights Commission report on the Ageing Workforce found that two in five (40%) older workers had experienced age related discrimination in the past 5 years. Similar proportions (46%) of workers (of any age) have witnessed it over this time period. The discrimination is most commonly manifested in the form of withholding interesting tasks, reduced access to promotions and bullying.¹²

Ignoring the contributions of older persons

Older persons contribute to the community in many ways. Most of these contributions, however, do not involve financial payment or the exchange of money. For this reason, the utilitarian calculus of the dominant materialistic and consumerist culture has difficulty in both recognising and valuing these contributions. In this section, we will highlight some of these contributions. Further, to prevent these contributions being undervalued, we will assign economic value to them.

Older persons provide a lot of care. Some are primary carers, perhaps of their spouse, a disabled adult child, or sometimes their own grandchildren. Many are informal carers, caring for family and friends, and particularly providing child care to their grandchildren. The economic value of the informal aged care provided by older Australians in 2015 was about $A60.3 billion. In 2014, Australian grandparents provided child care to 837,000 children. Indeed, they provided more child care than was provided by formal or paid carers. Older persons also contribute as volunteers. Without financial reward, their contributions often draw on a lifetime of skill, experience, and wisdom.¹³  In 2010, 2.9 million Australians over 65 were involved in volunteer work.¹⁴  In 2006, 5.4 million Australian volunteers (including many older persons) provided services equivalent to 454,000 full-time jobs.¹⁵  Older persons also provide peer support, visiting and befriending other older persons. When so many older persons are socially isolated, this is a very significant contribution which enhances what is called social capital.¹⁶

Moving beyond these merely economic measures, we should also recognise and celebrate important features of the contribution of many older persons. Many have reached a place of genuine altruism, where they are able to give without any thought of return. As we noted above, they are also able to draw on a lifetime of experience. Further, they are the memory of society, reminding us where we have come from, and therefore who we are, and where we are heading. This is of particular importance when older persons contribute to social, cultural and political decision-making processes and forums at the local, regional, national and international level. Finally, drawing on both their lifetime of experience and their early socialisation in a kinder and wiser time, older persons often offer us a more complete vision of life.¹⁷ These are very valuable contributions indeed.

Elder abuse

Sadly, we must recognise that older persons who can be denigrated, excluded and abandoned are sometimes also abused. Elder abuse is committed by someone with whom the older person has a relationship of trust, such as a partner, family member, friend or carer. It can be physical, social, financial, psychological, or sexual, and can include mistreatment and neglect. Its most common forms are financial abuse and psychological/emotional abuse.¹⁸ Data from the World Health Organisation estimates that 1 in 10 older persons experience some form of elder abuse every month.¹⁹

The victims of elder abuse are predominately older women, particularly those who are very dependent and socially isolated. Sadly, about 90% of perpetrators are family members.²⁰ In the finance industry, elder financial abuse is somewhat ironically called “inheritance impatience.” It can involve significant amounts of money. For example, in the 2013–14 financial year, the Elder Abuse Prevention Unit in the Australian state of Queensland assisted 139 older people who together had lost a total of $A56.7 million.²¹ 

In New Zealand, most research estimates that 2 to 5 percent of the older population may be victims of elder abuse.²²  Age Concern reports that it receives more than 2,000 confirmed referrals each year of older people facing abuse or neglect.²³  If, as estimated, only 16 percent of the actual number of abuse incidents reach service agencies,²⁴  this means that the likely number of elderly people subject to abuse is greater than 12,000. A study of respite care patients and caregivers in England found that 45% of caregivers admitted either verbal (41%) or physical abuse (14%).²⁵

II. Catholic Teaching

This is a necessarily brief overview of some of the more important Catholic statements about age discrimination. These statements, while critiquing age discrimination, also offer a positive vision of ageing and the contribution which older persons can and should make.

The best short statement of the Church’s positive view of older persons is perhaps found in paragraph 222 of the Compendium of the Social Doctrine of the Church. It recognises the positive contribution that older persons can make in the workplace, in the family, and in all of society. It therefore calls everyone to pay “generous attention” to them, and to see them as “partners in shared projects.” It also calls us to care for the needs of older persons, particularly those who are most frail and most marginalised. It quotes Psalm 92 to present the Church’s vision and hope for all older persons: ‘They still bring forth fruit in old age.’²⁶

Below, we will look at statements from the last three popes, along with the Church’s contribution to the UN International Year of Older Persons in 1999.²⁷

John Paul II

On 23 March 1984, Pope John Paul II addressed 8,000 older persons who had gathered from the dioceses of Italy. He described old age as “a time of life which is humanly and spiritually fruitful.” He reminded the assembled older persons, “You still have a mission to fulfil, a contribution to make.” He stated clearly, “According to the divine plan, each individual human being lives a life of continual growth, from the beginning of existence to the moment at which the last breath is taken.”²⁸  John Paul’s vision of old age is at once an inspiration and a challenge to older persons – and to all of us.

UN International Year of Older Persons

1999 was the United Nations International Year of Older Persons. It was officially launched on 1 October 1998, the International Day of Older Persons. On the same day, the Pontifical Council for the Laity issued The Dignity of Older People and Their Mission in the Church and the World. A year later, on 1 October 1999, Pope John Paul II issued a Letter to the Elderly. The Australian Catholic Bishops also contributed through their 1998 Social Justice Statement, which was titled The Challenge of Ageing.

The document from the Pontifical Council for the Laity is probably the most complete statement of Catholic teaching about ageing and age discrimination. It is just over 10,000 words in length. It has two chapters on the meaning and value of old age, with the first drawing on human insight, and the second drawing on the wisdom of the Bible. It has a chapter on age discrimination and the other problems that older persons can face. It has two chapters (the first general, the second more specific) on the Church and older people. Perhaps its most important sentence is the following: “The Church should heighten awareness of the needs of older persons, not least that of being able to contribute to the life of the community...”²⁹

Pope John Paul wrote to his elderly brothers and sisters as an older person himself. An interesting feature of this letter is his analysis of the Fourth Commandment to ‘Honour your father and your mother’: “Honouring older people involves a threefold duty: welcoming them, helping them and making good use of their qualities.” He also advised young people that “older people can give you much more than you can imagine.”³⁰

Benedict XVI

2012 was the European Year for Active Ageing and Intergenerational Solidarity. Pope Benedict contributed to this year on 12 November 2012 by visiting a home for the elderly in Rome run by the Community of Sant’Egidio. In his speech, he noted that society “dominated by the logic of efficiency and gain” often views the elderly “as non-productive or useless.” Against this, he insisted that human life even “in the years of old age... never loses its value and dignity.” Indeed, he recognised that “the wisdom of life” which older persons hold is “a great wealth,” and therefore that older persons are “a wealth for society,” “a value for society, especially for the young.” Prophetically, he stated, “The quality of a society, I mean of a civilisation, is also judged by how it treats elderly people and by the place it gives them in community life.”³¹ 

Francis

On 28 September 2014, Pope Francis met with about 40,000 older persons and their families. He recognised that “old age is a time of grace,” and that older persons, particularly grandparents, “are entrusted with a great responsibility: to transmit their life experience, their family history, the history of a community, of a people; to share wisdom with simplicity, and the faith itself.” A people who do not take care of its seniors, he warned, “has no future.... because such a people loses its memory and is torn from its roots.” Rather confrontingly, Francis described abandoning older persons in aged care facilities as “actually real and hidden euthanasia.”³²

Francis returned to these issues in his General Audiences on 4 and 11 March 2015. His first speech focussed on the abandonment of older persons and age discrimination; his second presented the Church’s vision of ageing and the contribution of older persons. In his first speech, he criticised a “culture of profit” or a “throw-away culture” which views older persons as a “burden,” and which therefore throws them away. He gave an example of an older woman in an aged care facility who had not been visited by her family for 8 months. Confrontingly, he called this a sin – indeed, he called it a “mortal sin” which could imperil our eternal destiny.³³ 

In his second speech, he insisted that “old age has a grace and a mission too, a true vocation from the Lord.” He particularly called older persons to prayer, suggesting that “prayer is the purpose of old age.” He also spoke of the “mission” or “vocation” of older persons to transmit true values particularly to the young. “How I would like,” he said, “a Church that challenges the throw-away culture with the overflowing joy of a new embrace between young and old!”³⁴

These same themes are expressed in nn. 191–193 of Amoris Laetitia, the recent Apostolic Exhortation on the family. Paragraph 191 is about the abandonment of the elderly and age discrimination. Paragraph 192 is about the role of grandparents and older persons in transmitting both “history” and the “most important values.” Paragraph 193 warns that the “lack of historical memory” is a serious danger for any society. “Knowing and judging past events is the only way to build a meaningful future.”³⁵

III. A Call to Action

There is something in this material to challenge each of us. If we are older, perhaps the most important challenge is to embrace this positive vision of ageing. This may require that we recognise and overcome anything within us which regards ourselves as older persons or the contribution that we make as second-rate or inferior. It may also challenge us to step forward to become involved in significant projects. It probably will ask us to ‘push back’ when we encounter age discrimination: for example, when a sales assistant serves a younger person before us, we may decide to say politely but firmly, “Excuse me. I was here first.”

If we are younger, one challenge is to ensure that older persons are represented in significant decision-making processes and forums. While this is important for every issue, it is particularly important for issues related specifically to older persons. In all cases, we may be surprised how much older persons have to contribute. Another challenge is to befriend an older person or older persons, and regularly to spend time with them. St Pope John Paul II reminds us that “older people can give you much more than you can imagine.”

Reverend Kevin McGovern was Director of the Caroline Chisholm Centre for Health Ethics for 9 years from August 2007 to July 2016. He is now a consultant at the Centre. He is also a member of Australia's health ethics peak body, the Australian Health Ethics Committee.

Endnotes

1. For more on this conference, including reports and photos, our distinguished speakers and their PowerPoint slides, see “The Older Person Today: giving and receiving care,” Caroline Chisholm Centre for Health Ethics (CCCHE), http://chisholmhealthethics.org.au/conference-7-october-2015.
2. I also drew particularly on another article written by a Chisholm Centre researcher, and I commend this article to the reader. For this, see Emanuel Nicolas Cortes Simonet, “Older Persons in Australia: Secular and Catholic Perspectives,” Chisholm Health Ethics Bulletin 20, no. 3 (Autumn 2015): 9–12.
3. David Wiles, “Who is old?: defining old age,” Australian Journal on Ageing 6, no. 4 (1987): 24.
4. Laurence McNamara, “Walking on Three Legs in the Afternoon,” (paper presented at the annual conference of the Australian Catholic Theological Association, Melbourne, 7–10 July 2016).
5. Judy Gregurke, “Older Persons Giving Care,” CCCHE, http://chisholmhealthethics.org.au/system/files/jg_presentation.pdf.
6. Mary Kite et al., “Attitudes Toward Younger and Older Adults: an Updated Meta-Analytic Review,” Journal of Social Issues 61, no. 2 (2005): 241–266 at 245.
7. Jennifer Richeson and Nicole Shelton, “A Social and Psychological Perspective on the Stigmatization of Older Adults,” in When I’m 64, ed. Laura Carstensen and Christine Hartel (Washington: The National Academies Press, 2006), 190.
8. Jon Nussbaum et al., “Ageism and Ageist Language Across the Life Span: Intimate Relationships and Non-Intimate Interactions,” Journal of Social Issues, 61 no. 2 (2005): 287–305 at 294.
9. Australian Human Rights Commission (AHRC), Fact or fiction? Stereotypes of older Australians (Sydney: AHRC, 2013), 4–5, https://www.humanrights.gov.au/sites/default/files/document/publication/Fact%20or%20Fiction_2013_WebVersion_FINAL_0.pdf.
10. Ibid., 8
11. Gregurke.
12. Lonergan Research Pty Ltd, "Ageing Workforce in the New Zealand Crown Entity Sector Survey Report 2014," online at http://superseniors.msd.govt.nz/finance-planning/paid-work/age-discrimination.html.
13. Ibid.
14. Volunteering Australia, State of Volunteering in Australia, 2012, http://www.volunteeringaustralia.org/wp-content/uploads/State-of-Volunteering-in-Australia-2012.pdf.
15. Gregurke.
16. Gregurke; Anne Gray, “The social capital of older people,” Ageing and Society 29, no. 1 (2009): 5–31 at 6. Social capital is “the array of social contacts that give access to social, emotional and practical support” within communities.
17. Pontifical Council for the Laity, The Dignity of Older People and Their Mission in the Church and in the World, 1 October 1998, Holy See, http://www.vatican.va/roman_curia/pontifical_councils/laity/laity_en/archivio/rc_pc_laity_doc_05021999_older-people_en.htm. The Pontifical Council calls these qualities the “charisms of old age.”
18. “Your Rights – Elder Abuse,” Senior Rights Victoria, http://seniorsrights.org.au/your-rights/. 
19. Judith Ireland, “Financial abuse of seniors a problem for all ages,” 19 October 2015, Sydney Morning Herald, http://www.smh.com.au/federal-politics/political-news/seniors-at-risk-of-fraud-financial-abuse-warns-age-discrimination-commissioner-20151016-gkaomk.html.
20. Senior Rights Victoria; Scott Pape, “The dirtiest, slimiest, most heartbreaking scam of them all,” 22 May 2016, Barefoot Investor, https://barefootinvestor.com/the-dirtiest-slimiest-most-heartbreaking-scam-of-them-all/. 
21. Pape.
22. K. Glasgow and J.L.Fanslow, "Family Violence Intervention Guidelines: Elder Abuse and Neglect", Wellington: Ministry of Health. 2006
23. http://www.ageconcern.org.nz/ACNZPublic/Services/EANP/ACNZ_Public/Elder_Abuse_and_Neglect.aspx. 
24. National Center on Elder Abuse, 1998, p. 12, in “Under the Radar: New York State Elder Abuse Prevalence Study,” May 2011, http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf.
25. Homer and Gilleard (1990), reported in Acierno et al, “National Elder Mistreatment Study,” March 2009, https://www.ncjrs.gov/pdffiles1/nij/grants/226456.pdf.
26. Pontifical Council for Justice and Peace, Compendium of the Social Doctrine of the Church, n. 222, 2 April 2004, Holy See, http://www.vatican.va/roman_curia/pontifical_councils/justpeace/documents/rc_pc_justpeace_doc_20060526_compendio-dott-soc_en.html.
27. The Australian bishops’ 2016-17 Social Justice Statement will also explore these issues. It is titled A Place at the Table: Social Justice in an Ageing Society. I am honoured to have been invited to launch this statement in September.
28. John Paul’s speech on this day is quoted in John Paul II, Christifideles laici, n. 48, 30 December 1988, Holy See, http://w2.vatican.va/content/john-paul-ii/en/apost_exhortations/documents/hf_jp-ii_exh_30121988_christifideles-laici.html
29. The reference details for this statement are above in endnote 16.
30. John Paul II, Letter of His Holiness Pope John Paul II to the Elderly, n. 12, 1 October 1999, Holy See, http://w2.vatican.va/content/john-paul-ii/en/letters/1999/documents/hf_jp-ii_let_01101999_elderly.html.
31. Benedict XVI, “Visit to the Community of Sant’Egidio’s Home for the Elderly Viva Gli Anziani, 12 November 2012, Holy See, http://w2.vatican.va/content/benedict-xvi/en/speeches/2012/november/documents/hf_ben-xvi_spe_20121112_viva-anziani.html.
32. Francis, “Meeting of the Pope with the Elderly,” 28 September 2016, Holy See, http://w2.vatican.va/content/francesco/en/speeches/2014/september/documents/papa-francesco_20140928_incontro-anziani.html.
33. Francis, General Audience, 4 March 2015, Holy See, http://w2.vatican.va/content/francesco/en/audiences/2015/documents/papa-francesco_20150304_udienza-generale.html.
34. Francis, General Audience, 11 March 2015, Holy See, http://w2.vatican.va/content/francesco/en/audiences/2015/documents/papa-francesco_20150311_udienza-generale.html.
35. Francis, Amoris Laetitia, n. 191–193, 19 March 2016, Holy See, http://w2.vatican.va/content/francesco/en/apost_exhortations/documents/papa-francesco_esortazione-ap_20160319_amoris-laetitia.html.