Aged Care, Elder Abuse and Euthanasia: “A fairer, kinder New Zealand”?
Dr John Kleinsman
The theme of a fairer, kinder nation has been taken up by our Prime Minister, Jacinda Ardern, as part of her narrative for what good leadership looks like. In her first 100 days speech (January 31, 2018), she voiced her commitment to “leave a legacy of a stronger, fairer, kinder New Zealand.” The phrase was utilised again in her leader’s speech at the Labour Party conference in November 2018 and was also used by Finance Minister Grant Robertson when presenting the 2019 “Wellbeing Budget”.
In using this phrase, the Prime Minister has provided us with a critical ethical lens through which her government’s policy-making decisions can be viewed and assessed. It is a lens that I hope will continue to be utilised by future governments – it provides a necessary, richer and more humane alternative to using ‘economic growth’ as the primary indicator for judging the ‘prosperity’ of our country.
The theme is not a new one for a Labour Leader. In 2014 it was used by David Cunliffe in an address given at the Grey Power AGM. Describing older persons as some of the most vulnerable members in our society, Cunliffe spoke of the need to “create a fairer, kinder New Zealand … [in which] all Kiwis can look forward to growing old” – one that has their “very best interests … at heart.”
‘A country in which it is not just safe for our elders to grow old, but one in which they feel valued as taonga and will flourish’: no-one I know would disagree that this constitutes a key characteristic of a fairer, kinder New Zealand.
Taking up this theme, and reflecting on whether legalising euthanasia is the right thing to do at this time – a question that may well yet be put to all New Zealanders in a referendum – it follows that one of the tests politicians should apply is whether legalising euthanasia will create a fairer, kinder New Zealand for our elders?
It is argued by some that the End of Life Choice Bill currently before Parliament provides an important legal remedy for those who strongly desire, but are currently denied, access to euthanasia. Proponents of change maintain they are simply advocating for ‘choice’, and that those who don’t want to avail themselves of euthanasia will still retain their choice to die a natural death. The veracity of this particular argument is premised on the (questionable) assumption that giving choice to a few will not undermine the choice to continue living for those who would otherwise not ask for euthanasia.
The veracity of the case against euthanasia, meanwhile, involves a more complicated argument – that giving choice to the few will, in real life, expose far greater numbers of people to the risk of a premature death because of the context in which our elders live – a context characterised by ableism, ageism, growing levels of social isolation for those over 65, and year on year rises in cases of elder abuse.
The statistics relating to elder abuse provided by Age Concern are shocking. In 2018 there were “more than 2,200 referrals. Two thirds of these [1,466] were confirmed to involve abuse or neglect”.1 Drawing on overseas research, it is recognised that the real number of abuse cases represent only 16% of the number reported,2 which puts the total of people being actively abused in New Zealand in any one year at more than nine thousand. It is of extreme concern that past figures from Age Concern show that the 2018 figures represent a 50% increase on the levels of abuse reported just four years ago in 2014. This state of affairs represents a tragic and shameful indictment on our society.
Justice and compassion demand that we ask: ‘What is going on in our culture to explain this disturbing phenomenon?’ The answer lies, to a significant extent, in recognising the increasing prevalence of negative attitudes towards older people in our society; a function of the erosion of their place and value in our world, combined with familial and societal pressures that in recent decades have made make it less practicable and more challenging for families and society as a whole to care for and support older people.
Disturbingly, Age Concern report that more than 75% of alleged abusers are family members, with more than 70% involving psychological abuse and 50% of all cases involving financial abuse. Typically, cases involve more than one type of abuse at a time.
In 2009, an Auckland University study3 identified “beliefs about the inter-generational transfer of money and property as leading to financial abuse”, a situation without doubt exacerbated by growing financial pressures on families. While interest rates are currently the lowest they have been for decades, a lack of housing stock, along with extreme house prices in the main centres and rising costs for people being cared for in rest homes, will ensure that financial pressures will continue to characterise our cultural landscape and will continue to contribute to our shocking rates of elder abuse.
Now, while the Age Concern figures focus largely on the ‘overt’ coercion and abuse that our elders are regularly experiencing, Michael Wood (MP), speaking at the second reading of the End of Life Choice Bill, eloquently describes an equally abhorrent and equally dangerous, but less well recognised, ‘covert’ or implicit pressure that our elders experience:
I am ... deeply concerned, on the basis of conversations with people and my knowledge of people, including my own loved ones, approaching an end of life situation, that many of those people ... [will] feel the implicit pressure. They feel the burden on their families, they worry about the pain that the final months may put them through, and they may see it simply as a better choice for other people to access the end of life provisions that are included within this bill. I do not believe that is conscionable.
In a similar vein, Don Mathieson (QC) accurately articulates how legalising euthanasia will play out in the rest homes caring for our elders:
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.
Our rising rates of elder abuse, combined with, and linked to, financial pressures and ageist attitudes that promote a dangerous undercurrent of overt and covert pressure, will, without doubt, influence the uptake of euthanasia by our elders should it be legalised.
It makes sense that the very availability of euthanasia will make our elders more vulnerable to a premature death. It is understandable that people who are neglected, undervalued, socially isolated and made to feel invisible, people who are conscious of the demands they are making on the State and/ or family at a time when resources are stretched, will come to believe they are a nuisance, a burden. This perception has gradually crept into our social narrative and is already a serious issue. In the words of one geriatrician:
I heard time and time again, older people telling me that they didn’t want to be a burden. Most were not terminally ill: just sensitive to a society that tends to regard its older population as a burden and therefore likely to accede to even subtle suggestions that they have had a ‘good-innings’.
The idea that people have had a ‘good innings’ points to changes that legalising euthanasia will bring to the ‘landscape of care’, by which I mean it will affect how we look at and regard our elders, especially those at the end of life. Psychiatrist Mark Komrad tells the story of the elderly father of a colleague of his who lives in Belgium, has a chronic condition and has chosen not to have euthanasia: “I am told, when his father complains about his symptoms that some of his friends will say – you chose not to have euthanasia.” This represents a subtle but profound shift in the collective psyche, one characterised by a loss of kindness, empathy and compassion. It is without doubt one of the most dangerous unintended consequences of legalising euthanasia. It is also one of the least well-recognised and spoken about risks of euthanasia legislation.
In the ageist, resource-impoverished society in which we live, many older persons will come to experience the ‘choice’ of euthanasia as a burden – the burden of justifying every single day, to themselves if not also to others, why they would not avail themselves of it. In my view, that is neither fair nor kind.
Our elders deserve better. There has never been a more dangerous time in which to introduce euthanasia in New Zealand.
Our Prime Minister has offered us a wonderful vision of a fairer and kinder New Zealand. In the current context, defined as it is by ageism and elder abuse, the End of Life Choice Bill, on balance, clearly fails the ‘fairer, kinder test’. The question I am left with is why she and many others remain blind to this fact?
1 See Age Concern, https://www.ageconcern.org.nz/ACNZPublic/ Information/Policy_and_Research/Research_into_elder_abuse/ACNZ_ Public/Elder_Abuse_and_Neglect_Research.aspx, accessed 4 August 2019.
2 See Elder Abuse and Neglect, (2007) Ministry of Health, https://www. health.govt.nz/system/files/documents/publications/family-violenceguideliens-elder-abuse-neglect.pdf, p. 15.
3 See Peri, Fanslow et al (2009), Keeping Older People Safe by Preventing Elder Abuse and Neglect, Social Policy Journal of New Zealand, Issue 35 at https://www.ageconcern.org.nz/files/EANP/Keeping%20Older%20 People%20Safe%20by%20Preventing%20Elder%20Abuse%20and%20 Neglect,%20Kathryn%20Peri,%202009.pdf.