A friendly senior doctor from a large hospital, Chris, told me he thought the introduction of euthanasia is inevitable – not because of the importance of personal choice, but because Australia will have so many old people that it simply will not have the capacity to “give everyone a hip and knee replacement”. Chris was correct about future health care challenges. In coming decades we face a rapidly aging population, a shrinking tax base and increases in health problems like dementia.
Chris’ perspective was pragmatic. It was also chilling. It suggests that it is feasible that euthanasia could form part of government planning for service provision for people nearing end-of-life. This planning may unfold relatively simply when systems try to use resources as efficiently as possible – viewing euthanasia as a back-up plan should some patients not be able to access treatments. If that sounds far-fetched, consider two cases from Oregon where patients’ applications for medical treatment were rejected, but followed by departmental notifications informing the patients they were eligible for assisted dying.
Many people worry that some elderly people will be pressured into euthanasia if it is legalised. On this topic we have to consider elder abuse. This country is waking up to the extent and nature of elder abuse. It can take different forms: financial, emotional, physical or protracted neglect.
The 2016 Victorian Royal Commission into Family Violence noted that risk factors for elder abuse included dependency on carers, social isolation, poor health, disability and the accumulation of assets. On elderly people’s wealth, the Commission heard that “financial elder abuse may begin with the best intentions … This can quickly progress to a sense of entitlement, particularly when adult children have mortgages or debts … The children may justify their actions by saying: ‘Mum doesn’t need money now, and it’s going to be mine anyway’.”
Reported instances of elder abuse included: fractured bones from assaults by family members; the altering of an elderly lady’s will and bank details after she was drugged; and the failure to toilet or clean a bedridden elderly person for a fortnight.
Public concerns about patient safeguards are recognised in the Victorian Voluntary Assisted Dying Act 2016. Sections 85 and 86 make it an offence, punishable for up to five years, to induce – through dishonesty or undue influence – another person to make an assisted dying request, or to self-administer the lethal medication that some patients will be permitted to keep in their home.
But everything we know about crime prevention would suggest that these laws will have little effect. Why? First, the chances of detection will remain low. The victim may not feel free to complain about being pressured and even if they do, basic precautions by offenders will mean that good evidence is unobtainable. Of course, if a patient dies after being tricked or pressured into self-administering a prescribed lethal dose, it’s feasible that all available evidence will point to the administration being entirely voluntary.
Secondly, multiple opportunities may present to commit such crimes. Thirdly, the crimes are easy to commit; it takes no planning or skill to repeatedly verbally pressure an elderly person behind closed doors. Fourthly, offenders may convince themselves that the pressure they are exerting is not wrong because, for example, the caring is too great a burden for their family to bear, or they believe they have their parent’s best interests at heart. Finally, the crimes may be attached to a reward, such as access to the victim’s assets.
In perpetuity, can we be confident assisted dying will not become form part of government planning for service provision for people nearing end-of-life? Over the coming decades, do we think safeguards against coercion will work? On both counts there are good reasons for concern.
Jeremy Prichard is Associate Professor of Law at the University of Tasmania.
This article draws on a piece previously published in The Examiner.
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