How voluntary is “voluntary”?

Respect for autonomy is one of the most convincing arguments for euthanasia. It was the theme of a strong defence of legalising it in Australia in the Journal of Law and Medicine by Margaret Otlowski and Lorana Bartels in 2010. They concluded that “ in a secular society with an ageing population” legalisation is inevitable.

However, in the latest issue of the JLM a criminologist at the University of Tasmania has made a vigorous response. Jeremy Prichard doubts that many people in the community will be able to give full and voluntary consent to ending their lives. He contends that the growing prevalence of elder abuse suggests that aged people could easily be manipulated.

“Such procedures may be safe for socially connected, financially independent individuals with high autonomy and self-efficacy,” he writes, but “circumstances may be entirely different for isolated patients with low self-efficacy who represent an unwanted burden to their carers, some of whom may benefit financially from the death of the patient (even just in a reduction of financial pressure).”

Sometimes the request for euthanasia may be genuine, but it has been prompted by subtle pressure. Carers may easily convince a patient that death is the best option for everyone. Dr Prichard cites some disturbing anecdotes from research into elder care in Tasmania. In one, a woman describes how she is treated by her husband:

“I had the stroke a few years ago, I’m absolutely helpless to do anything myself ... [My husband] gets annoyed because I have to go to the toilet all the time and he has to help me. ... In his own selfish way he cares for me too, it’s just that he’s so disagreeable, he’s a real disagreeable old grump, he doesn’t like anyone around ... He talks about he’ll be glad when he dies all the time and I say “well what will I do?” He says “I just hope my time will hurry up and come.” That’s my life and I’ve got to put up with it ... I couldn’t get anyone else to look after me.”

Very little research has been done on pressures that could be exerted on the elderly and disabled. “Research on the risks of voluntary euthanasia or physician-assisted suicide is in its infancy,” he writes.” So far as this article could ascertain, only one qualitative study has investigated the issues of pressure on patients to access voluntary euthanasia or physician-assisted suicide.”

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