The Desire to Die: Suicide and Euthanasia in the Elderly
Requests for assisted suicide are not rare. 12% of doctors reported having received at least one such request in the last year (Arnold, 2004). These high requests for death dove tail with the escalating rates of depression, especially in the Elderly. The issue of euthanasia is really an extension of the issues surrounding depression. Arnold’s research (2004) on the desire for death revealed that depression was a critical factor. This research suggests that a shift of focus is needed, if requests for euthanasia and attempts at suicide are to be reduced. Society has ignored the growing need for treatment of depression in the Elderly and as a consequence this population has shown an increased desire for death. Thus, euthanasia should be explored and treated rather than supported as a solution to the many problems the Elderly face.
Depression is the most common mental problem of the Elderly (those 65 years old and older) and suicide is 50% more likely to occur in the Elderly than among the young (Maynard, 2003). According to research conducted by Waern, et al. (2002), the common risk factors for suicide in the Elderly are physical illness (bringing a four fold increase in risk) and mental illness, especially mood disorders and dementia. According to Maynard (2003), depression is misdiagnosed as dementia in up to 32% of all cases. Additional risk factors were cited: newly diagnosed physical disorders, frequent losses, and a decrease in neurotransmitters. The presenting signs of depression can be misleading and hence are often over looked. The changes in cognition often lead to the misdiagnosis of dementia. The most commonly over looked physical symptoms are: anxiety, memory problems, loss of pleasurable feelings, slowed movement, irritability, sleep disturbance, weight loss and poor hygiene.
The consequences of doctors misdiagnosing or overlooking signs and symptoms are severe, often leading to requests for euthanasia or suicide. Improper diagnosis means improper treatment and an increased risk for suicide. People suffering from depression often visit their primary care provider prior to committing suicide (Waern, Rubenowitz, Runeson, Skoog, Wilhelmson & Allebeck, 2002). In fact, more than half make this visit one week before their suicide (Maynard, 2003). This statistic implies that health care providers are often given the chance to evaluate and treat the depression before a suicide attempt is made. However, this chance is often missed because the depression is not recognized and the patient fails to receive treatment. Additionally, even if the diagnosis of dementia is accurate, it puts the patient at a higher risk for depression. Those with dementia are more likely to become depressed (Maynard, 2002).
Another factor is focus of care. Adolescents are currently the main target for treating suicide (Pelkonen & Marttunen, 2003) despite the fact that the Elderly account for 25% of all successful suicides while they only represent 12% of the population (Sherman, 2002). There has been a steady rise in the diagnosis and treatment of depression in youth, while professionals reassuringly tell parents that “youth suicide is rare.” (Pelkonen & Marttunen, 2003). Comparatively, youth suicide is rare, but treatment is common place. The use of antidepressants in youth has shown a 2.9-4.6 fold increase, depending on class of medication (Zito, Safer, DosReis, Gardner, Soeken, Boles, & Lynch, 2002). All this focus on our youth has lead to little change in the diagnosis and treatment of Elder depression. These statistics reveal a common trend in the United States: the younger you are, the more likely you will receive treatment. Ethically, this is appalling! All people should have an equal chance to receive treatment for illness. However, the reality is that resources and economics limit the amount of services available. Due to poverty and shorter life span, the Elderly are often listed as a lower priority for care. America is an ageist.
Health Care Providers are legally required to obtain informed consent for all care. This means that the patient must be informed of their choices, the risks and benefits of all care they receive. Lastly, this means that patients have the right to choose what care they will receive and refuse care that they deem unacceptable. Even for the treatment of depression. However, an attempted suicide is an example of an exception to the informed consent laws. Legally, consent does not have to be given because the patient would die if treatment was with held. This means that the health care staff could legally force unwanted care onto the patient who has attempted suicide. Legally, it is established that all life is valuable and that the personal choices of the individual are superseded by the very value and worth of life.
Sanctity of Life argues that all life has inherent value and must be preserved at all costs. Quality of life suggests that there are conditions the failing body can impose upon a person that cause despair and torment. Quality of Life argues that compassion begs for health care providers to relieve suffering and torment. When a person has attempted to commit suicide or requests euthanasia, what is the quality of life? The patient is obviously depressed and feels there is little value in living. S/he believes his/her quality of life is low. If s/he were treated for depression, it is possible that his/her views would change and thus the health care providers should be obligated to give him/her that opportunity.
Euthanasia is a cop-out. It allows society to ignore the real issues at hand by pretending concern for the well being of our Elders. Euthanasia is nothing more than an extension of ageism. Suggesting that it is socially acceptable to end a human life simply because they are chronically sad (a condition which is medically treatable) and old is ludicrous and against the very foundational principles of our country: “Life, Liberty and the Pursuit of Happiness.” Instead of arguing whether or not it is ok to murder our Elders, the country should focus on improving the quality of life of those Elders so that depression and the desire to die are alleviated.
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