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Wednesday, 17 November 2010
Page: 1446

Senator POLLEY (12:45 PM) —I am sure that senators know the scope of the problem that we confront with child abuse. In 2008-09 the Australian Institute of Family Studies indicated that there were 339,454 suspected cases of child abuse and neglect—let alone the numerous unreported occasions. I have twice previously risen to speak in this place about abuse at the other end of the age spectrum: elder abuse. As the Australian government’s seniors website states, ‘Elder abuse and neglect receives less attention than child abuse.’ On this occasion, I will again describe the forms this abuse may take, who the abusers seem to be, and the frequency with which this occurs. I will also raise the very real concern that this abuse can lead to active and even involuntary euthanasia.

What do we mean by elder abuse? The Toronto Declaration on the Prevention of Elder Abuse states:

… a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. Elder abuse can take various forms such as physical, psychological or emotional, sexual and financial abuse. It can also be the result of intentional or unintentional neglect.

The Health Service Executive of the Republic of Ireland provides more detail, and I will quote from their report, Open your eyes, as there has been an attempt at systematic collection of data for the last few years. Objective data is difficult to collect, as there is serious underreporting of abuse—either by the individual or by the organisation providing their care. The report defines elder abuse as:

  • Physical abuse, including slapping, pushing, hitting, kicking, misuse of medication, inappropriate restraint (including physical and chemical restraint) or sanctions.
  • Sexual abuse, including rape and sexual assault or sexual acts to which the older adult has not consented, or could not consent, or into which he or she was compelled to consent.
  • Psychological abuse, including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks.
  • Financial or material abuse, including theft, fraud or exploitation; pressure in connection with wills, property or inheritance, or financial transactions; or the misuse or misappropriation of property, possessions or benefits.
  • Neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.
  • Discriminatory abuse, including ageism, racism, sexism, that based on a person’s disability, and other forms of harassment, slurs or similar treatment.

How often does this occur? That is difficult to assess due to underreporting. Some examples from the report Elder abuse: how well does the law in Queensland cope? will provide some insight:

  • Feelings of shame when abuse has occurred. For example, this may occur when a son or daughter has been physically violent to an older parent to coerce money from them.
  • Fear of inciting further violence, or of being punished or abandoned.
  • The consequences of reporting may be undesirable. If the violence of an adult child to an older parent occurs in the context of the parent residing with the adult child, then the parent may be concerned that reporting will lead to placement in residential aged care. The parent may have complicated feelings about implicating the perpetrator particularly if the person is their spouse, adult child or carer.

Older persons may also not report abuse due to impaired capacity. They may not be able to recognise the behaviour as abuse or, even when they do, they may not be able to articulate or even understand how to report the abuse.

As can be seen, getting an accurate estimate is difficult. This is further complicated by the array of definitions that are used in various jurisdictions to describe elder abuse. The World Health Organisation estimates the number of older people who are abused to be between one per cent and 10 per cent of the population aged over 65. Estimates vary substantially between countries. For example, in Japan it is quite low while in India and China it is quite high. Two studies in Canada gave varying results: six to 18 per cent of over 65s. The Republic of Ireland, who have endeavoured to be more systematic in the collection of this data, suggest that it is about five per cent of the older population. However, this figure excludes incidence of self-neglect. Estimates in Australia suggest between three per cent and seven per cent, although two studies conducted by Monash University which looked particularly at financial abuse indicated that rate of abuse may be much higher. As far back as 1996, a study in New South Wales suggested the average cost of elder financial abuse was $311 per week per person. That is $300 million per year.

Two years of data from Ireland suggest that psychological abuse is the most common form, closely followed by financial abuse. Calls to the Queensland Elder Abuse Prevention Unit—EAPU—hotline between 2006 and 2007 report that 38 per cent of complaints were about psychological abuse and 38 per cent were about financial abuse. However, 38 per cent of calls also reported multiple forms of abuse. This is consistent with other international reports. These are alarming statistics.

During this period of time, the cost of elder abuse to Queensland hospitals was between $9.9 million and $30.7 million. And who is abusing these older people? A very large percentage, between 60 per cent and 80 per cent, depending on the study, are family members or close friends—people with whom the victim has a close relationship. The Monash studies suggest that the most frequent abusers are sons, closely followed by daughters, guardians, spouses, carers, neighbours and significant others. Women are twice as likely to be abused as men, but the abusers are only marginally more frequently male.

Commenting on the recent report by the Queensland Law Society and the Office of the Queensland Public Advocate, Lindsay Irons said:

… the cost to the community is increasing, and in our report we quote figures that very conservative estimates here in Queensland put the financial cost at around $14 million or so, however because it’s very hard to detect and accurately measure research, the more accurate figures are probably in the order of between $1 billion and $5 billion, the cost of financial abuse.

Financial abuse is especially significant for older people, because the opportunity to recover from this assault is negligible.

In summary, elder abuse is an enormous problem. This is only a very limited indication of its scope and gravity. It so serious that I believe it is worthy of investigation by the Senate. Disability support organisations around the world have lobbied opposing euthanasia. Why? Because they see the huge risk that this legislation poses to any disadvantaged group.

In 1995 the Canadian Special Senate Committee on Euthanasia and Assisted Suicide wrote:

… legalization could result in abuses, especially with respect to the most vulnerable members of society. The ill and the frail are particularly dependent on those around them and on the health care system. Inevitably, and often without realizing it, these individuals cede control over their lives to the system and to those on whom they are dependent. For this reason, it would be difficult for others to assess whether an informed choice was made without coercion. If assisted suicide were legalized and accepted by the community, how could the expectations of the people surrounding the patient not influence his or her decision, particularly if the patient feels she or he is a burden on the family.

                …            …            …

… some would feel pressured to resort to assisted suicide where financial and institutional resources are scarce. Financial restraints that affect the health care infrastructure could also result in attempts, perhaps unconsciously, to influence patients to die more quickly and conveniently. All of the above factors could make it difficult to establish whether a request for assisted suicide is voluntary.

I intend to give a few examples of events that clearly present this dilemma—that it is not possible to legislate to prevent even ‘narrow’ intentions of euthanasia legislation to be abused. These are classic examples but they are not isolated; the reverse is true—they reflect frequent and widespread examples of what is really happening.

The first example relates to a man of Dutch heritage, a veteran of World War II, who gave his only relative, a niece, his enduring power of attorney. He subsequently developed cognitive impairment. He was admitted to a hostel as a concessional resident, partly on the basis of her statutory declaration. Later, the hostel built a sun room. The man liked to sit there. The hostel manager asked the niece to buy him a hat and gloves. She declined as she said he had no money—even though she had retained the balance of his pension after 80 per cent was paid to the hostel. It transpired that she had sold his properties, bought four penthouses, cashed in his superannuation and sold his car. She had realised $7 million.

The Oregon ‘death with dignity’ law and other similar acts claim to provide safeguards. Kate Cheney, age 85, was refused lethal prescription by her physician as he thought the request for assisted suicide was not Ms Cheney’s free choice but resulted from pressure by her assertive daughter who felt burdened with care giving. The family found another doctor to prescribe the lethal drugs and Ms Cheney died. This was reported in the Oregonian.

The Oregon legislation requires alternatives to assisted suicide to be discussed; however, there is no requirement that these alternatives be made available. Further, the ‘good faith’ provisions of this and other laws render all safeguards effectively unenforceable.

Barbara Wagner, an Oregon resident and recipient of Medicaid, was diagnosed with recurring lung cancer. Her physician prescribed Tarceva—a drug that increases the chance of survival by 30 per cent and increases the chance of survival after one year by 45 per cent. The letter she received from Medicaid denied funding for this chemotherapy but indicated that Medicaid would be prepared to fund doctor assisted suicide. This funding denial was based upon the Medicaid ruling that care which did not provide a greater than five per cent chance of a five-year survival would not be supported.

In 2009, H Rex Greene, former Medical Director of the Dorothy E Schneider Cancer Centre in California described this as:

… an extreme measure that would exclude most treatments for cancers such as lung, stomach, esophagus, and pancreas. Many important non-curative treatments would fail the five-percent/five-year criteria.

As Diane Coleman of disability support organisation Not Yet Dead wrote:

… is society really ready to ignore the risks, tolerate the abuses, marginalize or cover up the mistakes, and implicitly agree that some lives—many lives—are expendable …

Meanwhile, back in the Netherlands, in February 2010 a citizens’ initiative called Out of Free Will demanded that:

All Dutch people over 70 who feel tired of life should have the right to professional help in ending it …

A friend of mine, somewhat inappropriately, insists on talking about cars manufactured in a particular country as ‘throw-away cars’; is life becoming another disposable entity? I surely hope not.

Euthanasia and elder abuse are interlinked. We need to engage in conversations in our communities about these issues before any decisions are made. I would also like to add one of my own personal experiences. An 82-year-old woman who needed emergency surgery was presented to a health system under pressure because of lack of funding. The doctors had to weigh up whether or not the investment in that surgery was worthwhile, taking into account the patient’s age and health—the risks were 40 per cent in favour of survival. A second opinion was sought and the patient was lucky enough to find another doctor prepared to give her the opportunity to have the surgery. That woman is still alive now—two years on.

What will happen if we have voluntary euthanasia legislation in this country? What pressures will be put on that family and that individual? These are the sorts of issues that you cannot legislate on. I see euthanasia and elder abuse as being intertwined and I would encourage and urge those in this place and those in the community to think long and hard about the emphasis that we place on our elderly. We should think about the lack of respect that we are showing older Australians by allowing elder abuse to continue in our community. We need to educate the community.