Sebastian's Point

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Promoting Suicide during an Apocalypse 

David Franks, Ph.D.  |   12  June  2020

The coronavirus pandemic and the protests against police brutality have an apocalyptic air about them, but "apocalypse" means, in fact, the unveiling of what is already there. What has been revealed to those not on the margins is a preexisting condition of grotesque, lethal inequity for those on the margins.

Unfortunately, when a crisis reveals such preexisting conditions, those who were always more vulnerable suffer even more. In this context, for anyone who sincerely wishes to make a preferential option for the most powerless, the advance of pro-suicide legislation (the “End of Life Options Act”) on Beacon Hill astonishes by its perversity.

A new draft of pending physician-assisted suicide legislation (Bill S.2745) has, under cover of lockdown, broken through in the Massachusetts legislature, being favorably reported out of the Joint Committee on Public Health to the Joint Committee on Health Care Financing. This has happened after five previous attempts over a decade, and a statewide ballot initiative failed to advance what proponents now call "medical aid in dying."

Promoting this legislation in the midst of a pandemic in which at least 40% of the victims have been elderly persons living in long-term care facilities[i] (though only accounting for 0.6% of the U.S. population) shocks the conscience.

Promoting such a white-progressive and divisive desideratum at a time when the people cannot easily lobby legislators in person offends the most basic democratic sensibility.

As a nation, our very first concern when lockdown orders were handed down should have been to lavish massive resources on long-term elder-care facilities. Instead, we did what we have done all along: we ignored, with deadly callousness, the plight of the old—even though the economy was, presumably, being shut down for their sake in particular. Remarkably, some governors even sent recovering COVID patients into nursing homes.[ii]

If such illogical and lethally ageist disregard for the value of elderly persons could occur in these extraordinary circumstances, it should perhaps not be surprising that legislation that would intensify a public-health emergency predating COVID-19 has found its ironic moment of glory.

Despite nominalist attempts to wave away reality with words, physician-assisted suicide is still what it is: suicide. Suicide has been epidemic in America for a long time now, ending the lives of more than 47,000 in 2017—a 33% increase over the previous two decades.[iii] Suicide is an American crisis, and it is only getting worse.

In fact, the crisis is intensifying before our very eyes in long-term elder-care facilities. As Dr. Louise Aronson wrote in The New York Times:

 

"Earlier this month, a colleague who heads the geriatrics service at a prominent San Francisco hospital told me they had begun seeing startling numbers of suicide attempts by older adults. These were not cry-for-help gestures but true efforts to die by people using guns, knives, and repurposed household items.

“Such so-called ‘failed suicides’ turn out to be the most extreme cases of a rapidly growing phenomenon among older Americans as a result of the Covid-19 pandemic: lives stripped of human contact, meaningful activity, purpose and hope that things will get better in a time frame that is relevant to people in the last decades or years of life.

“Since late February, the stories from nursing homes and assisted living facilities have been appalling: people dying of neglect; people starving to death; defeated people lying in bed or staring out windows with no hope of reprieve; people with dementia fighting draconian restrictions they cannot understand and being sedated for these ‘behavioral issues,’ sometimes to the point of becoming bedbound and unable to eat.”[iv]

 

Again, the current crisis has exacerbated a preexisting condition. Even before the lockdown, nearly half of nursing-home residents were diagnosed with depression[v] (and, according to the CDC, we know that almost half of those who die by suicide suffered from a known mental-health condition).

 

As we read in an article resulting from a six-month investigation by Kaiser Health News and PBS NewsHour: “Most suicide prevention funding targets young or middle-aged people, in part because those groups have so many years ahead of them. But it’s also because of ageist attitudes that suggest such investments and interventions are not as necessary for older adults, said Jerry Reed, a nationally recognized suicide expert with the nonprofit Education Development Center.”[vi]

From that same article, we hear from Dr. Yeates Conwell, director of the Office for Aging Research and Health Services at the University of Rochester: “Prevention needs to start long before these deaths occur, with thorough screenings upon entry to the facilities and ongoing monitoring, Conwell said. The main risk factors for senior suicide are what he calls 'the four D's': depression, debility, access to deadly means, and disconnectedness.

 

“‘Pretty much all of the factors that we associate with completed suicide risk are going to be concentrated in long-term care,’ Conwell said.”

 

Indeed, perhaps a third of residents report suicidal ideation[vii] (again, even before the lockdown).

 

Yet this is the time the Public Health Committee gives its imprimatur to assisted suicide.

 

It is only going to get worse. Besides the mental-health fallout from the lockdown, we know that the “baby boom” cohort has had relatively higher suicide rates all along the line than other generations,[viii] and we should expect that that will continue as more and more of them enter into elder-care facilities.

 

Despite all of this, now is the time that the ruling elite on Beacon Hill pushes legislation forward promoting suicide among the elderly in particular.

 

Rather than a serious campaign to deal with social despair (so often tied to economic factors) and rather than increasing resources to treat depression, that is, rather than systemically confronting the public-health crisis of suicide (especially among the old, given the burden of the COVID pandemic), the supporters of this legislation would rather surrender that most exposed ground to suicide.

 

Rather than addressing staffing shortages and other horrors in elder-care facilities,[ix] problems which have been studied,[x] but which require a battle with the rapacious nursing-home lobby to address, supporters of this legislation would rather be working with that lobby to convert the premature death of the elderly into increased margins for corporate overlords (like the parasitism of Snowpiercer).

 

The COVID-19 pandemic has exposed fundamental inequities in our social system in general and in our healthcare system in particular: the elderly and poor minorities have been especially hard hit.

Despite the posturing of our supposedly progressive legislators on Beacon Hill, what we have here is a ruling class that serves oligarchic interests. The social upheaval of these last few months should have awakened consciences to the structural inequities that bedevil us. But these suicide supporters remain lethally oblivious. It is one thing not to address the preexisting conditions; it is even worse to exacerbate those conditions. Turn suicide into a “medical option,” and the inequities will only intensify.

It was edifying to listen to poor people and people of color testify before the Public Health Committee last year, as they tried to communicate, to legislators who occupy a different social position in this world, how fearful they were of legislation that would give, say, health-insurance companies the option to deny coverage for actual medicines in favor of a newly designated “medical” option: “aid in dying.” They have suffered denials of care all their lives; they know assisted suicide will increase the deadliness of systemic injustice.

Sadly, supporters of assisted suicide could not hear through their privilege. And the apocalypse has not woken them up. They have acted with astonishing irresponsibility.

___________________________

[i] See https://freopp.org/the-covid-19-nursing-home-crisis-by-the-numbers-3a47433c3f70?gi=614467847b3f.

[ii] See https://www.businessinsider.com/cuomo-executive-order-4300-recovering-coronavirus-patients-ny-nursing-homes-2020-5.

[iii] See https://www.cdc.gov/nchs/products/databriefs/db330.htm.

[iv] See https://www.nytimes.com/2020/06/08/opinion/coronavirus-elderly-suicide.html.

[v] See https://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf.

[vi] See https://khn.org/news/suicide-seniors-long-term-care-nursing-homes/.

[vii] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232590/.

[viii] See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107573/.

[ix] See https://khn.org/news/like-a-ghost-town-erratic-nursing-home-staffing-revealed-through-new-records/.

[x] See https://www.kff.org/medicaid/report/nursing-facilities-staffing-residents-and-facility-deficiencies-2009-through-2016/.

David Franks, Ph.D.

Chairman of the Board, Massachusetts Citizens for Life