"I don't want to be a burden"

Paul Russell
22 January 2013
Reproduced with Permission

Suicide contagion, also known as the Werther effect, is a well-documented phenomenon of serious concern for young people.

Also called "copycat syndrome", the understanding that knowledge of a youth suicide creates risk factors amongst peer groups, school classmates and even "friends-of-friends" networks has been taken seriously by educators, police and the media for decades.

The World Health Organisation has issued media reporting guidelines. Schools have protocols to ensure that students have access to counselling when a suicide occurs in a school cohort.

Young and impressionable minds can easily get caught up in suicide ideation. Macabre, unhealthy thinking about the circumstances of a death of someone close can foster thoughts of hopelessness and despair. Little wonder that a great deal of public funding, time and effort has been expended to combat a high youth suicide rate.

But why is news of a youth suicide greeted with far more concern than a suicide of an elderly or infirmed person? Certainly it's natural to lament a young life lost, a future snuffed out prematurely. But suicide in the elderly and infirmed is no less a tragedy = particularly as it often portrays a sense of loss of hope or ability to find support and answers to one's fears and concerns. But suicides, and assisted suicides, and suicide pacts, and murder-suicides are all treated as fodder for the evening news.

Isn't anyone thinking about the Werther effect on the elderly?

There have been a small number of elderly suicides and suicide pact deaths reported recently that make me wonder whether old people are vulnerable to the same copycat phenomenon.

Two suicide-pact deaths in Western Australia within the past year (both where the male partner survived) were reported to have been initiated because of fears associated with the possibility of needing to move into nursing home care.

Such fears are not irrational. After all, leaving one's family home and moving into care with only a minimum of personal effects and where someone is seemingly destined thereafter to become increasingly more reliant upon others is a legitimate concern. It's a life changing event at a time in a person's life when they are least likely to want any change. But how is it that, in these cases at least, the solution was suicide? After all, many thousands of Australians successfully deal with these fears every year.

Is it possible that the most recent suicide pact couple heard about the earlier couple or indeed others who had taken this path? Is it possible, prior to this knowledge, that their fears were held to a lesser degree = that they might have found another less dramatic solution? We cannot know.

And what affect do the media reports have on the elderly? A recent anecdote that came to my attention suggests that there's a "lowering of morale" when the elderly hear of such tragedies = especially if the deaths were local or of people with a public profile. The use of phrases like "forced into a nursing home" are emotionally charged and can hardly help.

The use of the phrase "you don't want to be a burden" and variations on that theme have been appearing recently in TV advertisements for funeral plan insurance. Again, whilst being a burden is a natural concern, its affirmation in sales slogans can hardly be helpful. As one might imagine, the ageing couple spruiking for the insurance are tanned, fit, well-groomed, affluent and clearly in control. Are those of us who don't fit this description destined to become a burden? Should we be thinking of another way out to make sure that we're not a burden or so that we'll leave a larger nest egg for our family?

Does the dark shadow of Exit International and other right-to-die groups have a further negative influence? I'm not so much thinking now of their ideologically-driven membership, but of others who come within their orbit and whose circumstances may make them vulnerable to internalizing negative messages; those who perhaps do find the thought of a future in a nursing home fearsome and unable to plan for the future. How do the evening news and current affairs profiles of these elderly suicides affect them? Does the thought of an early exit somehow become the only alternative?

A recent study of the activities of the Scottish Right-to-Die group, Friends at the End (or FATE) summarizes what we already know of the pro-euthanasia lobby. Here is what one activist had to say:

"The palliative care [philosophy] 'you live until you die' is bilge. A lot of people do live peacefully until they die. But for a lot of people the last few weeks of their lives are very unpleasant and their symptoms dominate them to the extent that they can't really think clearly about anything else. And it's that part that they want to avoid."

The modus operandi is clear: paint the picture of a bleak and pain-racked path to death using statements broad enough so as to remain unchallenged yet specific enough (usually by way of example) so as to provoke fear and concern.

If there are problems, fix them. People don't need to die in pain - experts tell us that; so let's make sure everyone has access to the very best of care. Life in our aged care facilities shouldn't be a debilitating experience - let's question the funding models and the service delivery mindful of the debt of gratitude, care and attention we owe to the elderly. We should not, by way of public policy, effectively endorse and amplify their fears.

Just as we all share concern for the mental health of our youth, we all should try to be aware, to be on the lookout for tell-tale signs of concern in our elderly loved ones. Affirming words and taking the time to listen = to give our elders the opportunity to share their fears = is so important. Comments like "I don't want to be a burden" are often really a cri de coeur for affirmation and not a wish to be gone. At a time in their lives of change, of uncertainty and insecurity, we need to be constant in our care and presence.

As our population increasingly ages in coming years we will as a society need to turn our minds more and more to this question of elder care. How we deal with this, I believe, will be a historical marker for this generation. Will we continue to turn a blind eye to the subtle and not-so-subtle messages of hopelessness or will we have the courage and imagination to revision what ageing in Australia should look like?