Death trap
The Press (Christchurch) March 31, 2003
by Carolyn Moynihan

As the debate on euthanasia gathers momentum it is apparent that most of the victims are women. But are they crying for help rather than crying to die, asks CAROLYN MOYNIHAN

In turning his back on euthanasia, Maurice Smith did more than give his wife the chance to die with real dignity and peace. He bucked a trend which has seen women become the main victims of the international mercy killing campaign.

As reported in The Press, two months ago Maurice Smith sat in his bedroom, pillow in his hands, wondering whether he should end the pain of his wife, who was in the room next door.

He decided against it, rejecting the wish of his wife, Bettine, who at the start of the year had asked him to help end her life.

Some weeks ago, TVNZ's Sunday programme devoted a segment to euthanasia in which all the candidates were women: Joy Martin, who died four years ago, Nelson woman Victoria Vincent who died last year with a plastic bag over her head, and a woman afflicted with motor neurone disease who wants her husband to end her life.

In the same programme was the omnipresent Philip Nitschke, preparing to counsel another Australian woman to end it all.

Here in New Zealand there have been three cases since January 1999 of elderly men killing their ailing wives and then unsuccessfully trying to end their own lives. There were no stories about women putting husbands out of their misery.

If the renewed campaign to legalise euthanasia in this country succeeds, it seems likely to make our society especially dangerous for women who are chronically ill or old and frail.

Between 1993 and 1997 Jack Kevorkian, in the United Sates, helped 93 people die; women outnumbered men two to one.

Two years ago Colorado State University psychologist Silvia Canetto surveyed more than three decades of mercy killing in the records of the Hemlock Society, a voluntary euthanasia group in the United States. She found that most of the time it was women who ended up as victims, albeit at their request.

"Many women do not have the resources, the sense of entitlement or the power and freedom to make the choice they desire, especially when they are sick or disabled," says Canetto. She suggests the preponderance of women in mercy killing cases may be related to broader social patterns of devaluing women's lives.

An American hospice nurse, Nancy Valko, backed up Canetto's research with her own experience. "When a man was dying, it was not unusual to see the wife and even ex-wives, as well as other family at the bedside. In contrast, it was just about as common to see a dying woman who was divorced and alone," says Valko.

Perhaps sick and disabled women feel more of a burden than do sick and disabled men because, for the first time in their lives, they are being cared for rather than providing the care. Yet, says Canetto, a request for death under these circumstances may be a veiled request to live. A woman may really be saying, "Do you care enough to want me alive and be willing to share in my suffering?"

Professor Kalman Kaplan, of the University of Illinois Medical School, surveyed mercy killing incidents in the United States and the Netherlands, publishing the results in the journal Ethics and Medicine last year. The study made a number of significant revelations.

First, a significant percentage of those seeking euthanasia were disabled, lending support to the concerns of disability groups. Second, a majority of those who died had complained of physical pain, but autopsy found no evident physical cause for their pain, indicating a likely psychological or emotional cause. The third significant finding was that women comprised the majority of those who died by euthanasia.

Kaplan argues that psychosocial factors are important in women's requests for euthanasia. "For example, a typical man choosing physician-assisted suicide may be suffering from terminal lung cancer and be in a great deal of physical pain," he writes.

"Ä typical woman choosing physician-assisted suicide may be somewhat disabled from chronic multiple sclerosis and, as a result, see her marriage break up and her economic situation deteriorate. Her pain may be just as intense as that of the man described above, but emerging from a partially psychosocial source."

This all makes sense. It is psychological suffering, after all, which leads younger, healthier persons to take their lives. For those with a degenerative or terminal illness, or succumbing to the frailty of old age, the fear of becoming a burden to the family and consequently being progressively abandoned to loneliness or the care of strangers is well-founded in our individualistic and busy society. To experience this abandonment must make death attractive indeed.

Loneliness more than physical pain seems to have led Australian grandmother Nancy Crick to take a lethal dose last May. The 70-year-old was said to be terminally ill from bowel cancer, in constant pain and isolated in her Gold Coast home. She had lost her will to live and weighed a mere 27 kg. An autopsy after her death, however, showed that her illness was not terminal. Her unbearable pain had another cause.

Bettine Smith has been through a very bad spell physically as a result of multiple sclerosis and it is understandable if it led her to ask for death. But as her husband's experience shows, we should not be too willing to believe such requests.

Let us take them as what they really are - cries for help and comfort - and then redouble our efforts to ensure that everything has been done, physically and emotionally, to alleviate suffering.

And let us be twice as suspicious when a woman asks to be killed, for women are twice as likely to do so - and probably half as likely to be getting the care and support they need.

Carolyn Moynihan is an Auckland writer.