Parents with a death wish

January 27, 2014
old couple bench

When Karen was summoned to a family meeting by her 86 year-old father before Christmas, she thought she knew what was in store. Her 84-year-old mother suffered early stage dementia and had fallen on several occasions; her father wasn’t coping. Karen thought her father might finally admit to needing help to stay at home, or maybe they’d decided to move into a care home. Family photos were taken, and he spoke of his wish to give the family some money. Then he dropped the bombshell. “I believe I have the means to take our lives,” he said, referring to his wife and himself. “How do you feel about that?”

Nothing had prepared Karen for this announcement though looking back, the signs were there. She started to cry. Another family member said, “If that’s what you want, it’s your choice.” Since that meeting Karen’s life has been in turmoil. She’s been unable to visit her parents because of her opposition to the proposed double suicide – or is it, in this case, murder/suicide? Her father is furious with her, and also, she’s afraid of what she might find.

At the heart of the issue for her is to what extent her mother is on board with the plan. Her strong-willed father seems determined. Two days after that meeting, Karen asked him, “Is this a serious option?” He said, “Bloody oath.” And he didn’t care if some of the family were opposed. When the mother was asked if this might happen soon, she said, “No, no; don’t be silly.” But the father said, “It depends on the circumstances.” Even if her mother still has capacity to consent, Karen wonders whether she’s just going along with her husband. “Mum still seems to be enjoying life,” Karen told me. “She loves going out shopping, she’s animated with the family…”

Karen is no stranger to assisted suicide, and she supports people’s right to end their suffering at a time of their own choosing. She is a senior hospital nurse. She’s been appalled to see people’s suffering prolonged against their wishes in circumstances that were hopeless. And she’s seen doctors quietly help patients with terminal cancer to die with dignity: “I feel o.k. about that; it’s that person’s choice and there’s no hope.” But her parents don’t have cancer or life-threatening illnesses; they’re not incontinent. Her mother’s dementia is early stage but she needs a wheelchair for outings. It seems to Karen her father is tired of being a carer, tired of life. He’s too stubborn to accept help, or perhaps believes it would only prolong their difficult circumstances. He’s said in the past that he and his wife would go into a nursing home “over my dead body.”

Karen’s found herself in an agonising dilemma. If there’s been a long-agreed suicide pact, should she bow out? Ten or 15 years ago her parents had been members of a pro-euthanasia group so it was possible they’d discussed this very eventuality. After 65 years of marriage, perhaps they should die together if that was their choice. Maybe this was a perfectly rational response to their future prospects. But nagging at her has been her father’s unreasonable behaviour during the preceding year. She’d taken this as possible signs of his own early dementia. For example, he’d cancelled her mother’s medical appointment with a geriatrician, and was angry when Karen took her to the appointment anyway. He refused to let his wife undergo an MRI. Generally he wouldn’t call an ambulance after the mother’s falls. How sound was he of mind? Was he robbing his wife of her right to self-determination?

In the end Karen decided to act. She rang her father’s long-time GP, and confided in him. The GP made a home visit, and told the father he believed he was contemplating what could be a criminal act. He insisted he have a psycho-geriatric assessment. That is now pending. Karen has always been close to both her parents. The rift has upset her deeply. And she’s unsure whether by interfering, she’s over-ridden her parents’ rights. She’s aware this is one side of the story. But she wondered what readers of the Coming of Age blog thought.

I contacted two people about suicide pacts among the elderly, and the role of adult children. Dr Rod McKay is a specialist in old age mental health. He’s conjoint senior lecturer in the school of psychiatry at the University of NSW. He said the most common reason old people wanted to kill themselves was because they suffered depression, and depression was highly treatable in the elderly. “You also have to worry about signs of early dementia,” he said. With suicide pacts, there was also the issue of the stronger partner having undue influence over the other, especially if cognitive impairment was a factor. “I would encourage anyone with concerns to seek help,” he said.

Dr Rodney Syme, vice-president of Dying with Dignity, Victoria, said psycho-geriatricians always believed  that wanting to end your life was a sign of depression among the old. “I’ve talked to hundreds of elderly people who’ve reached a point where they’re ready to die,” he said. “But society, their children say, ‘You have to keep going.’ No-one listens to them. The next step is the nursing home and they hate that idea.”

He said in the case of suicide pacts where the cognitive capacity of one partner was in doubt, duress was a major concern. “This highlights the need for clear and timely communication in all families about end-of-life issues. If the mother had made her wishes known to the family before the dementia….they wouldn’t be facing the dilemma now. People leave these things to the last minute.”

For help call Lifeline 13 11 14

What are your views? Is there a role for adult children? Please leave a Comment.

Coming of Age is updated every Monday. Click ‘Subscribe for free’ to get it emailed to you.