Elder Abuse finally receives some attention
An unpublished HSE report on elder abuse has been receiving media attention with the headlines highlighting the fact that last year more than 1800 cases of elder abuse were reported to the HSE. The figure for 2008 shows a significant rise on the previous reported period. When broken down into type of complaints the report shows that a quarter of the complaints related to allegations of psychological abuse, a fifth neglect, 16 % involved allegations of financial abuse and 12 % complaints of physical abuse such as slapping. And who were the majority of alleged abusers? The HSE report shows that in about 80 % of cases they were family members. The high level of involvement of family members in abuse should not be surprising given that these are the people most closely involved with the elderly, often acting as carers.
Levels of cases across the country varied dramatically with 47% of the cases being reported in the south. Yet there was a degree of consistency as to who was most likely to report the cases - a public health nurse, hospital or HSE staff member. Referrals from family members accounted for less than 15% of cases.
The reality is that the 2008 report from the HSE, with its finding of a significant increase in reported cases (double that of the previous 9 months), is in fact a reflection of a change in attitude towards acknowledging and responding to the fact of elder abuse. Over the last few months the HSE has published its Elder Abuse Policy and as a result has brought on line awareness raising for HSE staff and the wider population through its “Open Your Eyes” campaign. It also now has in place Senior Case Workers responsible for dealing with elder abuse across all regions of the country.
These, and other changes, have therefore resulted in an increase focus on elder abuse, and an increase in cases. However, the level of reported cases is in fact low compared to similar developed nations. According to a recent factsheet published by the WHO
“International prevalence estimates of elder abuse in community settings (including neglect by caregivers, physical, psychological and financial abuse) from Canada, Finland, the Netherlands, the United Kingdom and the United States of America range from 4-6%.” (more)
Of course we have no similar research yet from Ireland. Indeed, the HSE report, which remains unpublished, is a major step forward in creating official recognition for a significant and ongoing problem of abuse.
So it remains the case that if Ireland is in any way like other developed nations 1800 cases will be a mere fraction of the overall level of abuse currently going on behind the closed doors of elderly peoples own homes. The action taken by the HSE to respond to the problem of this form of abuse is to be welcomed but must be built on, with the development of good practice and effective guidelines. Intervention when needed must be monitored and assessed, protection policies developed and staff fully trained, resourced and supported. The sooner this is done, the better, and it is not as if Ireland has to reinvent the wheel in this area - a raft of International experience available to us to adapt and suit our own particular national needs.
Labels: Elder abuse, HSE
Free speech and euthanasia
On Thursday 9th April I headed off to CUH to attend the scheduled yet controversial lecture entitled "Why Euthanasia should be Legalised" by Professor Len Doyle. I was a few minutes late having enjoyed the spring walk and arrived to discover a very tense and unpleasant atmosphere coming from the auditorium. I was advised not to enter because the room had been taken over by an angry crowd of protesters who had intimidated the speaker into silence. I could hear for myself calls of "murderer" and "Nazi" coming from the room, as people who had attended to hear out the Professor quietly left looking shaken and upset. Within ten minutes the protesters had the auditorium to themselves; they were happily shouting about their own views and saying the rosary.
I have seen many protests, and would support anyone’s right to protest against those things that they disagree with but that right to protest needs to be balanced against others right to free speech. The worrying thing recently in Ireland has been, as Eoin O’Dell has pointed out in his post “Another Hecklers’ veto
”, that free speech appears to be subject to a degree of successful attack at the moment. This is happening both on campus, note the events surrounding the former Taoiseach Bertie Ahern
at NUI Galway and holocaust denier and historian David Irving
at UCC and off campus with pensioners heckling senior politicians
during the medical card protests.
The protesters on Thursday lay claim to the Constitution, religion and the rosary to support their aggressive and intimidating action. Clearly the Constitution protects free speech, even speech we don’t want to hear. And whilst religion may give people a sense of self-righteous certainty in their beliefs it does not mean that they have the right to silence others. A letter published in the Irish Times on Monday illustrates that sense of certainty in denying a claim that debate about euthanasia should be allowed. The author, erroneously likening it to child abuse:
"Madam, – The cancellation of the lecture on euthanasia in Cork University Hospital last week is to be welcomed. A society which has lost its sense of outrage is effectively morally dead. Thankfully, as was demonstrated on Thursday, Irish people still possess a moral compass and an instinct for when the most fundamental values in society are under threat…. We don’t generally debate the merits of ideas which we wholeheartedly reject as a society, such as, for example, child abuse or infanticide. So it is disingenuous of the HSE to state that it does not support euthanasia. If it does not support euthanasia, then why is it spending taxpayers’ money bringing over one of its most vocal proponents?" (more)
The point about free speech is that there needs to be a debate within any democratic country even about things that the majority of the population may find difficult. We do not get to choose who has free speech on the basis of whether we like the topic. As Ferdinand von Prondzynski has written in his blog “Speaking freely”, it is not the case that societies can pick who they want to hear from:
"Freedom of speech is almost certainly the cornerstone of democracy. The right and the ability to say what we want to say, however uncomfortable it may be and whatever the consequences, is indispensable to freedom more generally. All dictators will seek to restrict free speech and the free availability of uncensored information as their very first measure."
As for the debate on euthanasia, in a comment in today’s Guardian
Professor Doyle points to one very real reason why it does need to be talked about, even if most of us will have very strong reservations about it:
"One aspect of my work has always been to encourage clinicians to reflect on decisions about not providing life saving treatment or about its withdrawal from severely brain-damaged patients. I argue that while such practices are actually legal, their current clinical justifications lack moral coherence. This results in some vulnerable patients being put at risk of a lingering death and great suffering. I believe that, in the name of compassion, there should be a serious debate about whether or not a policy of highly-regulated euthanasia might help to solve this problem. Currently, medical practices that are undertaken to foreshorten life lack sufficient transparency, and we know from the reports of relatives that patients who cannot protect themselves may die in varying degrees of distress."
We know that doctors make decisions all the time regarding medical treatment that can impact upon someone’s life expectancy. My interest here is not to debate the issue but to point out to the opponents of euthanasia that life and death decisions regarding people in Ireland are already being made by the medical profession as a matter of reality. Whilst people may not like to think about it, may not like to acknowledge the difficulties surround modern medicine, the truth is that all countries need to be able to engage in debate regarding challenging and often disturbing issues. And those people who do debate them should be able to do so without fear of threats to their safety.
Of course, on a practical point, the HSE, CUH and the Gardai should have been a little more clued up as to what might happen on the day of the lecture. Particularly as one of the local radio stations had been happily whipping up public anger in the run up to the event. In the end the lecture was cancelled “in the interests of public safety”. Free speech needs to be defended on campus and off, in hospitals and on the streets. Perhaps the next time the HSE choose to invite a distinguished overseas speaker on the topic they might think about how best to organise such an event so as to deal politely but effectively with those, such as Youth Defence, who prefer silence over debate.
Labels: CUH, euthanasia, free speech, Len Doyle