Coercion & assisted dying/suicide: why is it suddenly recognisable when it isn't in DV?

[aweegc]

Ok I would post this on AIBU but I've gone through a coercive relationship and I'm still not strong enough to deal with "robust" responses.

First, the issue I'm raising isn't about death, it's about the sudden ability of everybody to recognise coercion.

I'm honestly aghast that every proponent of the upcoming bill responds to the possibility of coercion with some version of "doctors will be trained to recognise it" or "it has been shown to virtually never occur in the other countries that has assisted dying/suicide".

1. We have a law against coercive control, unlike many other countries. And according to the number of prosecutions of it, it barely ever occurs.

1. Coercion can be defined differently across jurisdictions.

1. If coercion isn't illegal in a country, how is data about its occurrence collected?

1. Does anybody talking about coercion know that there's MASSIVE manipulation involved, and by the very definition if it, someone deeply manipulated generally doesn't know they are. They won't (be able to) admit it and they are likely to demonstrate loyalty to the abuser in many cases, for a multitude of reasons.

I could go on.

But apparently, doctors will ask patients if they're being coerced. They'll know from talking to them.

I mean if it's that bloody simple, why aren't all the women (usually) in abusive relationships pinpointed and offered significant help? Why aren't all the abusive partners being located via this straightforward and quick method and being prosecuted?

I mean basically, the only surefire way to get away from a coercive partner is to be in the last 6 months of your life, and ask to be able to die.

I'm so disgusted by this lack of discussion.

Oh and all the "Look, just because some people might be coerced, that shouldn't remove the right of others to end their life."

And "Most families are loving, the idea there are lots of people wanting to have their relatives die is silly."

I have to admit to being totally triggered. I suffered multiple health issues while with my ex and at no point did he help me. Many times I thought I should just die. Never did I think I was being coerced, abused etc and I'd have definitely not given anybody that idea. In fact I was invested in presenting an image of him that he wanted the world to see. So I was frequently congratulated on having such a lovely husband.

I'm not sure why you feel attacked, OP. No one has told you you're wrong and there isn't a single comment saying long term emotional abuse is worse than bad health. Not sure where you got that from?

My point was that this bill will likely make no difference to anyone since by the time anyone's wish to die is approved, most likely they would be dead. So if a family member had tried to coerce them into it, it wouldn't change the outcome and it's unlikely it would change the timing. Your post relates specifically to the lack of coercion debate surrounding this bill.

I'm sorry you went through emotional abuse/manipulation for years. I really hope there is more research/education to recognise when people are going through it and successfully interfere.

And if you read threads on here, a woman in a poor situation for having a baby is told quite bluntly that she should abort.

I'm pretty certain that abortion was never intended to be a duty.

Yet suicide will go the same way, after all, who could justify their children's inheritance going on care fees if they could reduce costs by dying "with dignity"?

I completely agree with your point OP, it's highly unlikely that coercion will be picked up, and unjustified faith in doctors ability to predict length of life remaining means people won't care, as the person will have died soon anyway.

The financial incentives will be huge though, even carers at home can cost £100 a day.

Coercion for assisted dying (AD) and coercion in DV, despite the fact that sadly the latter does and can result in death the former is and should be at the request of the person who is dying.

So to compare DV to the assisted dying debate would be unethical because the abuser in a DV situation may or may not intend to kill because not all of them will.

Some abusers don't know they are abusers and see no harm in what they are doing but have no intentions to kill.

What DV and AD have in common is some very vulnerable person who just wants to be free from pain.

The AD debate needs to include a safety net around those who are dying so that they are not manipulated into ending their lives to benefit others financially or otherwise and that they are supported in their EOL care.

Survivors of DV, also need support to build their confidence and self esteem so they can be survivors not victims, be safe, heal and move on with their lives.

And I can easily imagine the coercion the other way, for purely selfish emotional or 'religious' reasons.

The OP is quite right that coercion may occur and should be looked out for, though how and by whom is the hard part but it should be looked for in either direction.

You might find this interesting.

https://archive.ph/uhGgX

This. Plus the victim and perpetrator won't suddenly assume those roles the day the patient comes to the doctor with the request. These patterns build up over years. So it's also very, very likely that the victim won't know they're being abused and more than that, would defend the perpetrator, especially in a situation when they're scared, may be living with them and/or relying on them for some kind of care/quality of life.

In many ways, coercion in a DV situation without serious illness is far easier to deal with, and that's saying something, because it isn't.

1. You do realise that DV and AD aren't separate issues. That's the point.

1. The fact that some abusers are absolutely naive to the fact they're abusive is irrelevant. They do it to feel good, or at least better in any number of ways. They know what is satisfying their psychological "needs" and to be honest, that's more than enough.

I'm not sure why you feel attacked, OP. No one has told you you're wrong and there isn't a single comment saying long term emotional abuse is worse than bad health. Not sure where you got that from?

There is a post (at least one, I'm in my phone so scrolling back is tricky when typing) that says they don't care about anything else, AD should go through because they witnessed a relative die. If you don't care about anything else, you're throwing people like I was, under a bus.

If you're already in hospital and about to be euthanised there will necessarily be people speaking to you about it. If you're at home and nobody is aware of your situation then it's much less likely that an expert will be asking you about it.

I looked back through all the comments and absolutely no one said they don't care about anything else or anything close to what you accused people of saying in your angry reply. One poster said they feel extremely strongly about this topic because of their own life experience. There was no implication from anyone that your abuse doesn't matter or that bad health is worse than something else.

And you're very contradictory too... You say this isn't at all about AD and could be about bananas for all you care, but if they feel strongly about AD being an option due to their valid personal experience, they're throwing you under a bus? How does that make sense?!

You should be wary of taking someone's different opinion to yours as an attack and making up stuff they never said. It makes you come across quite badly.

I also know someone who was put under pressure from medical staff to abort. She was quite young (though over 18 and in supportive circumstances and a stable relationship) and baby was diagnosed with significant issues. Though actually, after birth, it turned out the issues weren't as serious as the medics had thought - I don't blame them for that as mistakes and misdiagnoses do happen. But I do blame the staff for deciding they knew what was best for her (i.e, an abortion) and then putting pressure on her.

I think anyone who thinks assisted dying won't also follow this sort of trajectory, where some people are told by those around them, including medical staff, that it's the best option, is a fool.

C'mon @Fizzywizzy2 , you're being disingenuous. I'm reading the same thread as you and I agree with OP: there are a couple of responses at the start of the thread which clearly defend the right to AD despite also recognising the inherent risk of coercion. Sure, the phrase 'don't care' isn't used, but there sentiment is pretty clear to me, and OP is not unreasonable to point it out. You are quite unreasonable to tell her she's overreacting.

I think it is difficult to say whether the medical staff were putting pressure on her to abort. She was clearly adamant that she wanted to continue with the pregnancy so may have interpreted being given medical opinions (which are not the same as personal opinions) to abort as pressure, and was then telling everyone she was pressured that way.

Also, with AD, the final outcome ie. death, is going to be the same. It’s not about killing healthy people, or people who have a chance of recovery. The difference is whether you want to linger in pain and misery, or to bring your inevitable death forward.

If she felt pressure to abort (which she didn't want to do), does it matter whether the staff meant her to feel pressure though?

OP, I absolutely agree with you.

I nursed a (poor as a church-mouse) parent through months of excruciating pain until their very undignified death and frequently wished for something like an assisted dying bill.

I have since lived through a coercively controlling relationship. Nobody would have known, as, like the OP suggests, I was invested in upholding his projection of himself to the world, despite living in fear for years. Significant decisions were made about my life, earnings, career, even about my friends and family -all decided for me and as if I was arriving at those decisions independently, through skilled and subtle manipulation, gaslighting and veiled threat. The thought of a serious diagnosis in that relationship still fills me with dread. But as I said, nobody would have known, despite our circle including a majority of people in the type of caring professions which one would normally expect to be able to identify the coercive aspect of DV, due to us both working in such fields.

A hospital doctor was interviewed on R4 the other day describing how he'd completely missed a case of active coercion in a family dynamic, being completely taken in by the compelling presentation of the coercive family member until an attending social worker pointed it out to him. It left a deep impression on him.

MiL is currently receiving care at home at a hefty monthly charge. I worry that she somehow feels she 'shouldn't' move into residential care because the costs would increase further. There's no familial coercion: as she receives state benefits, nobody stands to gain from her effectively 'reducing costs', but she worries about being a burden on local authority funding. When people say things like 'by the time a person manages to get their request for AD across the line, there won't be much to quibble about in terms of care costs saved' they completely miss the point. The coercion itself will still have occurred. Also, predictions of life-expectancy can be woefully off, and coercion could easily happen with this in mind.

I have wondered, in moments of exasperation, whether an asset-freeze would deter coercion, so that in cases of AD there is no prospect of financial gain for a period after the person's death, and whether this would disincentivise those who might put pressure on a terminally ill relative for financial reasons.

@MagpiePi Yes, the terminally ill person is dying anyway, but with the added horror of simultaneously experiencing coercion.

Few situations renders a person so invisible as when manipulated and coerced in plain sight of the very people who should be helping you and nobody noticing. I did experience this in medical settings and it was a surreal, dissociative experience.

A poster was saying yesterday that what ultimately gave her the courage to leave her coercively controlling relationship was the fear of how her abusive partner would respond were she to receive a serious diagnosis.

There will definitely be coercive family members waiting in the wings who feel this bill gives them carte blanche to act with impunity.

I increasingly get the feeling that people who have not directly experienced CC and known the fear and humiliation (and chilling surprise of what you find you are prepared to do or put up with for fear of the consequences of non-compliance), have little real understanding of how someone could literally end up signing away their life.

And I could have burst into tears on hearing the result of the vote....so many vulnerable people who will now be even more at risk

And you could also burst into tears having to watch some of the deaths people endure (I’ve wanted to and I would consider myself pretty hardened to it). It’s a complete furphy to claim that increased supports for palliative care will fix this. Irrespective of the best palliative care on offer, some deaths are going to be absolutely horrific. Others will be really good. And others lie within that spectrum. Does palliative care need to be better funded, yes. Would this ensure everyone gets the ‘good’ death they deserve, no. I believe this is a much needed tool.

@HoppingPavlova, I don't think anybody is saying that there isn't a place for this discussion and that assisted dying would not be welcomed in many, many cases.

What is being highlighted by OP is the blithe declaration that instances of coercion will be noted and addressed, when there is little evidence to show that this happens in other cases of familial coercive control, such as in domestic violence. Coercive abuse is overlooked daily in settings which have the safeguarding of the vulnerable front and centre of operations (such as in schools, the police, social care, the judiciary and social services) despite considerable safeguarding training and the very best intentions of the professionals working within those structures, so why do we think that this would be in any way different in palliative settings?

As OP suggests, consult with the experts who work in women's domestic violence services; invite them to share best practice and help shape the debate going forward.

I live in the Netherlands where euthanasia is legal. I know more families where it was denied at the end than went through with it, and far more where the paperwork was done but never used. The doctors here take their oath to do no harm very seriously. They won't carry out the procedure if there are any doubts at all. I have confidence that British doctors are as morally robust. So yes, there is a small risk of coercion, but I think there's a greater risk that the British rules are so strict that actually not many people will be able to make use of them. By the time you've only got 6 months and have to do a lot of complicated paperwork it will rule out most dementia patients and a lot of patients on strong medication because they just won't be able to demonstrate adequately sound mind. I struggle to believe that someone coerced who really didn't want to die would be able to keep up the facade through multiple appointments without the abuser present without showing signs of confusion or not knowing what the 'right' answer is. Surely if they are that badly brainwashed, they'd also be talkable into conventional suicide anyway.

I'm in favour of assisted dying BUT I am worried about the things you mention, OP.

I've noticed a growing disdain generally for the elderly, sick, disabled. And when I hear people talking about the 'sanctity of life' I can't help but think that too many people do not see (some other) people's lives as at all valuable.

I personally know a family where the surviving parent is descending rapidly into dementia (alone) and the children neither understand nor can be bothered to support (nor seemingly want 'their' inheritance spent on additional care or a care home). If assisted dying were legal, I do wonder how their feelings or influence might sway any decision re AD.

Given the poor state of the NHS, changes in people's attitudes and in social construct, I fear more of us will be facing a pretty grim end of life. (But AD will positively hasten that grim end for some.)

Wasn't a young woman with anorexia euthanised in the Netherlands? Do forgive me if I don't find it a beacon of reassurance

I think, once AD exists, any political will to find the money to improve palliative care, elderly care and maybe even mental health care will disappear.

I understand the arguments for it and I have had family members who might well have taken advantage of it. But I feel strongly AD is an option to add to a well-resourced and well functioning end of life support, not something to add into a flawed and struggling system.

I completely agree and I'm so angry at MPs who have come forward and said that they voted for it but had reservations.

@username8348 that link is shocking.

I'm going to paste it here (MNHQ please delete if not permitted):

(Article by Janet Eastham for The Telegraph)

Assisted dying is sexist, report finds

Mercy killings are overwhelmingly violent domestic homicides of women by men, say campaigners

A study by think tank The Other Half found that assisted dying created an ‘unacceptable risk that women are coerced into state death’.

Assisted dying is sexist and will lead to women being disproportionately killed, a report has found.

The study, produced by non-partisan think tank The Other Half, found that assisted dying created an “unacceptable risk that women are coerced into state death”.

The research was led by Fiona Mackenzie, the organisation’s chief executive, who was awarded an MBE for her role in driving legislative change to stop “rough sex”, claims being used as a defence in violent assaults and homicides.

Ms Mackenzie analysed UK “mercy killings” and data from countries with legal assisted dying. She warned that without safeguards to detect abuse and coercion, the law proposed by Labour MP Kim Leadbeater risked the state “delivering domestic homicide on behalf of abusers”.

The report cited two cases in which men who killed their partners were “championed” by Dignity in Dying, despite histories of domestic violence.

In 2022, the group backed a man under police investigation for assisting his first wife’s death in the 1990s, despite him being jailed in 2017 for bludgeoning his second wife with intent to cause grievous bodily harm.

Ms Mackenzie also accused the pressure group of operating a “cut-price British Dignitas” in the 1970s and 1980s.

Her research revealed that two men working for the organisation, including its general secretary, were convicted for six deaths – five involving women suffering from multiple sclerosis, depression, and cancer.

The full report will be shared with MPs on Monday ahead of Friday’s free vote Ms Leadbeater’s Bill to legalise assisted dying for the terminally ill.

Ms Mackenzie highlights concerns from jurisdictions such as Oregon, where she claims “women with anorexia, disabilities and other ‘challenging’ female conditions have been funnelled into ‘assisted’ death”, adding: “Providers of assisted death can and do coerce.”

Dignity in Dying, the pressure group behind Ms Leadbeater’s campaign, argues that the prevalence of “mercy killings” and failed suicide pacts is evidence of the need for reform the law on assisted dying, as those who kill sick partners deserve leniency.

Last year the group welcomed new Crown Prosecution Service guidance distinguishing mercy killings and suicide pacts from murder and manslaughter, saying: “Differentiating acts of compassion from serious crimes is an important milestone on the road to law change, as well as a clear indication that the blanket ban on assisted dying does not work.”

But The Other Half analysed data from 100 of these killings in the UK and found that “despite claims…‘mercy killings’ are not the wanted, ‘hastened’ deaths that need assisted dying” but instead “are overwhelmingly violent domestic homicides of women, by men: and show that our society is still poor at detecting and responding to domestic abuse”.

Of the 100 UK “mercy killings” over 25 years, the report found that 88 per cent of perpetrators were male, and 78 per cent of female victims were neither terminally ill nor willing to die but were often elderly, disabled, or infirm.

Killings were frequently triggered by care demands and involved excessive violence, with “overkill” –the use of unnecessary brutality – common.

Dignity in Dying was founded in 1935 as the Voluntary Euthanasia Society. By the late 1970s the organisation also operated under the name Exit.

In October 1981, its general secretary, Labour councillor Nicholas Reed, was jailed for two and half years for three counts of aiding and abetting suicides and one of conspiracy to aid and abet.

His colleague Mark Lyons, 70, received a suspended sentence for seven charges of aiding and abetting suicides and conspiracy to aid and abet. Both had initially been investigated for 250 deaths.

‘Lesson should terrify us’

Ms Mackenzie said that the convictions of Mr Lyons and Mr Reed is “a lesson that should terrify us”, saying: “If you’re an organisation campaigning on this, you need to be really accepting of the reality of human nature.

“You tried to run a ‘cut-price British Dignitas’ and ended up causing the deaths of disabled women and trying to kill a woman who didn’t want to die.”

A spokesman from Dignity in Dying said: “Dignity in Dying is a professional campaigning organisation working within the law to change the law. No one working in our organisation today was working on these issues in the 1970s or 1980s, including during Nicholas Reed’s brief leadership of the Voluntary Euthanasia Society.

“We campaign for law change because we want dying people to have safeguarded choice; a reform supported by the vast majority of the British public.

“The current law fails to protect people, including women who may be experiencing domestic violence. As this report shows, currently investigations only take place after someone has died, when it is too late to help them and too late to prevent abuse or coercion.”