Sarah Harte: We cannot allow assisted suicide debate to devalue older people

Old age is not a disease and we shouldn't treat it as one

Ageism is probably the last acceptable form of discrimination that remains unchallenged in society, with older people often unfairly stigmatised.

Last week, a Yale professor was under attack for suggesting the mass suicide of elderly Japanese might solve some of Japan’s problems.

During the course of an interview in 2021, Dr Yusuke Narita (37) had said: “I feel like the only solution is pretty clear.” 

Referring to the practice of ‘Seppuku’ or disembowelment by dishonored Samurai in the late 19th century, he continued: “In the end isn’t it mass suicide and mass ‘seppuku’ of the elderly?”

Was he serious? Defending himself in the New York Times last week, he said his earlier statements had been “taken out of context” and that the phrases “mass suicide” and “mass seppuku” were “an abstract metaphor” and that he ought to have been “more careful about their potential negative connotations”. 

Dr Narita reportedly clarified that he was in fact “primarily concerned with the phenomenon in Japan, where the same tycoons continue to dominate the worlds of politics, traditional industries, and media/entertainment/journalism for many years”.

Some Japanese commentators have welcomed his comments, saying that it has ignited essential conversations about pension reform and social welfare changes. 

Unsurprisingly, others have found his comments distasteful.

Meanwhile, Dr Narita’s ideas have made him a social media star with many young followers receptive to his ideas.

He previously discussed euthanasia, predicting that the “possibility of making it mandatory in the future” will become part of “the public discourse”. 

Yet, a society making choices about who gets to live and who gets to die, whose life is more valuable in the context of resources isn’t as whacky as we might think.

During the early stages of the pandemic when things were looking hairy, it was said that some Irish hospitals had quietly decided that if there was a paucity of ventilators it was ‘goodbye’ to the over-70s.

In Italy, particularly in the Lombardy region where hospital capacity was overwhelmed and medics were dying, existential decisions of whom they would treat, and whom they would let die, became a reality for doctors who faced agonising decisions.

Not everyone is treated equally

Admittedly, it was in the context of critical care where resources were particularly scarce, but it does show that when push comes to shove, citizens are not all automatically treated equally as a matter of law and ethics.

If there’s a contest for medical resources, your claim on life-sustaining treatment may decrease as you grow older — but could it apply in other contexts?

Dr Narita has said that his comments apply to the Japanese economic context with its aged population, low birth rate, increased social welfare, and pension burdens falling disproportionately on the young. 

Sound familiar?

Currently on the agenda of most EU countries is how to fund an ageing population without wrecking the public finances.

Part of this fundamental rethink is that people should work longer, which won’t thrill everyone but is more of a crowd-pleaser than mass suicide of the elderly.

In 2024, Ireland will move to a new “ flexible pension age” model similar to systems already in place in several EU countries, and mandatory retirement at 66 will be prohibited.

Only the French in their inimitable way are considering lowering the retirement age. They seem to reject the puritanical view that you only have worth in the world when you work, and that unless you are rich, you should work until you drop.

Underpinning all of this is a debate not just about resources but about the deeper question of a human being’s worth.

What life means or more specifically what it means to end it will soon be faced by Irish politicians in the context of assisted dying rather than balancing the books. 

However, human nature being what it is it’s easy to imagine the potential for economic dimensions or selfish interests to assisted death scenarios.

A newly convened Special Oireachtas Committee is set to consider assisted suicide in depth: it will be chaired by Kerry TD Michael Healy-Rae and consist of nine TDs and five senators.

Last December, it was reported in this paper that Tánaiste Micheál Martin had concerns about assisted death and spoke about the need for “very, very strong safeguards”. 

He said: “I would just be nervous that through any legislation that’s passed — and I’m open to persuasion on this — but that you would create an indirect pressure on older people in particular, people who are coming to the end of their lives, and all sorts of pressures can happen.”

He has a point. There is a reason our law allows a will to be challenged when it is felt that duress or undue influence has been brought to bear on a deceased person in terms of how they exercised their testamentary disposition. 

The late Vicky Phelan with then Labour Party leader Alan Kelly and TD Gino Kenny during the launch of Dying with Dignity Bill 2020. Picture: Gareth Chaney/Collins

Doubtless, some readers will be familiar with the concept of relatives drawing up a chair beside the hospital bed of an ailing relative for less than altruistic reasons.

Imagine how that pressure might play out if a vulnerable older person had resources to leave, there was a State-mandated mechanism for people to ‘voluntarily’ end their life, and relatives as potential beneficiaries felt that their aged relative had ‘a fair innings’ and they were in need.

Chillingly, Dr Narita in his musings cites the financial burden of his mother’s medical expenses who died when he was 19 but then economics is often cited as a motivator for women opting for abortions, a rationale pro-life thinkers find heinous. 

Sensational ideas by intellectual provocateurs for the sake of clicks are unhelpful. However, it’s the values that underlie Narita’s ideas and their economic background that are of interest.

Plenty of young Irish people feel short-changed, locked out of the housing market, saddled with state debt, and the hangover from the zealous borrowing of their Gen X parents. This is highly unlikely to translate into a receptiveness to Narita’s ‘final lebensraum for the young’ solution. 

But unpleasant thinking can insidiously take hold, people can gradually coalesce around ugly values. 

Ageism last 'acceptable' form of discrimination

Ageism is probably the last acceptable form of discrimination or bias that remains unchallenged societally, probably because it’s not as ‘sexy’ as combating racism and sexism. Older people constitute a stigmatised group in most Western societies.

Last month, The Alliance of Age Sector NGOs launched a report, Telling It Like It Is: Combatting Ageism, calling for the appointment of an independent commissioner for ageing and older people.

It is hoped that this would action a programme for government that prioritises older people and which would see enhanced investment in programmes and services to combat ageism nationally. This kind of change is needed to counteract the idea that older people are simply a burden on the balance sheet of life.

For anybody looking to see what older people are capable of, Monday’s uplifting documentary Super Agers available on RTÉ1 playback is a must-see. 

Pointed out is that negative perceptions of ageing are modifiable. 

Older people are better at conflict resolution, better negotiators, and taking a perspective on something. Old age is not a disease.

Back at the ranch grappling with the knotty problem of euthanasia and working out whether we’re bestowing a last human right or going down a slippery slope is likely to be highly contentious and needs robust but careful debate.

For some, particularly those facing a painful drawn-out death it’s unthinkable that you shouldn’t have a right over how to exit.

The late Marie Fleming, who suffered from MS, bravely took a landmark legal case challenging our law on assisted death, which she lost in the Supreme Court in 2013, the year of her death. 

Last October, End of Life Ireland, a volunteer-led advocacy group, delivered a petition to Leinster House supporting the right to die with dignity with almost 5,000 signatures calling for end-of-life legislation supporting the right of those with a terminal illness or an incurable condition to die and “they have suffered enough”. 

The College of Psychiatrists has already strongly come out against assisted dying saying that a dignified end should be possible with “good palliative care” and citing the risks to older vulnerable people.

Call it euthanasia, assisted suicide, dying with dignity, or assisted dying but as a social, cultural, and ethical issue, this one is a whopper. In the meantime, our sympathies to elderly Japanese who must be sleeping with one eye open.