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                         Sending a Message

The image that flickered across the TV screens in early February of retired
pathologist Jack Kevorkian, MD, being cheered in a church by supporters of
physician-assisted suicide sent a chill up the spines of many experts on
elderly suicide. 

"The message he is communicating to people who say they want to die is
exactly the opposite of what I want to communicate," said James E. Spar,
MD, of UCLA's Neuropsychiatric Institute. "Kevorkian says: 'If you're so
miserable then it's OK to end your life.' I say 90% of suicidal people have
a treatable mental illness. If you want to help them, treat their mental
illness." 

Also disturbing to Dr. Spar are the attitudes of some family members of
elderly patients admitted to his psychiatric unit. Family members will say
they don't want any heroic efforts, even when the person admitted isn't
physically ill, he said. "People are awfully quick to give up on somebody
else when that other person is, to some degree, a burden."

Experts say older depressed people quickly pick up on that message and it
affects the decisions they make. And with the aging of the nation--the
elderly are expected to grow from about 14% of the population to nearly 20%
by the year 2030, or about 65 million people--suicide will likely become a
bigger issue.

Social, economic, and political concerns also affect suicide rates, with
economic circumstances among the most crucial, said Jon L. McIntosh, PhD,
professor of psychology at Indiana University-South Bend. "During times of
prosperity, suicide rates go down," he said.

From 1980 to 1990, the suicide rate among white men 75 and older rose 32%,
to 60 deaths per 100,000, according to the National Center for Health
Statistics.

Though it was a boom decade, during national elections elderly people were
told they would face taxes on Social Security benefits and cutbacks in
Medicare and Medicaid. "It seemed like you were going to lose no matter
what," Dr. McIntosh recalled. "The elderly felt threatened emotionally and
financially."

They also heard or read stories about stresses on the so-called sandwich
generation--baby boomers who care for their own children as well as their
parents. Add to that their own fears about aging and the emotional
pressures were heightened.

Additionally, the proliferation of news about Alzheimer's disease and other
illnesses associated with aging scared everybody, Dr. McIntosh said. "That
attention to the problems of aging made people feel very leery of older
adulthood for themselves and their parents. Unfortunately, it looks more
negative than it should...

"Physicians when trained can do a great deal," said Joseph Richman, PhD,
founder and president of the New York State Association of Suicidology.
"But the training in the recognition of suicidal people is horrendous in
our professional schools and postgraduate training. Rather than improving
this, there's more and more emphasis on physician-assisted suicide." 

[Dr. Ronald Maris, PhD, who heads the University of South Carolina's Center
for the Study of Suicide,]...fully expects the emergence of euthanasia
clinics where the elderly, whether physically ill or not, will be able to
quietly end their lives.

"It's a slippery slope," he said. "Once there's the possibility of doing
it, the question of who has the right to kill themselves will be expanded."
But ultimately, our goal is to live as full and as active a life as we can,
Dr. Maris said. "There are social and moral implications of elderly
suicide. It's a loss for society and families. It's the loss of a natural
resource by premature death."

[Society Sends Suicidal Message, Deborah Shelton Pinkney, American Medical
News, 3/14/94]

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