By Heather Campbell Pope
This is Part 2 of a blog series on men and dementia.
The Manitoba Court of Appeal recently sent a strong message about the importance of protecting and caring for society’s oldest-old.
In an October 2019 ruling, Justice leMaistre stated, “More Canadians than ever are living to the age of 85 and beyond. Society benefits from the wisdom and life experience of our elders. It is essential that we protect them and provide for their care, particularly as they experience physical and mental-health challenges associated with aging.”[i]
The case involved an adult son who pled guilty to criminal negligence causing the death of his 89-year-old mother. A judge had initially sentenced him to three months in jail; the appeal court increased the sentence to two years.[ii]
At the time of the offence, Ronald Siwicki was aged 62 and living with his mother, Elizabeth Siwicki. In November 2014, Mrs. Siwicki fell out of her bed and was unable to get up. Her son was unable to move her back into bed. For the next 26 days, she remained on the floor, where she died on December 17, 2014.
During the time she was on the floor, her son gave her water and the nutritional drink Boost. He did not reposition her or seek medical or other assistance.
Mrs. Siwicki died from complications due to bedsores and prolonged immobility. After her death, first responders found her body in a deplorable state on the hallway floor: “She was on a plastic sheet with a blanket over her. She was covered in feces and urine, her hair was matted and dirty and she had several gaping and infected bedsores on her leg and hip. The house was described as being in an appalling state: cluttered, dirty and smelling of urine and feces.”
According to the pathologist, Mrs. Siwicki would have been in significant pain until the nerves in her wounds died. The autopsy also showed evidence of dementia. Had she received appropriate care, her death would have been “completely preventable.”
Those who knew Mr. Siwicki described him as “immature, indecisive and passive,” and as someone who would never go against his mother’s wishes. He had never been financially independent and had lived with his parents all his life. Mrs. Siwicki was described as a strong, independent and stubborn matriarch.
The Crown appealed the three-month sentence, arguing in part that the judge overlooked substantial aggravating factors, including Mrs. Siwicki’s vulnerability and reliance on her son, as well as his failure to seek assistance for her, regardless of her wishes. The Court dismissed this ground of appeal, finding that the factors were addressed by the parties in their submissions and were squarely before the sentencing judge.
Prior to his mother’s fall, Mr. Siwicki maintained that he had tried to get her help, but she did not want medical intervention, nor did she want to go to the hospital. She was afraid she would die there. Mr. Siwicki raised the possibility of getting homecare, but she refused. Two of his friends offered to help, but she refused.
Mr. Siwicki installed a safety bar and chair in the shower, and when she could no longer wash herself, he washed her. He also arranged for a home visit, and his mother initially agreed to go to the hospital once-a-week, but then refused. Mr. Siwicki said the only response someone at the hospital gave him was that “sometimes this happens.” He also had his brother-in-law try to persuade his mother that she needed help, but she refused. One cold day, Mrs. Siwicki went outside inadequately dressed and he called 911 after he could not get her back inside the house; when paramedics arrived, she refused to go to the hospital.
When she fell out of bed and he could not lift her back, he gave her a pillow and blankets. When the blankets became soiled, he brought her fresh ones. He also gave her water and a nutritional drink; the autopsy suggested she was not dehydrated or malnourished.
Mr. Siwicki has since acknowledged that “his responsibility was to help his mother rather than follow her wishes.” However, the case raises broader societal questions about the highly libertarian perspective dominating the elder rights movement. It is worth asking whether society’s internalization of the “right to live at risk” message might be insidiously contributing to dire outcomes, and lenient jail sentences. As I argued in my master’s thesis on loneliness and the law, the rights pendulum has swung too far in favour of unfettered autonomy; we are letting vulnerable seniors like Mrs. Siwicki needlessly suffer.[iii]
Regarding the principles of deterrence and denunciation, the Court of Appeal found that the sentencing judge erred when she focused on Mr. Siwicki’s personal circumstances rather than the circumstances of the offence.
The appeal court also found that the judge erred in her proportionality analysis. In particular, she lost sight of the difference between failing to provide the necessaries of life and criminal negligence causing death, which is a more grievous crime and involves higher moral blameworthiness. These errors led to a demonstrably unfit sentence.
In sentencing Mr. Siwicki to two years in jail, the Court of Appeal emphasized the prolonged nature of his conduct, which lasted at least 26 days, and the fact that he “had an extensive network of friends, as well as his nephew, who offered him support after his mother’s death, yet he did not ask for help from anyone while she was still alive.”
While an extreme case, tragic deaths like Mrs. Siwicki’s raise several issues about family caregiving. As the sentencing judge noted, it is hard to understand how the relationship of devotion between Mr. Siwicki and his mother “could end with her dying in such profane circumstances.”
Mr. Siwicki had a duty to provide adequate care for his ailing mother; why did he fail to do so? His mother’s death was medically preventable, but was there adequate caregiver support and follow-up to help him navigate the difficult circumstances?
In a pre-sentence report, a psychiatrist found no evidence that Mr. Siwicki had a mental illness or a mood or anxiety disorder; however, he did demonstrate “dependent traits and a history of hoarding.” He was assessed as a very low risk to reoffend.
When an adult son commits elder abuse or neglect, the dominant narrative often frames it as a case of “the unsuccessful son in the basement.” However, as I suggested in Dementia Justice’s housing vulnerability report, this language may be unhelpful.[iv] Without condoning such conduct by adult sons, a preferred approach may be to modify the narrative to align it with the well-established understanding that in some cases the perpetrator may be experiencing his own mental health issues, including caregiver stress. Indeed, a counsellor who saw Mr. Siwicki while he was on bail described him “as being overwhelmed with the situation.”
Mr. Siwicki’s lawyer has stated that his client will be appealing to the Supreme Court of Canada.
Beyond the gender politics of dementia
[i] R v Siwicki, 2019 MBCA 104 at para 1.
[ii] R v Siwicki, 2018 MBQB 115.
[iii] Heather Campbell, Parens Patriae 2.0: Invoking the Superior Courts’ Protective Jurisdiction to Help Lonely Older Men Age-in-Place (University of Saskatchewan, College of Law, LLM Thesis, 2016) at 3.
[iv] Dementia Justice Society of Canada, Nowhere to Live: Housing Vulnerability of Criminal Defendants with Dementia (Ottawa: Dementia Justice Society of Canada, 2019) at 32-33.
By Heather Campbell Pope
This is Part 1 of a blog series on men and dementia.
Dementia can occur in both men and women, yet mainstream dementia culture frames it as a women’s disease. A few years ago, the Alzheimer Society of Canada launched a nationwide campaign that aimed to make the disorder “a women’s issue.” In the time since, there has been no similar focus on men. This is despite men being affected as patients and caregivers.
The breast cancer movement has faced a similar critique. Some critics of the pink ribbon campaign say that it has feminized the illness, reinforcing the misconception that breast cancer only happens to women.
For better or worse, this criticism has gained some support despite men accounting for less than one percent of all breast cancer cases. It is recognized that the stigma of being a man with a “women’s disease” can delay diagnosis, making survival less likely. As Beyoncé’s father, Mathew Knowles, recently said on Good Morning America after going public with his breast cancer diagnosis, “Men want to keep it hidden because we feel embarrassed. And there’s no reason for that.”
In contrast to breast cancer, the gender difference in dementia is less extreme, making its feminization even more misguided. While it is commonly reported that two-thirds of diagnosed dementia cases are women, the unspoken statistic is that one-third are men. Thirty-three percent is hardly negligible; at a minimum, the number challenges the feminist notion that dementia is a women’s disease.
Context also matters. For instance, the limited evidence suggests that the majority of people with dementia who come into conflict with the criminal justice system are men:
"Men like Second World War veteran Jack Furman, who at age 94 was charged with second degree murder after he allegedly attacked his care home roommate with a shelf; and 74-year-old Piara Singh Sandhu who was charged with two counts of second degree murder after he allegedly pried the metal base off a bedside table and bludgeoned his two roommates to death; and widower Peter Brooks, who at age 76 was convicted of second degree murder in the death of a fellow long-term care resident and sentenced to life in prison with no parole eligibility for 10 years."[i]
These men are our husbands, fathers and friends. Yet in part because they exist in smaller numbers, the women-centred dementia movement has kept them on the margins.
To further justify the focus on women, many dementia advocates also highlight the gender differences in caregiving. It is frequently said in campaigns and informational material that the majority of caregivers are women, particularly wives and daughters. There is little mention of the contributions by husbands, sons and other men in caring for their loved ones with dementia.
Mainstream dementia advocates also point out that women caregivers tend to experience more distress. However, this does not negate the fact that the consequences of caregiver stress in men can be severe. The problem is not exclusive to male caregivers, but unmanaged stress can lead to desperate acts.
While an extreme case involving an inexcusable crime, Michel Cadotte’s 2017 killing of his wife, who had Alzheimer’s disease, raises uncomfortable questions about caregiver stress. At sentencing, the Quebec judge said, “As citizens, we can only hope that the alarming cries of the difficulties caregivers face, as well as the problem of the growing number of people with Alzheimer’s disease, will have been heard.”
Last year, the federal government launched a new $20 million initiative to address dementia. Consistent with the Liberal Party’s feminist agenda, the Dementia Community Investment Fund prioritizes projects that target certain populations including women. Similarly, released in June 2019, Canada’s first national dementia strategy has a women-centred theme; there is little recognition of the impact dementia has on men as patients or caregivers.
During a federal election forum hosted by Dementia Advocacy Canada, moderator André Picard of The Globe and Mail asked Conservative Party candidate Lisa Raitt whether we need programs to specifically address dementia’s disproportionate effect on women. Ms. Raitt acknowledged the importance of doing so, but thoughtfully concluded, “It’s a human issue.” NDP candidate Stéphanie Mercier agreed and added: “In regard to support, it’s not just about women, it’s also about the husbands that it will happen to.”
To be sure, some dementia organizations are tackling men’s needs. For instance, the Alzheimer Society of Toronto has launched a woodworking program where males with the disease can socialize and collaborate on projects and small repairs.
While such local initiatives are encouraging, men with dementia need greater support across the country. This moral obligation exists independent of facts and figures; having men’s concerns meaningfully addressed should not be contingent upon reaching statistically significant numbers.
As Dementia Justice recommended in our housing vulnerability report, a first step could be the launch of a positive national campaign to raise awareness and reduce stigma about dementia’s impact on men——as patients, caregivers and, for a smaller number, criminal defendants who enter the justice system due to responsive behaviours.[ii]
It is time to move beyond the gender politics of dementia; otherwise, the current feminization of the disease will continue to push men’s needs to the margins——fuelling stigma, delaying diagnoses and discouraging requests for help.
Caregiver son 'overwhelmed' in elder neglect case
[i] Heather Campbell, “Killers with dementia: Canada’s overlooked criminal defendants” The Lawyer's Daily (6 March 2018).
[ii] Dementia Justice Society of Canada, Nowhere to Live: Housing Vulnerability of Criminal Defendants with Dementia (Ottawa: Dementia Justice Society of Canada, 2019) at 52.