Do Human Rights Have a Use By Date?
Written by Mr Peter McClelland
Sunday, 01 November 2015
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Physician and writer Dr Karen Hitchcock put the cat among the pigeons in her controversial article, Dear Life: On Caring for the Elderly in a recent issue of Quarterly Essay. The central thrust of her argument is that contemporary society is steeped in ‘ageism’. She suggests that the elderly are now often seen as a burden – “difficult, hopeless and homogeneous” – yet all of us would do well to remember that “they are our parents and grandparents, our carers and neighbours, and they are every one of us in the not-too-distant future.”

Potter-Kathleen-Dr-220 Dr Kathleen PotterThere are many who would agree with Hitchcock’s ageism argument. Even a cursory glance at commercial television and social media would suggest that there’s more than enough of it to go around.

Nonetheless, when she states that “sometimes limits are placed on care that suits the system rather than the person” a quick riposte from some commentators might go along the lines of well, that’s life… it happens all the time!

Social justice and fairness
There’s one medico, with extensive experience in aged care and its use of medications, who doesn’t completely agree with Karen’s argument. Dr Kathleen Potter recently completed a research trial in the frail elderly based in Dongara and Geraldton.

“I don’t, in a broad sense, buy Karen’s argument regarding ageism because it’s actually reversed in some ways. There’s no disputing that the very elderly are a highly vulnerable group but a lot of people in their 60s, the ‘baby-boomers’, are a powerful demographic. Many of them have accumulated a great deal of wealth and political power while those in the younger age bracket are struggling to get a foot in the door of the housing market.”

“It’s a social justice issue and the concept of a fair redistribution needs to be addressed. Specifically, the best use of health resources and hard questions need to be asked about the balance between giving a 90-year-old a valve replacement and child immunisation.”

“Ultimately, it comes down to a financial equation.”

Nonetheless, Kathleen supports the central premise of Dear Life and is also concerned with the increasing use of other forms of mathematical modelling.

“I think what Karen is trying to say is that’s it important to treat people as individuals. You can’t just put in sweeping processes and protocols based upon the latest algorithms. The latter is an increasing trend in medicine and its dumbing things down. Next step, it’s the robots!”

“Human beings are far too complex to be reduced to a simplistic equation.”
man-240 “We institutionalise the elderly because it’s cost-effective.”

Elderly fight for treatment
A case recently came to the attention of Medical Forum that underscores the innate complexity when it comes to serious decision-making in relation to the elderly.

It involves an elderly man, with mild cognitive impairment residing in an aged-care facility. He developed acute pneumonia, was sent to hospital, treated and returned to the nursing home. His condition worsened and his GP (who wishes to remain anonymous) wanted to send him back to the ED for admission and further supportive treatment but that transfer was blocked because he was said to be ‘not for resuscitation’ and his care described as ‘palliative’.

The GP told us: “They cited an Advanced Health Directive (AHD) that stated that the man ‘declined intervention’. I’ve known this person for the best part of a decade, he doesn’t have a terminal illness and he is ambulant and able to do many things for himself. He would have difficulty understanding the complex nature of an AHD and it turns out that the form was signed on his behalf some years ago by a relative who wasn’t ‘next of kin’.”

“I’m really concerned that ‘Not for CPR’ on an AHD is being misinterpreted as ‘Not for Any Active Treatment’. I’m equally worried that ACDs, which essentially become a death warrant, are being signed by people with reduced capacity or by family members without proper legal authority.”

“Older people do get sick and they do need hospital treatment. They shouldn’t have to fight for it.”

Changing attitudes
The satirical novel, House of God and its elderly ‘GOMERS’ – Get Out of My Emergency Room’ has a contemporary equivalent, says Kathleen in our very own ‘Crumbles’, ‘Bed Blockers’ and ‘Granny Dumps’.

“That was our attitude as junior doctors, those terms were bandied about and I think Karen Hitchcock is right that the elderly are sometimes seen as a different species. It’s a difficult area because, while writers such as Karen and US surgeon Atul Gawende in Being Mortal argue that the elderly should have more autonomy leading to a ‘good end’, it’s impossible to accommodate everyone’s requirements.”

“We institutionalise the elderly because it’s cost-effective.”

“There’s room for improvement and it is one part of medicine we’re not doing particularly well. Maybe we see death as a failure of treatment rather than something that’s inevitable?”