Less aggressive treatment for the elderly

When I saw the above headline in an article in the Herald, I thought it was going to be about abuse of the elderly. Sadly such abuse is real and ongoing and requires constant vigilance by relatives, friends and visitors. It is an important issue and deserves its own post. However, today, I want to concentrate on the real meaning of the headline, which actually refers to the main argument in a new book by Prof Phil Hanlon.

He states that the National Health Service in the UK is becoming unsustainable and suggests a form of “rationing” or passivity in the treatment of the frail elderly. Now when I was in my twenties a furore was caused when it came to light that notes of patients aged 65 and over were marked D.N.R – Do not Resuscitate. At the time I wondered what the fuss was about….. after all, 65 sounded very old. At least it sounded old way back then; as a 66yr old elderperson, things look very different.

But – and yes I think there is a “but” – we are getting ourselves into a pickle over costs in the NHS and we are also confused about what is the best policy for medical treatment at the end of life. I have seen mentally fragile patients put through extremes of treatment which have caused them great distress and pain, causing me to wonder why on earth it was being done. Yet, as a society, we are judged on the way in which we treat our elderly, our disabled and our vulnerable members.

A week or two ago I wrote about advances in care for those with dementia. Care for people with this illness can be improved in all sorts of ways and I would never suggest that a life is not valuable and worthwhile. But at the end of my life, I would hope that I would be spared invasive, and yes Рaggressive Рpainful medical procedures that may or may not extend my life.  Perhaps I am actually saying that we need to learn ways of dying and making dying, where possible, a dignified, pain-free, worthwhile experience.

Where good palliative care exists, it is wonderful. Over the years, as minister, relative and friend I have sadly seen too much that was not good. Instances where the dying person is almost abandoned yet wired up to all manner of equipment. Instances where someone wanted nothing more than a sip of water or a more comfortable pillow……… ¬† and no-one wanted to know.

So what does good elderly care represent?
I think it is simple: good care is about justice. It is what we each would want for ourselves and our loved ones. The problem is will that be possible?

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