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 – aggressive – painful 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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13 Responses to Less aggressive treatment for the elderly

  1. You bring up a great topic. I am really distressed about our nationwide denial of death. If we just get our faces lifted, get our tummies tucked and smile a lot, even when we are in pain, we will live forever. Why bother? The extreme measures taken at the end of life can be degrading and extend years of misery. The journey of the older years is toward death.

    At age 75, my Dad had a heart attack and collapsed in his rose garden. Would they leaveft him there to die? No, he was resucitated, and went through all sorts of procedures to keep him alive for three more years. His quality of life was shot to Hades.

    After several of ‘abuse’ at the hands of the medical people and his wife including several bypasses, treatment for diabestes related problems, chemo, etc. he died from cancer of the bone (very painful and slow process).

    My stepmother kept on trying to keep him alive (while blocking his children from visiting him). Finally, he told her, you can’t handle this, and checked himself into a hospice and were he was alone when he died.

    More than once, I have told my husband, if you find me in the garden, just leave me there for recycling. I would rather die with my nose full of the scent of roses and violets than oxygen burning my nostrils and and several tubes protruding from my body.

  2. Such a very important subject and one which must have some affect on nearly every family in the country. I too have seen at close quarters seemingly callous disregard for the most basic creature comforts ignored while electronic techno gadgetry was used to sustain “life”.
    Like you, I greatly fear for the future of our ageing population unless there is a radical change of practice very soon. Where and how the finance for this will come from is a huge question but one which must be addressed very soon.
    I am at varience with much of Christian and medical opinion on the subject of sustaining ‘life at all cost’. For me, quality far outways quantity and it is our duty and should be a prime concern to see that equality of good humane caring treatment is available for every sick ageing citizen.
    Sorry, a bit of a rant, I know, but this is such an important subject my fingers ran away with me.

  3. Lyn says:

    Important topic everywhere. I’ve just returned from an interview with the local Hospice. My husband received hospice services at the end of his life, and it is a wonderful organization. I like that they help people to live our their final days as closely to their wishes as is possible.

    I’m very much in favor of people being able to make choices about the issues of treatment and care in late years, and I worry about the necessary funding to make it possible. I’m not advocating keeping someone alive “at all extremes,” or allowing depletion of funds for the wrong reasons; but the elderly should have the same rights for care and comfort as anyone else. I’m your age, and I’ve given a lot of thought to this. I don’t want to live if my quality of life and the probability of recovery is not there; but I certainly hope there’s not an automatic DNR for us either!

  4. Marcia Mayo says:

    A large part of love is knowing when to let go. Some great things to think about here. Thanks to all of you.

  5. LC says:

    This post hits where I am right now with my mother. I am struck by these words in your post: “Instances where someone wanted nothing more than a sip of water or a more comfortable pillow………and no-one wanted to know.” She hasn’t regained strength following a recent hospitalization. Next week we start the rounds of doctors once again, all contributing (at least in my mind) to the quality of her life. But is dragging her around to doctors the right thing? We’ve talked about no extreme measures to continue life. If there is no hope of recovery, she wants no feeding tubes, no respirators etc. The best I can do right now is work to stay focused on some version of the “more comfortable pillow and the sip of water,” and to pray for God’s highest and best good for her.

  6. LC
    If you can do that for her you will have done your very best and she will have benefitted as much as she can, rather than have to live with the inevitable guilt of leaving her to the “automatic pilot” of standard end of life treatment.

  7. Cloudia says:

    Often over-treatment means lower quality of life!

    Let’s stop “treatment” when it makes no sense, but continue CARE till the end.

    Good thoughtful post, Freda

    Aloha from Waikiki

    Comfort Spiral



  8. Mina says:

    We all seem to have recollections of elder-suffering. I just hope in such a situation I would have the strength of an elderly in-law when admitted to hospital at age nearly 99 with a broken hip. She refused all treatment, pulling out drips etc, actually turning her head to the wall till she managed to pass away 4 weeks later.

  9. freda says:

    I so agree with you, schmidleysscribblins, I get fed up with being made to feel that I am not making enough effort to be young. At this time of life I want to be able to relax and enjoy each day as it comes. Of course anxiety gets in the way sometimes, and the reason I raised the dying-well issue is because we all have to face death and dying in the end. Dying in the garden with the smell of roses all around sounds ideal.

  10. freda says:

    Sorry everybody, I am getting in a muddle with answering your comments, so I’ll have to make do with a general update. I wanted to be able to respond to each one separately, the flesh is willing but my computer skills are not up to it. Lyn, I’m with you in that I don’t think an automatic DNR linked to age could work. Each patient has different problems and quality of life is what matters most. Mina, I’m not sure I would have the strength to refuse all treatment – I’m too much of a coward. Pain is something I don’t handle well. Still…… at the end of all the discussion I think we are all agreed on the need to see that sensible and humane decisions are made. The time to talk about these things is now, while we can do so rationally and with compassion.

  11. Thank you for this freda. I’m in training for ordained ministry at the moment and this week is a themed study week on death dying and bereavement. The issues you have raised are not ones we have yet discussed and yet are likely to be an important part of my future ministry. No answers but lots of questions from reading here.
    Thanks again

  12. freda says:

    Thanks, Janet, most people have to face the dying/death of someone close to them at some stage and in ministry it is part of parish life. I hope you get the chance to discuss these issues during your training. You might find the following site useful:
    http://vicarfactorycalling.blogspot.com/ (Sorry, you’ll need to do a copy and paste to find it.) All good wishes with your continued training and ordination.

  13. Pingback: Life as it is | What’s the Story in Dalamory

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