Dear Life: On Caring for the Elderly
Not so long ago, middle-aged children and their ageing parents would have “the conversation”. If you were gentle, it went something like: “Mum, Dad – sis and I have been talking. We think it’s time you moved. We’ve found a retirement village that we think you’d love.” You might sweeten the deal by describing the village’s country club, happy hours and electric golf buggies, suppressing a smile about an episode of Seinfeld, in which George tries to persuade Frank and Estelle to move to a Florida seniors’ condo complex.
These days, as physician Karen Hitchcock writes, the conversation has become downright morbid – and often initiated by the elderly themselves. “Almost every day an elderly patient will tell me – with shame – that they are a burden or a nuisance, that they’re taking up a hospital bed that someone else needs,” she writes. This “what’s the point of life” narrative, Hitchcock warns, is “the beginning of the euthanasia defence”.
Hitchcock, a gifted writer and public hospital doctor, has not written an anti-euthanasia polemic. But her essay challenges the presumptions of the libertarian left and the economic right – that end-of-life care is too demeaning or too expensive.
The supposedly enlightened bargain we make with ourselves at age 70 not to become geriatric, dependent, unproductive and uncomfortable, is not necessarily how we will feel at age 90. “Those impairments may turn out to be bearable, after all.”
She is sceptical about so-called “advanced care plans”, in which people predetermine their future levels of care after hospitalisation. “Who’s to know if they change their mind three months after writing the plan?”
Nor is she convinced by the economic rationalist line – given fresh impetus by the Intergenerational Report – that we cannot afford to fund medical care in the late stages of life. Spending on health is rising at the slowest rate than any time since the 1980s. Australia spends less on health as a percentage of GDP than some developed nations. People 95 and over incur half the average health costs of people who die between the ages of 65 and 74. “Unsustainable” care is merely a cover for those who want to force Australia into a US-style private health system.
Hitchcock’s essay is not comfortable reading, but it is compelling: “We do not know if our treatment [of the elderly] was futile until the patient dies.” PT
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This article was first published in the print edition of The Saturday Paper on Mar 21, 2015 as "Karen Hitchcock, Dear Life: On Caring for the Elderly ". Subscribe here.