Toxic messages feeding fear
by Paul Russell
I wrote recently about a play that ran in Melbourne called 'The Magnolia Tree' and how the notion of being a burden and the genuine fears of anyone approaching decisions about like-changing events like entering a nursing home and the 'elephant-in-the-room' of money and the cost of care can make our elders feel like they are a burden and may put them at risk of Elder Abuse.
Putting aside the issue of euthanasia and assisted suicide and the spectre of Elder Abuse for a moment, I am genuinely concerned about the treatment of our elders in Australia and most if not all of the Western World. Aging and the effects of aging make our elders, generally speaking, passive recipients of social policy as well as of the negative tropes that seem to me to be increasing in our media. Once in Australia we had a political movement called 'Grey Power' that gave voice to this increasingly large but otherwise almost voiceless demographic; but Grey Power is no more.
A recent headline: 'Rising rates of nursing home residents dying from preventable incidents' brought this matter into sharp focus. According to the article, a Monash University study noted that,
"A rising number of Australian nursing home residents are dying from potentially preventable causes, such as falls and choking, the first comprehensive study of fatalities finds.
"The “disturbing” 400 per cent rise in the incidence of premature deaths over the past decade has prompted calls for a new national strategy to improve safety.
"The deaths of more than 21,000 residents of accredited nursing home deaths were reported to coroners between 2000-2013.
"An analysis of the fatalities by Monash University found almost 3300 (15 per cent) died from “external causes”, with falls the greatest cause of preventable deaths."
Add this to a number of cases of abuse of elderly persons in nursing homes and the recent furore over abuse and poor standards of care in a Mental Health Aging facility in Adelaide and it is hardly surprising that our Elders genuinely fear supported care.
This is in addition to the normal and entirely understandable resistance people may have of moving out of a family home they may have known for years into a care facility where their world may shrink considerably and where the idea that such places are simply 'God's Waiting Room' - in otherwords: a reminder of their mortality - is certainly not likely to be a comforting thought.
Next week, the Australian Law Reform Commission will release the results of their extensive inquiry into Elder Abuse in Australia. Last year the New South Wales Parliamentt conducted an extensive inquiry and the South Australian and Western Australian Parliaments are currently looking into the issue.
Note: Victorian Residents can join the push for an Inquiry in their state by signing the Parliamentary Petition. Click HERE for more details.
This is important work; but valuing our elders is much more than simply preventing abuse. It requires more from all of us and certainly more from funding bodies and aged care sector regulators in how care and support is delivered.
As The Magnolia Tree unpacked for us, these issues have a significant frictional interface with discussions about assisted suicide and euthanasia. Concerns about risk of abuse in vulnerable populations such as the frail and aged have always been part of the discussions. Recently, this interface took a seriously sinister twist in three separate incidents across the globe.
Pro-euthanasia British neurosurgeon, Henry Marsh in an article in The Sunday Times responded to anti-euthanasia messages about risks to the elderly saying that, "They argue that grannies will be made to commit suicide," he said. "Even if a few grannies get bullied into it, isn't that the price worth paying for all the people who could die with dignity?"
Price worth paying! Really? Well at least he admits that the risks do exist and will likely be more than simply theoretical.
Again in Britain, the Conservatives were roundly criticised for their election proposal to make elderly people pay for care in their own home unless they have less than £100,000 in assets; what some called a 'dementia tax'. It would force them to use up the value of their residential property. Currently these costs are largely met by the Exchequer - a public cost in supporting elderly people to live in their own homes.
One social commentator claimed that this would cause significant problems:
“These might include discouraging people from seeking help, placing a greater burden on unpaid carers and driving increased use of hospitals and long-term care. Access to services will depend on a triple lottery of where you live, what you can afford and what is wrong with you.”
The policy has since been dropped. Leaving the rights or wrongs of the policy aside, I was gobsmacked by a response from journalist and former Tory MP, Matthew Parris on the pages of the UK Spectator. Parris lamented the demise of the policy claiming that it would have the positive effect of creating a 'Darwinian' social impetus for children of the aged and demented to push for euthanasia for fear of seeing their inheritances diminished:
"I’m saying that as the bills for dementia care thudded more heavily upon the doormats of those who hope to inherit, then very, very gradually, probably over generations, the argument for letting or helping people die when their lives had emptied would begin to find more favour."
We are indeed fortunate both in Australia and the UK that, in spite of the problems, we have well funded default medical and elder care safety nets in addition to private insurance. Beyond the debates over 'Obamacare' or 'Trumpcare' the US system is decidedly different, somewhat fragile and seemingly more limited. The 'money question' there has reared its head a number of times in relation to insurance cover and the availability of assisted suicide.
The Washington Times ran an article about claims by Brian Callister, associate professor of internal medicine at the University of Nevada, that he tried to transfer two patients to California and Oregon for procedures not performed at his hospital. But representatives from two different insurance companies denied those transfer requests by phone:
“And in both cases, the insurance medical director said to me, ‘Brian, we’re not going to cover that procedure or the transfer, but would you consider assisted suicide?’ ”
The phone calls took place last year within the span of a month, Dr. Callister said. He said he did nothing to prompt the suggestion in either case.
The patients were not terminal, but “would have become terminal without the procedures.”
“It was estimated that their chance for cure — cure, not just adding time — of about 50 percent in one case and 70 percent in the other case,” Dr. Callister said.
It is a serious concern that insurance companies would seek to ration what seems would have been life saving interventions. (see video) It is an open question whether they have refused similar requests for patients in states that do not allow assisted suicide.
A spokesperson for the US Medical Insurance Industry denied the claim saying that, “Health plans do not withhold or deny life-sustaining care in states that have physician-assisted suicide.” Privacy considerations wil likely mean that the full story will never be known. But we do know that when two Oregon residents were legitimatley denied access to an experimental cancer drug some years ago by the state-funded Medicaid, they received in their written notification advice that Medicaid would cover their assisted suicide costs. They felt that the state was steering them towards their suicide.
Through all of this, Matthew Parris' chilling call for a Darwinian 'survival of the fittest' public policy begins to appear less sensational and more prophetic.
Euthanasia and assisted suicide have an inbuilt message that some lives are not worth living. Parris, Marsh and the generally poor attitude towards our elders do much the same thing.
We must do better.