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Prolonging life or extending suffering and death?

Dr Ross Walker
Thursday, January 24, 2019

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With the recent political rumblings about the aged care sector, along with the Royal Commission into this sector about to commence, I thought I’d repeat my comments around this entire issue. Firstly, without a radical rethink of the entire aged care subject, nothing will change, regardless of a Royal Commission or grand standing by any political party on this issue.

It is my opinion that the current function of aged care is to make huge amounts of money for the people running aged care institutions and not specifically for the recipients of this care, which it definitely should be. This is precisely the reason the Federal government is starting the Royal Commission. For too long, companies and financial consultants involved in the aged care sector have been making enormous amounts of money by draining the limited coffers of vulnerable people, who need some form of supervised care once they age.

Even more independent people living in retirement villages are often charged exorbitant amounts of money for the privilege, gradually draining their children’s inheritance. We have seen the horrendous behaviour of the banks affecting many unsuspecting people living in this country, even charging people who are no longer alive. Suffice to say, it’s my view that the aged care sector is no better.

This brings us to the rather thorny topic of end-of-life care. The aged care sector is, of course, divided into many areas with one of the most contentious issues being high dependency nursing homes for people who are, typically, towards the end of their life.

For anyone who has visited or been involved in this level of care for very dependent and often very ill people, these institutions leave a lot to be desired. I am not criticising the hard-working staff, who in the vast majority of cases are very dedicated, caring people, who do offer comfort to people in this miserable situation. What I am criticising is the entire philosophy behind this aspect of aged care. As a doctor with 40 years’ experience, I think it’s important that we prolong everyone’s life but no one’s death. Any sensible doctor knows when a person has entered the death phase. This is where someone has end-stage Alzheimer’s disease, where they cannot recognise their loved ones; a person with terminal cancer; a severe disabling stroke; a chronic end-stage neurologic condition, such as motor neuron disease, where a person is wheelchair bound finding it difficult to breathe or swallow or some other severe disabling chronic condition from which there is no recovery but certainly ongoing misery.

With any of these above conditions, a common practice these days is that when someone gets sick with an acute infection, they’re filled to the eyeballs with antibiotics rather than allowing the person to pass on naturally without any intervention, thus ending their misery. The other day I was driving past one of these facilities and saw an emergency ambulance in the driveway. In my view, there is no such thing as a medical emergency in a high dependency nursing home!

I saw a patient the other day in my practice whose husband (who is not my patient) fits this criteria but is still being administered cholesterol lowering pills, blood pressure treatment and blood thinning agents. It is time that the medical profession and relatives of people in these situations worked together to make the decision to end the person’s suffering as quickly as possible. I am not suggesting these people should be euthanised but am suggesting that chronic therapy for conditions such as high cholesterol, hypertension or blood thinning be stopped and the only therapy the person be administered is pain relief and sedation.

Regular morphine for these “death phase” cases takes away the terror of death and hastens the inevitable. It is my opinion that the average stay in one of these high dependency nursing homes should be, at most, less than a month, rather than the months to years that some people endure until their inevitable death. Surely the job of any good doctor is to relieve suffering. In my view, the obvious suffering of languishing in a nursing home for months to years is unacceptable and society as a whole needs a complete rethink on this issue.

Published: Thursday, January 24, 2019


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