A letter in last Thursday’s Times tells us something, perhaps, about the evolution of society’s thinking about dying, death, the competition for NHS resources, futile care and the declining value life holds for the ageing and the elderly both in the eyes of society and in their own eyes:
Sir, It makes sense to limit some expensive drug treatments to the people who can best benefit society as well as improving the quality of life for the patient. I am an old person (73) and an ex-nurse and I do not understand why so many oldies are obsessed with getting every treatment available, to prolong their lives.
My mental and physical health are deteriorating. This is a fact of life, not a complaint. If I should become ill I will gladly forgo any expensive cure to allow someone younger than me to improve their opportunity of a better quality of life, and the chance of being more use to society. I ask only for palliative care and the chance of a quick release from life when I feel ready to go. I am not alone in this attitude.
The fact is that many old people are a burden on society. Like all nurses I have cared for the elderly as well as I could, but there were many occasions when I wondered why we were doing it. People who cannot accept this argument should work for a few months in a care home where many patients are demented, incontinent, unable to care for themselves, and have no visitors.
Like many of my friends I have made a living will to express my wishes in the event of acute illness. I would like to be able to apply for a prescription which could be used if I ever feel like a quiet and peaceful exit before things get too bad.
Gill Pharaoh — Pinner, Middx
Matthew Parris made this contribution to the debate:
I’m 65 this year and I wouldn’t dream of expecting the taxpayer to divert scarce funds my way for expensive drugs that would do more good for a teenager. My conscience even troubled me over the cost to the NHS of an operation last December to stop my right hand clawing up, as I can manage perfectly well without a couple of fingers.
My late father (a retired electrical power engineer) told me after the Chernobyl disaster that they should use oldies like him to go in and secure the generators. He was serious. I never admired him more.
It strikes me that it’s one thing seeing yourself to be finite, and quite another to consider yourself expendable.
Perhaps “expendable” is an attitude in the minds of others, whereas “finite” might be how Ms Pharaoh wants to see her life, so that it isn’t extended beyond a bearable level at a huge cost to the NHS budget? Being a celebrant has taught me that budgets apply in illness, death and the after-death stuff, however tactful we try to about it.
Obvious enough, perhaps, but in our culture we don’t tend to talk much about the essential facts of money. The emphasis the GFG has always put on choosing the elements of a funeral as a form of shopping is very valuable.
A similar bluntness about the cost of medical treatment might be more welcome than we think, since it already goes on behind the closed doors of ethical committees and NHS trusts. I was once at a training exercise when we were given hypothetical dilemmas for hospital managers – should they spend a lot of money on treatment for a dying child, or buy a scanner, etc etc. At the end of a very tricky and interesting discussion, we were told that every one of the case studies was a real dilemma that had been faced by NHS managers. You could’ve heard a pin drop.
I feel great admiration for the courage and selflessness expressed in the original letter, especially as the writer had been a nurse whose attitude is informed by experience.
The mainstream media tend to refer to lives ‘saved’ by medical treatments when it would be more accurate to state that lives are ‘extended’ by treatment.
Of course we all want the best possible care for ourselves and our families but this has a wider social cost. In June I’m cycling from Edinburgh to London to raise funds for Help for Heroes. Many of the soldiers wounded in Afghanistan would have died from their injuries had they occurred in previous conflicts but prompt medical treatment and swift evacuation to excellent facilities in Selly Oak have saved their lives. But caring for them and giving them the best possible life is extremely expensive. Help for Heroes has raised £140 million since it was established in 2007 but has committed to a similar level of expenditure in the next few years. And this is for a group of soldiers that can be numbered in the low thousands – they really are a special case.
‘Lord let me not live to be useless.’ John Wesley
I realise that this post is actually about euthanasia/assisted suicide/the right to die…but I am going to say nothing about any of those issues. My views on these issues are extremely complex and fluid and would almost certainly change if I found myself or someone I loved in a similar situation.
What I am going to comment on about this post is something which is making me very uncomfortable. So much so that I had to go away and think about it for a while. It is the underlying assumption that the elderly, by which we mean ‘the retired’ are useless/a burden to society, by which we mean ‘not contributing any money’. Well, no. They are not contributing any money….they have already spent a lifetime doing that. However, not contributing wealth and being useless are very different things and it worries me greatly that we have created a society so centred on material wealth that we do not see beyond it. Elderly people are not superfluous to a healthy society, they are vital to it. Many are grandparents without whom increasingly hard pressed parents would struggle to cope. They have experience and wisdom beyond our imagining and have often, quite literally, seen it all before. (‘Don’t do that, its a crap idea. It was a crap idea in 1947 and its a crap idea now….’). Do we really want an increasing proportion of our society to feel that it has no point? No purpose? No worth?
I sincerely hope not.
Rant over 🙂
You have a good rant, Jennifer, and I hope it was cathartic!
Perhaps it’s the case that elderly Brits fall prey to used car syndrome. ‘Don’t throw good money after bad, use it to mend a newer model. I don’t need headlights any more, anyway.’ Perhaps it’s self-deprecation. I hope no one is making them feel obsolescent and useless, but perhaps, given our economic system, people begin to feel like this when they’re no longer able to generate money. I dunno.
Good rant, though.
All human life is of equal intrinsic worth. The problem is that with limited resources the NHS is having to allocate what it has based on extrinsic worth. This is an issue in itself, but allowing for it I still think that factors other than economic need to factor in that equation.
As we are breeding faster than we are dying, and the world’s human population is increasing by geometrical progression, it is a matter not of conjecture but of axiomatic certainty that we will one day, perhaps quite soon, have to decide not only who lives but who is born, whether by policy, war. or otherwise Assuming we don’t destroy ourselves first, of course.
Or, we could always choose to grow up instead and survive not by legislation but by compassion.
Worth reading this – http://www.npr.org/blogs/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis?utm_medium=Email&utm_source=share&utm_campaign=storyshare
Let’s not forget that the advocates of don’t-bother here are old.