Age should not be deciding factor in a person's care

Columnist

Tuesday 16 October 2012

THE woman was frail, elderly and unconscious.

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Colette Douglas Home

Beside her bed, a machine monitored her vital signs. She was in the high dependency unit of an acute hospital having just had heart surgery. Her consultant was explaining to me the difficulties associated with her care.

Aside from her heart problems she had kidney disease and her lungs were compromised. The more he talked the more I wondered why she had been given the operation.I asked what quality of life she could expect when she recuperated. He was very non-committal. I found myself totting up the cost of the heart surgery, her place in the intensive care unit, the time of the several consultants who were overseeing the treatments to her various failing organs then there was the bed and the nursing care.All this was to keep an 84-year-old woman in a state none of us would wish for her or anyone else. Her life expectancy could probably have been measured in miserable months. Meanwhile the waiting lists lengthened. Meanwhile middle-aged patients with coronary disease were getting worse as they queued for an operation.I admit it. I couldn't see the point.Happily, it wasn't my decision. The compassionate doctors and nurses who tended the woman did their absolute best to keep her alive for as long as possible. Did her age play a part in my reaction? Undoubtedly it did. Age has always been a factor in deciding whether a patient should or should not receive a particular medical treatment. But it wasn't the only consideration for me, or even the principal one. Few of us welcome the prospect of death. But as people grow older many have the greater fear of life being preserved at an intolerable level. There is a point, surely, when medical intervention ceases to be about keeping someone alive and starts to prolong death.It's why some people have Do Not Resuscitate on their notes. It's why many are furious when they find they have been resuscitated anyway. I heard a recent example on the radio: a woman had been brought back from death and instead of being grateful she complained. She didn't want to go through the dying process all over again.Now a report from the Royal College of Surgeons and Age UK has warned that people are being denied life-saving treatment just because of their age. They are told they are too old for heart or cancer surgery however good their underlying health is. And that is every bit as wrong.You only have to look at septuagenarians Paul McCartney, Ian McKellen, Judi Dench, Maggie Smith and Melvyn Bragg to realise that age is relative. Seventy is the new 50, which is why it is shocking that surgery could be denied on age grounds alone. Underlying health must be the determining factor.Our youth-dominated society means the decrepit elderly are disregarded. According to a new report into Care for Old People in Acute Hospitals in Scotland, patients suffering from dementia aren't always given due respect or care. Some staff refer to patients as "feeders" and "wanderers". They're spoken to like children. The report said some were described as needing "fed" or "toileted". It is disrespectful. It objectifies the patient. It diminishes their dignity and reduces them from a person to a task. It's in part this cultural disdain for the aged that causes people to be written off by their date of birth alone. Someone young and ill may take up more resources than a pensioner who has enjoyed a healthy life. No-one would dream of denying the former life-saving surgery. And yet the number of years left to them might be the same.Surely what matters is the overall health of each patient.Most of us aren't greedy. We grow more accustomed to the notion of mortality with each passing year. The chief anxiety of very old, or very ill, people I have known was that medical science would try too hard and keep them going after the quality of their days diminished.I need look no further than family and friends to remember people who, when confronted by a potentially terminal diagnosis, have said thanks but no thanks to surgery.One man, a keen gardener, chose a year of feeling fit enough to enjoy looking after his beloved blooms rather than an operation that would have robbed him of muscle power. Another refused chemotherapy that could offer only months spent feeling unwell.Some people can never sate their hunger for life. But few want it at any price. I think people are reassured by initiatives like the Liverpool Care Pathway which is used throughout the UK to ease the suffering of the dying in their final hours.It involves the removal of food and fluid and the giving of heavy sedation. Clearly it must be scrupulously supervised. But, if it offers a good death instead of a protracted one, it's to be applauded. Nature decrees that by and large the old have a shorter time left to live than the young. But it doesn't follow that when resources are limited age should be the deciding factor.Even the economic argument is flawed. The Royal College of Surgeons report also notes a sharp age-related decline in surgical procedures such as hip replacements and hernia repair. Yet these save money in the long-term as well as improve quality of life.My own mother had repeated hospital treatment for heart failure until, in her mid-nineties, she was given a pacemaker. She breathed easier and was not hospitalised for her final seven years.Someone who is in pain and immobilised for want of a new hip will need social care. An operation is both compassionate and cost-effective.People must be seen as individuals when they present for diagnosis and they must be treated accordingly. It isn't the date stamp on the birth certificate that should determine the resources spent on them but their fitness and their attitude.We learned during the recent Paralympics not to judge a person by their disability. What should determine the treatment of every patient is how well they can live, not how long they have lived.

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Age should not be deciding factor in a person's care

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