End-of-Life Choice, Palliative Care and Counseling

Posts Taggedintensive care

Everyday Elder Abuse

Tomorrow is World Elder Abuse Prevention Day. It’s a day to appreciate that elders in our society endure abusive behavior every day and to consider how we might remedy this deplorable situation.

We hear of instances in which families, caregivers or others physically assault or verbally abuse elders in their care. Whether these instances arise from criminal pathology, frustration or plain meanness, we should all be on the lookout for such abusers, report them to authorities and encourage punishment.

Compassion & Choices focuses on other forms of abuse — the ones most commonly and even routinely — inflicted on elders. These forms are rarely recognized as abuse and are never punished. I’m talking about the pain, torture and invasion of bodily integrity from “heroic” and futile medical procedures associated with end-of-life care.

Most elders in this nation die in acute medical facilities. Even those whose deaths are anticipated following a long battle with cancer, heart failure or lung dysfunction do not die in the peace of their homes. Even they, the long-time dying, must endure the cold mechanical interventions of intensive care. Often in violation of express wishes stated in an Advance Directive for Healthcare, our elders must bear insertion of tubes to measure arcane pressures, tubes to breathe, to siphon throats, to empty urine, to drain fluids, to administer food and fluids. They must submit to the constant clicking, humming, droning and ringing of the machines and alarms at their bedside.

Add to this scene severe and unnecessary suffering from inadequate treatment of pain. Add to this a rampant failure to acknowledge and palliate agonizing symptoms like breathlessness, itching, hiccoughs, nausea, dizziness, bedsores and draining wounds of surgery .

What emerges is a picture of widespread, systematic, Medicare-supported torture of our elderly, dying citizens. Shame, shame on us for using taxpayer’s money in this indefensible manner.

When an 85-year old man like William Bergman, dying of mesothelioma, moans in pain with every breath, as his daughter pleads with doctors to prescribe more effective pain medication, that is elder abuse. Compassion & Choices won a court judgment to that effect, the first of its kind, in 2001.

When an 82-year old woman like Margaret Furlong receives full cardio-pulmonary resuscitation in violation of her Advance Directive, and endures ten days of intensive care despite squeezing her son’s hand to communicate her desire to have her hands untied and machines discontinued, that is elder abuse. Yet when Compassion & Choices helped bring this case as elder abuse and failure to honor an advance directive, it was thrown out of court.

When medical providers encourage irrational hope in endless rounds of chemotherapy for advanced, end-stage cancer, that research indicates are unlikely to extend life but sure to degrade its quality, that’s elder abuse.

When institutions withhold vital information about medical practices like terminal sedation or aid in dying, which they deem immoral, and hold patients hostage to their own beliefs in the redemptive power of suffering, that is elder abuse, and abrogation of informed consent principles. Catholic facilities that enforce gag rules and bar conversations about legal aid in dying, even when a patient inquires, are doing just that in Oregon and Washington.

Compassion & Choices is not alone in naming such examples “abuse” and “torture” and citing them as human rights violations. International conventions, treaties and courts demonstrate an understanding of the veracity and gravity of such charges. Numerous internationally recognized principles address patient care and the right to bodily integrity.

The European Charter of Patients’ Rights for example sets out, “Each individual has the right to avoid as much suffering and pain as possible, in each phase of his or her illness. The health services must commit themselves to taking all measures useful to this end, like providing palliative care treatment and simplifying patients’ access to them.” Policies restricting opioid availability and causing patients to suffer unnecessary pain abridge the human right to be free of torture.

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, has stated, “[E]very competent patient…should be given the opportunity to refuse treatment or any other medical intervention. Any derogation from this fundamental principle should be based upon law and only relate to clearly and strictly defined exceptional circumstances.”

This year, let’s acknowledge our national habit of over-treatment at the end of life for what it is: elder abuse, torture and a violation of human rights. Let’s stop withholding information, ignoring wishes and inflicting elders with futile, painful treatment and unnecessary pain and suffering. And certainly, let’s stop using Medicare taxes to pay for this national scandal.