In this moving and controversial Quarterly Essay, doctor and writer Karen Hitchcock investigates the treatment of the elderly and dying through some unforgettable cases. With honesty and deep experience, she looks at end-of-life decisions, frailty and dementia, over-treatment and escalating costs.
Ours is a society in which ageism, often disguised, threatens to turn the elderly into a “burden” – difficult, hopeless, expensive and homogenous. While we rightly seek to curb treatment when it is futile, harmful or against a patient’s wishes, this can sometimes lead to limits on care that suit the system rather than the person. Doctors may declare a situation hopeless when it may not be so.
We must plan for a future when more of us will be old, Hitchcock argues, with the aim of making that time better, not shorter. And we must change our institutions and society to meet the needs of an ageing population. Dear Life is a landmark essay by one of Australia’s most powerful writers.
“The elderly, the frail are our society. They are our parents and grandparents, our carers and neighbours, and they are every one of us in the not-too-distant future . . . They are not a growing cost to be managed or a burden to be shifted or a horror to be hidden away, but people whose needs require us to change . . .” —Karen Hitchcock, Dear Life
Karen Hitchcock is the author of the award-winning story collection Little White Slips and a regular contributor to the Monthly. She is also a staff physician in acute and general medicine at a large city public hospital.
The issues of geriatric and end-of-life care are very different, topics which many people tend to avoid, either through not contemplating the lives of those who have done much but are becoming a burden, or by confiding that if ever they themselves were in such a position, early despatch would be desirable. These views usually change, even reverse, when older age has come, when the small discomforts aren’t as bad as the alternative. Sometimes. Other times, life is less wonderful and a blanket approach to end-of-life options is discordant with reality The rationalisation of public health that leads to pigeonholing both policy and people in aged care facilities is just as abrasive as the platitude that extended life expectancy is a societal boon. There are gaping disconnects, aching ironies and, sadly, a lack of debate beyond the realm of the bean-counters on this central and growing issue.
Hitchcock tackles problems, options and outcomes at a personal level, through the lives and experiences of patients and health care professionals. She traverses the terrain between love, empathy and pragmatism deftly but without an ounce of dismissal. A friend said that everyone must read this essay, alas I fear many will not because of the unease the topic generates. They will be the poorer. Hitchcock’s essay is a brief (70 pages), balanced and profoundly caring treatment of this topic and I am indebted to her for her insights.