jeudi 25 août 2011

If you're going to get rid of Medicare, you're going to have to give people a way out

Forgetting for a moment about the utter ridiculousness of the right's insistence on how much they revere the sanctity of life at the same time that they want to pull the medical rug out from everyone who reaches the age of 65, the fact remains that if the elderly cannot obtain medical care, or if they WANT to leave before becoming a tremendous cost to society, we're going to have to come up with a way to do it.

Yesterday in the New York Times, we read about a couple who decided to exit peacefully and without violence -- through self-stafvation -- and got kicked out of their assisted living residence:

As it happened, the elder Rudolphs had a long and satisfying old age in Albuquerque, N.M., where they lived for 60 years; they gardened and volunteered with the Boy Scouts and served as leaders in their Presbyterian church. When their large house and gardens became difficult to maintain, they built a smaller one in a neighboring town, then moved again to a retirement community.

“At that point, some health issues began to emerge,” their son said. Mrs. Rudolph broke her hip and was in and out of rehab, suffering frightening episodes of delirium.

“Dad had a permanent catheter,” said Neil Rudolph. “Physically and mentally, they began to go downhill.” In October, they entered an assisted living facility called The Village at Alameda, thinking it would be their last home.

The Rudolphs faced increasing pain and debility. Mr. Rudolph, 92, suffered from spinal stenosis; Mrs. Rudolph, 90, had become largely immobile. Both showed symptoms of early dementia. So in January, they set in motion their plan to stop eating and drinking.

And the facility tried to evict the couple. The administrators, apparently on orders from the corporate legal department in Maryland, told the family the Rudolphs had to leave the next day.

Current management would not comment beyond an e-mailed statement saying that when a resident “requires alternate placement, medical attention, or a level of care beyond the facility’s capabilities, we have an obligation to notify a medical provider.” Fundamental Long Term Care, the firm that owns the facility and more than 100 others in 14 states, did not respond to requests for interviews.

As Neil Rudolph recalls the events, he protested that the couple — already on Day 4 of their fast — had nowhere to go. He also pointed out that their contract required 30 days’ notice of discharge. The following day, administrators called 911, reported a suicide attempt and told the paramedics to take the elder Rudolphs to a hospital.

So much for the peaceful passage.

Voluntarily stopping eating and drinking — as the Rudolphs had learned from consulting with Compassion & Choices, the largest national organization working to expand end-of-life options — is a legal way to hasten death without drugs or violence, usually in about two weeks. In a survey of hospice nurses in Oregon, published in The New England Journal of Medicine in 2003, respondents reported that most of their terminally ill patients who had deliberately refused food and fluids had “a good death,” with low levels of pain or suffering.

“They said, ‘That’s what we want to do,’” Neil Rudolph said, emphasizing that his parents’ decision was hardly impulsive or caused by a bout with depression. He and his sister, Elaine Spence, and their spouses had come from Colorado to be with their parents and had called in a hospice organization. “We all discussed what it meant and whether they were sure,” he said.

When his parents said they were, he helped them write a statement affirming their decision and then told the assisted living administrators about their plan.

Shortly thereafter, two emergency squads, from the Albuquerque Fire Department and Albuquerque Ambulance Services, converged on the scene. Neil Rudolph’s wife called a reporter from The Albuquerque Journal, to whom the elder Rudolphs gave outraged and lucid interviews. The emergency crews soon called a doctor at the University of New Mexico’s emergency medicine department, part of a consortium that consults when a 911 call brings a situation outside the norm — and this certainly qualified.

The Rudolphs were eventually able to check out the way they wanted to, but it was only because their children rented a house for them and, with the help of hospice and taking turns in a round-the-clock vigil, were able to provide the necessary care. What about people without the resources to rent a facility away from the medical community, or without children, or with children who are unable or unwilling to provide this kind of care and oversee this kind of exit?

We can't have it both ways as a society. We can't rail against "greedy geezers" and have politicians screaming about how much it costs to keep the sick elderly alive and at the same time put roadblock after roadblock in the way of a dignified exit. If we can't have an exit that doesn't cost hundreds of thousands of dollars and agonizing pain and indignity, and we can't obtain medical care, what are we supposed to do when our time is up?

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