Aged Care – has the Royal Commission addressed the real issues?
The recent Royal Commission into Aged Care in Australia has released four basic recommendations.
- There is a strong need for a new Act that should determine the rights of older people, including their entitlement to care and support based on their needs and preferences.
- The system needs stronger governance to ensure the rights of the elderly.
- Age care workers need better conditions & training.
- More funds should be made available for the Aged Care sector.
Although I agree with all these recommendations, I believe this very expensive exercise of having the Royal Commission in the first place & then implementing the findings are not dealing with the central issue that no one in any form of authority seems willing to address. When I raise this with almost everyone working in aged care, there is almost universal agreement with what I am suggesting.
Firstly, in this article I am only referring to people in high dependency aged care with no possibility of returning to life outside the nursing home. Any sensible doctor is fully aware when the patient has entered their death phase.
It is my opinion that doctors in this situation should be practising (which let me say many are doing so under the radar) what I call “compassionate medicine”. As a doctor, I believe our first and most important responsibility is to relieve suffering. A good doctor relieves suffering, attempts to make an accurate diagnosis and form a reasonable and appropriate management plan for the underlying condition the person suffers. I believe we should do everything we can to prolong someone’s life but do nothing to prolong their death. Most sensible and well-trained doctors can clearly determine in conjunction with the person and their family, when the patient has entered the death phase. The death phase in my view is when a person has a terminal illness with absolutely no possibility of recovering.
There are 5 basic situations apart from sudden death where a person is in their death phase.
- Terminal cancer
- End stage Alzheimer’s disease where the person no longer recognises their loved ones
- A severe stroke with a subsequent disability from which there is no reasonable chance of recovery
- Severe intractable pain for which no reasonable medical therapy is leading to any degree of relief
- Other end stage neurologic conditions, such as motor neurone disease, where the person cannot deal with their own daily needs. Without wishing to sound crude, I call this the “bum wiping rule”. If another person has to wipe your backside and there is no possibility that this will change and you consider the quality of your life to be miserable or you aren’t in a position to even discuss the issue, it is my view that all medical therapy should be stopped apart from pain relief and sedation.
I would administer progressive doses of narcotics placing the sufferer in a peaceful oblivion allowing nature to take its course rapidly. What we have now is many people languishing in institutions such as nursing homes, at times, for months to years dying slowly in total misery. This is more the norm than the exception and, in my view, society has gone mad to accept its dying citizens being treated in this fashion. There are many people working in palliative care already practising compassionate medicine but often palliative care is not extended to those people languishing in nursing homes. I’m not suggesting that compassionate medicine will be the answer for everyone but in my opinion, it is certainly the answer for most of us if we are placed in this situation. It is my view that we will markedly reduce suffering for many people if compassionate medicine becomes the norm not the exception.