Why wait to die?
When my 93-year-old father went into hospital this spring with a badly infected ingrown toenail, his doctors not only amputated the toe, but immediately installed two aortic stents, without consulting family. They were about to replace his heart valves, too, before my brother and I implored his carer to drag him back home. Had he remained in the grip of American medicine, I dare say they’d have given him a kidney transplant, an espresso colonic cleanse and a face lift. He’s covered by Medicare, and American physicians are often tempted, as they say in the insurance biz, to “farm the claim”.
In the NHS, doctors have no financial incentive to over-treat. But according to NHS gerontologist David Jarrett, British medical practitioners are usually driven to use all the means at their disposal to extend the lives of suffering seniors, regardless of the patients’ quality of life, out of fear of litigation. Physicians also fear families. Opponents argue that, if assisted dying were legalised in the UK, greedy families would pressure the elderly to bow out early, just so relatives can get their mitts on the money. The real problem is quite the reverse. Jarrett attests that it’s families who are most guilty of pushing doctors to pull out all the stops to keep loved ones, technically anyway, alive.
When Jarrett chose his specialty in the Eighties, gerontology was a niche field. It’s now the largest medical specialty in the UK. As he wrote in last year’s 33 Meditations on Death, he chose “to practise a branch of medicine where the relief of suffering took precedence over saving life. How wrong I was.” The book is full of anecdotes about elderly patients subjected to intrusive, often painful tests and treatments only to die anyway. That’s hardly the soft-focus sayonara scene we prefer to anticipate, with doting relatives gathered round, the tender saying of last things, and lots of pillows. Although most people poll as preferring to die at home, only one in five Britons do so. Most of us will die in hospitals or care homes.
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