Better care homes, or better euthanasia?

By Rob Wipond, December 2010

Parliamentary committee members witness a dramatic confrontation over elder care.

Local MP Denise Savoie invited two representatives from the federal Parliamentary Committee on Palliative and Compassionate Care to hear Vancouver and Victoria speakers in November. Developing recommendations on elder care, assisted suicide and abuse, the committee’s half-day session before 40 people at James Bay New Horizons broke down in a bizarre, foreboding fashion. 

Presenter Wanda Morris set an emotional tone. (A Right to Die Society advisor, her online bio reflects on the putting “gently to sleep” of “my sister’s beloved dog, Sparky.”) Morris advocated legalizing “merciful euthanasia under a physician’s supervision,” describing people suffering pain “like my bones are sticking through my skin.” Would we deny people the right to jump from the Twin Towers to escape the flames of 9/11? Our laws, she said, are a “devastating, odious form of tyranny.”

While Morris acknowledged that it was also important to improve our elder care system, in the meantime, she pleaded, people need another option. 

“I object!” One elderly man cried, demanding to present an opposing viewpoint. Another similarly protested. But another wept in concord with Morris, describing emptying her mother’s lungs of fluid in her final days because “she couldn’t die her way.”

Savoie politely redirected the audience to the agenda.

Victoria Hospice’s director of research, Michael Downing, said he personally supported assisted suicide, but listed conditions to enable people to responsibly choose it: They have to be in an environment where their rights are upheld, and they feel comfortable, supported and respected amidst kindness and options.

Downing acknowledged assisted suicide can involve “occasional abuse and slippery slope issues.” Two European studies found many cases where patients hadn’t reasonably consented to their euthanizing. Like Morris, Downing felt elder care needs improvement but, meanwhile, assisted suicide could be a good option for some.

However, a menacing backdrop was gradually painted of irresponsible care providers in a gravely mismanaged system.

Economist Robert Evans argued that governments invoke the false threat of a “grey tsunami” of boomer retirees to cloak their own perilously poor management. Retiring boomers should generate only “one percent per capita per year health care cost increases,” he said. However, increases in BC in expensive diagnostic tests are making us spend alarmingly more per elderly patient. 

“What are the outcome differences?“ Evans asked, describing vast geographical variances in diagnostic practices, where more spending often doesn’t correlate to better care. A seminal US study, he explained, found, “The finest health care system in the world costs twice as much as the finest health care system in the world.”

Health care consultant Marcus Hollander promoted an integrated system with flexible, accessible supports for in-home and group home care, to divert the elderly from expensive institutions. Even though cuts to such programs caused a near-doubling of costs per elderly BC patient in the 90s, added Hollander, government continues promoting institutional and corporate approaches. “It’s really a set of values that underpin the system,” he suggested.

SFU gerontologist Gloria Gutman then explained that four to six percent of elderly in our communities experience abuse. In institutions, a US study found some 40 percent of care staff admitted committing physical or psychological abuse, from denying visiting rights to “chemical restraining.”

This grim assessment of health care professionals aggravated some audience members into again loudly protesting the “extremely biased,” “cherry-picked” euthanasia presenters. Again, Savoie deflected them.

Amanda Brown, a staff trainer and policy developer with the Vancouver Coastal Health Authority, expressed concern about how BC guardianship laws mandate health providers to perform investigation and support functions for elderly people who may be experiencing abuse. She said “elder abuse is not an admitting diagnosis,” and noted that abuse situations can be dangerous, and that there’s a dire lack of training, regulations, monitoring provisions, or best practices.

“We’re building an adult protection service from the ground up, with no new resources,” Brown said. “Yet no one else has the mandate, either.”

Unstoppably flushed now, one elderly protester marched frontwards. Philip Ney, retired psychiatrist and medical professor, recounted histories of mental patients being euthanized. “Can you trust the doctors?” he asked, tipping the formal politeness of the room over precipitously. 

He donned a lab coat, pulled out a stethoscope and goblet, and began to act as the Greek doctor Hippocrates. 

One parliamentarian left. The room began emptying. Some sat transfixed.

A “patient” emerged from the audience to drink Hippocrates’ elixir of healing…or poison? “It will ease your pain and give you rest.”

Savoie interrupted. Ney responded, “You want to get rid of me...”

The awkward struggle for control of the room became a powerful representation of the struggle between opposing positions to be heard and respected.

On one side: A push to form a merciful law for elderly assisted suicide. On the other: Dramatically increasing anxieties about a mismanaged, even abusive elder care system which would be instituting that law.

A volatile concoction, indeed. 

And it also seemed an essential ingredient was missing. No one had even mentioned BC’s draconian Patients Property Act. Under this law, doctors can conduct a five-minute mental “examination,” declare people “incapable,” and then take away from them absolutely all control over every aspect of their lives—and deaths. 

So if we intend to inscribe into law an elderly person’s inalienable right to assisted suicide, wouldn’t it be vital to simultaneously inscribe into law inalienable rights to a decent standard of care and reasonable spectrum of autonomy? Aren’t these legal rights essential to keep together, like key ingredients for a calming antidote?

I raised this with Downing. “A very interesting thought,” he replied.

The session’s tension dissipated in personal discussions.

Rob Wipond still hopes the BC Liberals will follow through on plans to replace the Patients Property Act.