Fear of losing autonomy key aged care issue

Even before the royal commission, no one in Australia wanted to go into aged care. And little wonder. The interim report on aged care revealed an array of serious problems.

For far too many older Australians, the aged care system provokes the fear of being abandoned and dehumanised by an unsatisfactory system that appears to value continued existence to the almost complete exclusion of considerations of quality of life.

Aged care fosters dependence and strips autonomy by disallowing personal affects, enforcing rules and regulations, essentially rendering someone devoid of what makes them an individual.

For example at any given moment today, somewhere in Australia, there will be a bed-bound 80-something year old person being admitted from a nursing home into an emergency department, probably on the orders of their son or daughter (and probably for good reason).

They will receive the best treatment available — treatment which in some cases will merely render them more incapacitated while extending their life for another few days or months.

Another manifestation of this fear of losing autonomy, as well as the failure to address care for chronic diseases, is the push to legalise euthanasia. Indeed, loss of autonomy was cited as the primary reason people accessed euthanasia in the US state of Oregon.

Assisted dying is currently on the agendas of both the Western Australia and Queensland governments, following implementation in Victoria earlier this year. Fear of an undignified, painful death is also the driving force behind this legislation.

Yet few if any elderly Australians have an advance care plan to guide decisions about treatment goals, and perhaps fewer are seen by a palliative care physician despite chronic disease or symptom burden.

It is ironic that modern medicine has achieved such great ages by way of life-sustaining treatments — and yet people are looking to government to provide death on demand.

But we can and should fix broken medical systems, as well as alleviating the fears of the elderly, before legalising assisted dying. The medical system more broadly needs to balance considerations of quality of life, with the focus on extending quantity of life.

The royal commission has a long way to go in ensuring aged care is synonymous with genuine compassion and independence. The medical system has a long way to go in ensuring people live and die better not just longer. But until it does — we should not facilitate peopling taking their own lives in fear of a system we have created.