A stethoscope to the moral heart

Dear Life: On Caring for the Elderly, Karen Hitchcock, Black Inc.

As we keep being told, increasing numbers of us are becoming what we increasingly don’t want to be: old. And in our youth-obsessed society we put off growing old, which partly explains the almost manic passion with which many retirees travel and live life to the fullest, before the perils of old age begin stalking and we become a burden affecting ‘normal’ society.

We hear about the burden on taxpayers, and the ‘crises’ in our hospitals – that is the usual story – but Karen Hitchcock, a doctor and writer, suggests we instead have a crisis of attitude. In Dear Life she puts a stethoscope to the moral heart of our society, and diagnoses ageism. ‘Where’, she says, ‘are the parliamentary enquiries?’ She says that the elderly regularly tell us, self-deprecatingly, that they are a burden, and we, in our coldness, actually believe them. Because we largely agree.

And so, Hitchcock, writes, there is a pervasive desire to get the elderly out of hospitals so that they don’t ‘waste’ resources. A younger person exhibiting the same symptoms that elderly patients present would not be treated the same, but hospital staff often fear elderly patients’ slow recovery rates and that the hospital may get stuck with them.  The elderly, supposedly, just keep getting sick and it becomes less and less productive to treat them. When severe symptoms present, staff are often too quick to assume an elderly patient is dying and will shunt them off into palliative care. Often, however, following the level of care we would afford any other human being, elderly patients recover like other human beings.

It doesn’t help that, for various reasons, the elderly are over-proscribed. And often policy is contaminated by economic rationalism, leading to the neglect of patients themselves. But despite the rhetoric, Australia spends relatively little on hospital care and can afford to be more generous. Hitchcock also suggests that it doesn’t help that medical professionals are often lured into specialisation by the fat pay cheques, thereby turning them into doctors of symptoms rather than people. The book is full of harsh judgements, but by someone on the inside who can envisage better ways.

Just like other people, the elderly need time, touch, holistic understanding, and some lee-way. They need to be treated like adults. This, she says, is the problem with end-of-life agreements: they don’t take into account the journey of patients and medical staff, the ambiguities, the negotiations and changes-of-mind, and simply try to lock patients into black and white decisions. She is scathing about pontificating, under-informed celebrities such as Andrew Denton, who jump on the euthanasia bandwagon and are recklessly sure of their positions, where consideration is needed. Hitchcock, very movingly, argues from her place as a professional carer duty-bound to protect life, for better care for those alive, rather than simply assuming a quick exit is best for everyone. This is not a blanket condemnation of euthanasia, but a questioning of motive, and a note of caution.

In all this, Hitchcock comes across as almost heroic in her empathy, a view she would likely discount. She simply describes doctors and nurses as human beings, with faults like others. She praises and criticises where she deems it fair. She isn’t tarring all medical professionals, but drawing attention to cracks in the system. What comes across in her book is the picture of a society and a healthcare system that is muddle-headed and cold-hearted regarding the elderly. But we can be thankful for a practitioner such as herself who speaks loudly to our society, and gently to her patients.

(Reviewed for the Uniting Church)

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