What's an older person's life worth?

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Older personOn 23 August, the International Day for the Remembrance of the Slave Trade and its Abolition invites reflection on the connection between slavery and such more modern phenomena as human trafficking, the abuse of 457 visas, women forced by penury to stay in abusive homes, and so on.

But this year the reflection was interrupted by a political story from the Northern Territory. Like most Top End stories, it was illuminating and diverting. Politicians there rely less on spin to conceal their true meaning. They tell it as they see it, and to a Southerner, what they see is often hair raising but never boring.

The Northern Territory Minister for Health, John Elferink, was interviewed by the ABC. He argued that the money spent on the health of the elderly, and particularly on those in the last year of their lives — a million dollars for each person — would be better spent on children.

I suspect if you spoke to somebody who, ... for arguments sake, had end-stage renal failure and said: 'We can continue treatment but by discontinuing treatment your grandchildren would have a better opportunity' ... Many of those old people would say 'Yeah I accept that'.

Many Australian politicians and health administrators would secretly sympathise with the position attributed to the Minister, but few would speak so bluntly. They might also be more careful with statistics and be more reluctant to upset older voters. Some might also reflect that in the Northern Territory, Indigenous Australians are seventeen times more liable to suffer from renal disease than other Australians.

Mr Elferink later clarified his comments, saying that he simply wanted to raise questions about the helpfulness of many costly interventions at the end of life, a subject already widely debated.

But underlying this debate, and latent in Mr Elferink's imagined conversation, lies the twin assumptions that the life of an older person is of less value than that of someone who is younger, and that people's value is measured by their economic contribution. On these assumptions it follows that the way in which we treat different people can rightly be decided on economic grounds.

From this perspective, people are ultimately seen as things. This is precisely the attitude of the heart that was embodied in slavery. For slavers, human beings were things to be hunted, sold, transported and sold for their labour and as breeders of future slaves. They were about profit. For traders they were a profitable cargo that could be carried on in otherwise empty boats. For employers they were a cost. To employ free labourers cost more than buying slaves.

Employers, of course, always wanted the best deal. Traders who could lower the cost by packing more slaves into ships and by spending less on food and hygiene, were more competitive. Similarly, slave owners who could reduce their overheads on food and living conditions and force their slaves to work harder would also be more profitable.

Ultimately slavery was abolished because enough people believed it incompatible with human dignity for people to be owned by other people and deprived of freedom. They recognised that people are more than a cost. They are our brothers and sisters to whom we are responsible. If they are vulnerable, as were the emancipated slaves, we have a responsibility as a society to ensure that they can live decently regardless of their economic contribution.

That was a noble ideal. It has always been under pressure from those who see other human beings as means to their ends. They usually shape arguments from economic needs and limited resources.

In the Northern Territory the economic stringency created by cuts in federal funding and other factors is real. It may mean cuts in local spending. But if so, the territory budget should ensure that these cuts do not put at risk the health and welfare of vulnerable people. Budgeting should serve the good of all the people, and especially the most vulnerable — both the elderly and children.

People at the end of their lives should be involved in the decisions about their own treatment, informed of its likely effects. They certainly should not be pressured to decline treatment, still less have decisions made for them on the strength of their economic contribution to society. People who are free, not slaves, deserve as much.


Andrew HamiltonAndrew Hamilton is a consulting editor of Eureka Street.

Older person image by Shutterstock.

Topic tags: Andrew Hamilton, ageing, health, ethics, euthanasia

 

 

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With respect Andrew, I think you are drawing a long bow between a process akin to medical triage where the objective is to do the most good with limited resources while respecting the dignity of each person, and the slave industry and market, where the objective was to maximise financial gain irrespective of the effect on any individuals. A better parallel with the slave trade would be the government's (and opposition's) approach to asylum-seekers who arrive by boat.
Ginger Meggs | 21 August 2015


More than ever I think we need the input of Medical Ethicists of the calibre of the late Nicholas Tonti-Filippini to this debate. John Elferink's original statement reveals to me the rather narrow one dimensional way most of our politicians think. There are many things about Old Age we need to have an ongoing national conversation on. Medical treatment is just one aspect of this. I am worried that, as you point out, there is a stage where older people may become likened to an old car whose only place is a wrecker's yard. There are many things older people need, not all medicine and not all costing money. Asian societies have traditionally respected their older people who are not isolated and considered just a burden. There are many, many aspects to this conversation we should have started years ago.
Edward Fido | 22 August 2015


It's puzzling how religious people can't abide the idea of dying - you'd think they'd be glad to leave the vale of tears and meet their maker. And doesn't Christianity have a sacrifice at the heart of it? Yet the idea that old people might willingly accept that medical resources would be better applied elsewhere, is not be considered? Or, admirable?
Russell | 23 August 2015


That's a rather startling statement by Mr Elferink. Those Territorians (Northern)! End of life decisions are complex and, ideally, should occur between patient and doctor in a trusting relationship. Money should never be part of the conversation. The elderly and the very young are invaluable contributors to our society, in every way that counts. Even a Territorian should get that.
Pam | 23 August 2015


Food for thought in this article. I think it is particularly interesting that Mr Elferink's example involving renal failure, just happens to be 17 times more likely to impact indigenous people in NT rather than people of European heritage. Some of the moral issues are similar to those discussed in the recent Quarterly Essay dealing with age care and end of life dilemmas. No easy answers in times of declining revenues and budget deficits, though perhaps the main thrust of Andrew Hamilton's article is that we shouldn't let economics be the only or dominant lens through which we examine the issue.
Rob Kiddell | 24 August 2015


Thanks Andrew! It brings to mind a piece of research undertaken by the University of Oxford in recent years that shows a correlation between higher levels of grandparental involvement and greater child wellbeing.
Hollywood | 24 August 2015


Catholic medical ethics has never demanded that doctors employ extraordinary means of maintaining human life. Because of the capabilities of modern science to use what are very expensive technologies to maintain in a human frame a mass of tissue which can never comply with Pope John Paul II's definition of human life, yet has the appearance of a human being, modern society in its misunderstanding of what is happening continues to see that mass of tissue as Mum or Dad and refuses to let go and allow Nature ( or God, if you prefer) to have its (or His) way, backed up by the equally misunderstanding civil law. Unfortunately some Catholic non-medical ethicists of passing fame have also not understood the capabilities of Medicine for what they are. Australia's internationally pre-eminent, decorated and honoured medical ethicist is a Mercy order nursing nun who indeed does understand, and never belonged to any created "ethics centre" or pseudo-academic institute. Pope Paul's definition, universally accepted in Medicine by believers and non-believers alike is, "human life is the possession of that unitary and integrated whole that is the human self" and excludes all life dependent on artificial means of maintaining what is essentially a very sophisticated physiological preparation. There is no doubt that millions of dollars spent on fruitless medical activities as those described here would be better spent on enterprises that would restore, salvage or improve what is true human life. True human life, however, has nothing to do with age, something that also escapes the understanding of many. There is some medical ethics for you to contemplate Edward F!
john frawley | 24 August 2015


Elferink`s comments are crude and poorly thought through, but Andrew`s piece is also pretty off beam. I work a lot with elderly people in the health care system, and the biggest problem is lack of "tailoring" to individual "true" need. In paradox to the tone of the article, elderly patients are far too frequently getting very expensive but inappropriate and futile care. It is commonplace to see elderly patients spending weeks in ICU and then dying within days of discharge from there. Elderly people, and the frail in particular, need assessing for whether they are in fact in the dying process (with death inevitable in the near future irrespective of what treatment you give in the short term), what their background quality of life is like and likely to be in the future id they survive current episode, and whether they are dementing or not. Care needs to be proportional to all of that, never futile, always compassionate, but certainly not always therapeutically aggressive. These can be very difficult decisions to make, and good, empathetic, well trained health professionals need to be central to that. Family and even patients themselves are frequently poor at this decision making and may need a lot of guidance, and the right course is not always to do less, but usually should be.
Eugene | 24 August 2015


I heard this interview. He presented his thoughts as a conversation starter. However, I immediately realised that he was sugar coating dangerously near-Orwellian propositions. But instead he had a readily available first stage suggestion to hand: recently the NT passed legislation allowing us to make end of life plans and choices. He could have strongly urged people to consider this. At 70 I have done so -- I do not want expensive life extending treatment and I say this in the context of seeing our wonderful daughter, diagnosed with cancer during her second pregnancy and then having a stem cell treatment. Now she is well, working and mothering her children: money well spent. However the Elferink thinking strays into the area of addressing those less skillful and comfortable with western thinking which includes many Aboriginal people who are already seriously over-represented in our prisons, hospitals and school disengagement. How does he propose culturally appropriate end of life planning for non-literate, non Western life styles? Furthermore, how does he propose end of life planning for those with dementia? Finally, I am concerned that he is implying some sort of guilt trip for those who choose to be treated and stay alive -- and we all know that women are far more likely to self sacrifice.
Jane | 24 August 2015


Where did the figure of one million dollars a year come from? Never mind the ethics, look at the arithmetic
Frank | 24 August 2015


John Elferink’s attitude is that spending on health is fixed and that therefore decisions must be made about priorities. Of course. But he is asking the sick to make this decision. As Andrew points out it is Aboriginal people in the NT who, bearing the burden of terribly iniquitous poor health, will be asked to choose between decreasing infant mortality for instance and supporting their loved elders in the final stages of their lives where they are living on a machine undergoing renal dialysis for end stage renal disease. If the NT can’t afford to provide effective health care for all its citizens throughout their lives then the NT is truly a failed state and Elferink and all other politicians in the Territory who are banging the drum of Statehood should run and hide. Surely the health budget is insufficient to meet the wide spread needs in the Territory but that means adding to the budget not asking the sickest, poorest, most marginalised people in Australia to make such a terrible choice. Let’s have fewer AFL and ARL football extravaganzas in the Territory, costing the NT government millions, and use that money to promote Primary Health Care at every level.
Mike Bowden | 24 August 2015


Many in the NT with renal failure are not terribly old either. An elderly person or someone with a terminal illness might also state the desire to be there for their grandchildren for as long as they possibly can
Fiona | 31 August 2015


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