We have an epidemic of older patients requiring care, ill equipped facilities, a culture which denies the reality of aging and the inevitability of death, and a failure to address the ethical issues relevant to elder care. This failure could be caused by pragmatism, or even a lack of imagination, but the actual answer is not that simple. The problem has arisen from the fact that medical science, which largely decides how elders should live out their final days, and puts a premium on preserving health, has little to no concept of what gives life meaning and is unwilling acknowledge mortality. Medicine places value on preserving life and health, while ignoring the question of meaning and value. Economics places a premium on cost effectiveness,
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Falls can be disastrous, and can increase morbidity and mortality, but often at the cost of restricting freedom and mobility. How many patients who would love to be mobile, are forced to stay in bed because of the danger of falling, or because of insufficient staff to ensure safe mobility, and how many, as a result, develop learned incontinence, bed-sores, experience weight loss and muscle wasting, and require antipsychotic medications or restraints? Unfortunately, most of the evidence at this point is purely anecdotal, but any nurse can recount numerous stories of requiring patients to remain in bed, and the corresponding marked decline which occurs as a result, all in order to prevent a fall, and preserve an obscure concept of safety? Why do they make these decisions, which they know are demoralizing to their patients? The answer is generally insufficient staffing to ensure safe mobility and the damaging economic consequences of a patient falling. This is not to say that falls, bed sores, and the other issues are not costly, because they are. The issue is that we have enacted legislation and protocol to bolster safety and prevent harm,but have not addressed the more significant issues at hand. We have confused autonomy and freedom, muddling the definitions, have made idols out of the concepts of ‘health’ and ‘safety’, and have stripped the lives of our elderly population of any substantive meaning or …show more content…
The unyielding realities of biology, demography, and history are poised to incinerate the comforting illusion that “adulthood can last forever, if you want it to.” American society’s next great cultural challenge will revolve around the definition of and worth assigned to aging and elderhood. It is possible to envision an old age that ripples with beauty, worth, and meaning, but the realization of such a vision begins with and depends upon a solid understanding of the structure and function of human elderhood...What we need is a radical reinterpretation of longevity that makes elders (and their needs) central to our collective pursuit of happiness and well-being (2010). Can we as believers and health care practitioners, in good conscience, blunt the cumulative value of an entire life of choices and experiences for the purpose of elongating that life, and can we allow a culture which denies the realities of death to allow our elderly to descend into misery, denial, and depression? Gawande sums up the question
Falls can be disastrous, and can increase morbidity and mortality, but often at the cost of restricting freedom and mobility. How many patients who would love to be mobile, are forced to stay in bed because of the danger of falling, or because of insufficient staff to ensure safe mobility, and how many, as a result, develop learned incontinence, bed-sores, experience weight loss and muscle wasting, and require antipsychotic medications or restraints? Unfortunately, most of the evidence at this point is purely anecdotal, but any nurse can recount numerous stories of requiring patients to remain in bed, and the corresponding marked decline which occurs as a result, all in order to prevent a fall, and preserve an obscure concept of safety? Why do they make these decisions, which they know are demoralizing to their patients? The answer is generally insufficient staffing to ensure safe mobility and the damaging economic consequences of a patient falling. This is not to say that falls, bed sores, and the other issues are not costly, because they are. The issue is that we have enacted legislation and protocol to bolster safety and prevent harm,but have not addressed the more significant issues at hand. We have confused autonomy and freedom, muddling the definitions, have made idols out of the concepts of ‘health’ and ‘safety’, and have stripped the lives of our elderly population of any substantive meaning or …show more content…
The unyielding realities of biology, demography, and history are poised to incinerate the comforting illusion that “adulthood can last forever, if you want it to.” American society’s next great cultural challenge will revolve around the definition of and worth assigned to aging and elderhood. It is possible to envision an old age that ripples with beauty, worth, and meaning, but the realization of such a vision begins with and depends upon a solid understanding of the structure and function of human elderhood...What we need is a radical reinterpretation of longevity that makes elders (and their needs) central to our collective pursuit of happiness and well-being (2010). Can we as believers and health care practitioners, in good conscience, blunt the cumulative value of an entire life of choices and experiences for the purpose of elongating that life, and can we allow a culture which denies the realities of death to allow our elderly to descend into misery, denial, and depression? Gawande sums up the question