Overview of experience Caring for the Elderly and Terminally Ill

Elderly people in Rest Homes are able to choose how much medical intervention they would like in the event of illness, ranging from full cardio-pulmonary resuscitation to palliative care.
  • Palliative Care involves a shift of treatment goals - from cure and prolongation of life to the control of suffering, which is paramount to a good death.
  • Assisted Suicide is a cop-out....it is defeatist....it means failure.
  • Euthanasia should not be touted for a group of people who no longer feel useful or important - no longer valued by society.
  • In Rest Homes, Hospices and Hospitals, nurses and doctors are managing death well and people are dying peacefully.
  • Fears, anxieties and even pain are alleviated by trust and confidence in the care being delivered.
by Mary Stewart, Registered Nurse

Elderly people in Rest Homes are able to choose how much medical intervention they would like in the event of illness, ranging from full cardio-pulmonary resuscitation to palliative care
  • Palliative Care involves a shift of treatment goals - from cure and prolongation of life to the control of suffering, which is paramount to a good death.
  • Assisted Suicide is a cop-out....it is defeatist....it means failure.
  • Euthanasia should not be touted for a group of people who no longer feel useful or important - no longer valued by society.
  • In Rest Homes, Hospices and Hospitals, nurses and doctors are managing death well and people are dying peacefully.
  • Fears, anxieties and even pain are alleviated by trust and confidence in the care being delivered.
Transcript of a talk given at a Public Forum on Euthanasia held in Wanganui, April 23, 2003.

My name is Mary Stewart, I am a common garden variety nurse and I manage a 20 bed Rest Home here in town. My expertise is in the care of the Dying Person. It is not in public speaking - in fact I tend to speak too loudly due to having to talk to mostly hearing impaired people all day and hearing impaired teenagers all night.

Talking about hearing loss, I took Bob from the Home to see his GP about his ears. The doctor fished out a suppository from his ear. Bob asked, "What's that for Doc?" and the doctor explained that it was used for when you get "bunged up!" Much to my delight Bob quickly replied, "Now I know where my hearing aid is!"

Nursing the elderly has always been considered the Cinderella of nursing. It is hard physical work and not particularly glamorous. So. . . Why do we do it? In the Home where I work, over 50 percent of our residents are over 90 years old. These elderly people are our treasures - not old, more valued than that - they are priceless antiques. Needless to say Death is a fairly common event in any Aged Care Facility and needs to be managed sensitively.

When people are admitted to a Home, they pretty well realise they will probably die there and are usually very open about the whole subject of death. One of the ways I get to discuss the subject of dying is in a questionnaire about individual beliefs, values, spiritual and cultural needs. This covers things like family involvement in decision making, through to if they were dying would they like family with them, or any other requirements they can think of.

Elderly people in Rest Homes are able to choose how much medical intervention they would like in the event of illness. This can range from full cardio-pulmonary resuscitation to palliative care.

From my experience there are very few elderly people making unrealistic choices. Most would choose the aggressive treatment option - i.e. treatment of illnesses that can be treated, but no extra-ordinary measures like life-support machines.

Palliative care
The palliative care option would be common with those with life threatening conditions. Palliative Care involves a shift of treatment goals - from cure and prolongation of life to the control of suffering. This symptom management means managing symptoms associated with the dying process. The most talked-about symptom of course would be pain.

The challenge for the GP and nurse is to ensure the person dies pain-free. In the 22 deaths I have been present at in the last 3 years, all have died peacefully, without pain, and with dignity.

Sufficient pain relief is paramount to a good death, but there are many other contributory factors which influence this outcome. Family involvement can be a great comfort or it can be a curse to the dying person. Unresolved conflict within families can exacerbate pain. A skilled nurse often spends more time nursing the family than the patient. Dying can be a time for past hurts to be healed and for quality time to be spent with the dying person.

There is such a thing as a 'good death' and in my opinion these are the ingredients:

  1. Someone with the ability to manage the event - to ensure that good symptom management occurs
  2. Caring and loving nurses, caregivers and other requested people i.e. family, friends, ministers making themselves available for the dying person. The major difference between cure and care is that cure implies the end of trouble, whereas care carries with it the sense of ongoing attention.
  3. Acceptance by the dying person that they are going to die and that the people that are looking after them know how to help them. Faith in the management of care during the terminal stages is extremely important, not only to family but also to the patient. Fears, anxieties and even pain are alleviated by trust and confidence in the care being delivered.
  4. The presence of Hope - not based on false promises but on a belief that rewarding times can still be had. This involves a change from dying from a terminal illness to living with a life-threatening disease.
So where does Assisted Suicide fit into this picture? It doesn't. It isn't needed if everything else is happening. Assisted Suicide is a cop-out....it is defeatist....it means failure. Failure regarding the care, the medical input, and sometimes failure from lack of family support.

An article in the Wanganui Chronicle from a local GP stated that he had been asked for "Death Medication" in several Rest Homes on numerous occasions. I was horrified. Why did they feel the need for this? Were they in pain?...were they depressed? - if so why didn't anyone address this? Were they lonely - then why didn't someone visit them? Were they not well cared for? Did they not feel loved?

Euthanasia should not be touted for a group of people who no longer feel useful or important - no longer valued by society.

My son is a yellow ribbon ambassador i.e. he volunteers to be involved in his school in the prevention of youth suicide. ON reading this article he wondered whether his time might not be better spent on working with elderly people.

It is abhorrent to say as a society, "You young ones can't kill yourselves but, oh okay, you oldies, you guys probably should!!!" If there was a law change, and even if families of elderly didn't openly encourage their "loved ones" to end it all, how many sick and aged people would feel it a duty to "do the right thing"?

Voluntary Euthanasia will lead to Involuntary Euthanasia - there is nothing surer.

Imagine how depressing it is to get a call from a daughter to see how Mum is doing - the conversation goes like this, "How's Mother?" "Doing really well." then the inevitable, "Oh dear, when is she going to die?!!!"

Ask any Aged Care facility where they can see Elder Abuse - not very often from poorly paid caregivers - very often by families, not providing adequate funds, questioning every little amount spent, not visiting... horror stories abound even in little old Wanganui. Euthanasia, if made law, would be a continuation of this - the ultimate in Elder Abuse.

On a happier note - please observe the death notices in the paper, especially those that said "died peacefully at a Rest Home, Hospice or Hospital" - this is the norm not the exception. Nurses and doctors are managing death in these facilities well.

I will leave you with a quote from Dame Cecily Saunders, a British Hospice Pioneer -
"Palliative Care providers usually recognise that most people are not afraid of dying as they are of being abandoned. The worst thing we can do is abandon someone who is hurting. Attitudes which promote death rather than affirm life are the ultimate abandonment."