The Liverpool Care Pathway (LCP), Euthanasia and the Green Party

I have only just realised that the Greens Party is also keen to see estate tax re-introduced - euthanasia and estate tax are certainly interesting combinations.  Particularly in light of what Carolyn Wallace says about the potential consequences if euthanisia is legalised.

http://www.vexnews.com/2010/07/death-tax-greens-party-plans-to-tax-the-d...

The Greens policy says its proposed death tax would exempt family farms, small business worth less than $5 million and the family home. They don’t specify a rate, but in the United States their estate tax rate is 55 cents in the dollar.

Transcript of Carolyn Wallace's interview:

https://indymedia.org.au/2015/04/19/interview-with-carolyn-wallace-on-eu...

Carolyn Wallace is the director of clinical services at Southern Cross Care, Tasmania’s leading aged care provider.

https://www.youtube.com/watch?v=o9VlQO7MK5c

Q: Why is the aged care sector such a large stakeholder in end of life care?

People only ever come to residential aged care when there is no other option left for their care. Usually it’s the last place they live. At our ‘Rosary Gardens’ facility, for instance, in the last 12 months the average length of stay for a new resident is just under 60 days.  So people really are coming at the end of their life for end of life care.

Q: Are there misconceptions about the dignity of living and dying in an aged care facility?

That’s partly because people know nothing about what aged care is, and so they assume, and a lot of the pro-euthanasia information, puts across the impression that death is undignified unless it’s very deliberate when actually that is not the case. Most Australian aged care facilities adopt what’s a philosophy called a palliative approach to care. It’s not palliative care. What most people think of as palliative care is actually end of life or terminal care. But a palliative approach to care embraces the W.H.O. definition of palliative care which affirm life, consider that death is normal and that the role of palliative care and the palliative approach is to neither hasten nor postpone death. So a palliative approach is built on that premise. It’s an evidence-based approach and its aim is to improve people’s quality of life through…and particular people with a life limiting illness…through early identification and assessment of any issues and concerns, be they physical, health related, medical, cultural, spiritual, all aspects and it also adopts a very open and positive attitude to death….The residents, even those with a significant cognitive impairment, know that this is their last home. People chose to work in aged care because they feel that the aged have a value and the experienced staff in aged care realize that one of their primary roles is to assist somebody to live the end of their life with some dignity and with some value. As I said before a palliative approach neither hastens nor postpones death but the staff pride themself that one of their main goals is to help people have a good death.

Q: Do the elderly have control over their end of life medical treatment?

Aged care is one of the areas of nursing where there is impeccable assessment over the whole gamut of the person’s needs, not just their physical needs. Any competent person in this state can decline any medical treatment option that may be offered to them, at any stage. That includes things that may be quite simple such as an investigation. Any competent person can decline to have that now, there’s no need to have anything special or any special legislation to make that happen, everyone has that right now.  Any person, any adult, can also plan for what they would like to have happen, when they are no longer able to do that for themself. Anybody can make an advanced directive. In a person who is no longer competent, who hasn’t made an advanced directive, we and their treating GP would always speak to their families before embarking on a course of treatment such as something as simple as antibiotics for a chest infection.   At any time people have the right to say ‘no, that’s enough’, or ‘no, I don’t want that’.  

Q: If euthanasia or assisted suicide were introduced what type of pressure would the elderly experience in an aged care environment?

Residential aged care is community living, and so people live in a community with people they didn’t know before they came here and there is a sense of community amongst them. So if Mrs Brown in room 10 decides, she and her family decides, that she is going to euthanase herself, her family will talk to her friends, Jean and Shirley and Bill and the other people with whom she has lived for some time and their families and that will set people thinking about their self worth ….and residents will think, well should I not, should I do that, and it may be something they have never considered before. They may think that they’re a burden on their family; my daughter now has to travel 20 kilometers 3 times a week to visit me, that’s an imposition on her, so perhaps if I took the same path as Mrs Brown perhaps I could save my daughter that trouble. There are lots of financial implications for people, perhaps instead of having that short holiday on the gold coast my son and daughter-in-law could now have a nice overseas holiday if they could access my estate. A lot of these are unintended consequences of Mrs Brown euthanasing herself. However, they are very real consequences,  and so you’ve got people who are happy and happy that their quality of life was what they would expect it to be at that stage of their life are now finding … they’re questioning that value and people are actually devaluing themselves and devaluing their contribution.  I think the atmosphere…it’s a very cruel thing to do. It would be a very cruel atmosphere in the facility, it would very quickly become full of people who think I’m actually here, I probably shouldn’t be here, I probably should have had the courage to euthanase myself but I haven’t,  therefore I am even less than those people who have chosen to do that.

Q: What type of pressure and abuse are the elderly already subject to?

There are two things that fall into the resident abuse category that you see every day in an aged care facility. One of those is what I would term petty or minor financial abuse, where relatives regularly ask the elderly resident for money. The other thing that you see regularly is people enforcing some social isolation on their family members by limiting who can visit, by not helping family members who were significant  to the resident who can’t get themselves there independently by always having some excuse  why they can’t come, and those people often only encourage visitors who will follow a particular line of thought  that the family wants, so if you had a family member  who was keen that mum went  down the euthanasia path…those sorts of people…and sometimes they don’t realize that they’re doing  it, would discourage very actively  visitors who might give mum a different perspective or  encourage mum to question this particular family member’s view. If you have that family member whose opinions inform the rest of the family’s and that person thought that mum should euthanase herself, very quickly that family member will influence others

Q: Is there a need to introduce euthanasia or assisted suicide in view of the standard of end of life care in Tasmania?

My personal view is I don’t think the legislation is necessary at all. Any individual has the right now to decline or refuse any treatment option that is offered to them. Palliative care services work very well in all but a very few extreme cases and you shouldn’t write legislation for the extreme cases, you should write it for the multitude as it were….

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Furthermore, with aged care facilities (as they are now called) staffed as they are, I am having difficulty imaging the 'dignity of dying'.

https://www.scribd.com/doc/261998291/038-457-Visa-Changes-Sell-out-Hospi...

I know of one facility involved in aged health which employs staff from overseas on temp working visas, facilitates and supports their application for permanent residency (not sure if this is via claiming exceptional circumstances or the promise of employment for a minimum of 2 years), after which presumably through an informal agreement, the workers are given the flick (too expensive now as they have to be paid proper wages), and replaced with more temp working visa staff. Rinse and repeat.

While I don’t know all the details, and unsurprisingly those involved play their cards close to their chests, it keeps staff costs down for the business, and the low skilled worker secures a fairly hassle free ticket into the country. Also unsurprisingly, some of these workers have no interest in wiping the arses of aging Aussies, and the attitude and practices they bring to the job would make your blood curdle.

This type of thing is a fairly open secret if you mix in those circles.

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ALL you have to do is ask around and you will find plenty of unpleasant stories about what is now going on in the  'aged care facilites', (and the intention is to add euthanasia and estate taxes to this mix?)