Tom Koch is a Toronto-based consultant in gerontology and chronic care. He has written extensively about aging, disability, elder care and medical ethics.
Age is a chronic, not a terminal, condition. And yet, as Canadians live longer, we often do not celebrate our longevity, but worry about its continuance. Suddenly, the idea of a long life is seen as something fearful and worth ending.
A current example is the recent Globe and Mail report of the March 27 shared death by lethal medical injection of George and Shirley Brickenden, both in their 90s, in their Toronto retirement home. They were, by all reports, an engaging, intelligent and relatively healthy couple.
The story raises real concerns about the grey-zone of medical ethics, targeting the end zone of what today is being promoted as a reasonable basis to end life. The question is: Who is fragile and how do we respond to their needs and fears?
For more than 30 years, I have worked with fragile seniors and their families, including my own. For 25 years, I’ve also worked with and written about adults living with a range of chronic conditions. The thing I learned from, and with, them all is that while death is inevitable, there is no clear past-due date for any of us.
In the medical assessment required before physician termination, one doctor wrote that Mr. Brickenden “has a serious and incurable illness, which is age-related frailty. It is end stage.” This was a way of fitting Mr. Brickenden into the legal standard requiring a patient’s death be “reasonably foreseeable” and inevitable.
At what age does survival become an inevitable “end stage” diagnosis? In the 1980s, The Hastings Center’s famous philosopher and ethicist, Daniel Callahan, set 65 as the end point for a reasonably engaged, intelligent, useful life. In his early 80s, he said he was rethinking that.
Waldorf Seniors’ residence in Côte Saint-Luc, Que., recently celebrated the lives of 20 vocally happy residents, all centenarians. They symbolized the way today we may live for decades engaged, interested and joyful. That is the triumph of modern medicine and social advances. Sure, some were in wheelchairs; others used walkers. None saw these as reasons to die.
Chronic and sometimes limiting conditions are the price many of us pay for living into maturity. The things that once killed us in youth or middle age are now conditions that we may carry with us into our 90s, at the least.
Heart disease is managed through medication, pacemakers/defibrillators and sometimes surgery. Today’s diabetics live more carefully, but well for decades with a controlled diet and medication. Other chronic conditions are similarly controlled.
People grow fearful of their futures when accident or illness intrude. Everyone facing a chronically-limiting condition goes through a period of depression and sometimes despair. We worry that the life we lived is over and, we wonder: What will one lived differently be like? Good treatment addresses our fears, it does not embrace them. It helps people through and past crisis points.
That won’t happen when age is considered a terminal diagnosis, however, when physician-assisted death is the go-to answer. Ever since Jack Kevorkian, physicians in this line of work have had termination as their reflexive response. If you need help living, see someone else.
We want to grow old but are afraid of aging. We want to be healthy and in control and so we fear any kind of disability. Thinking of age as a terminal condition easily ended plays to our fears, not the potential of our lives. The simple truth is circumstances may change at any age; we can’t control that, only our response to them.
This tale of shared termination sets a dangerous precedent, not only for seniors, but for us all. It means we need not face our own fears of fragility. It stops us from asking why some seek to end rather than continue their lives. If pain is untreated, social or familial services unavailable, if required assisted devices are not offered, then early death may seem preferable to continued life whether one is 19 or 90. The real fault then is not fragility or old age, but the failure of care and treatment.
Promoting the fear of terminal frailty, rather than care and support was not what the Supreme Court or the Canadian Parliament embraced in their legal judgments. On reflection, I’ll bet it is not what most Canadians want for themselves, or each other.