Bias towards elderly who will not go quietly

[Anonymous]

My mid-80s parents have always made it clear that they want to live for as long as possible, damn the torpedoes.

Do they want CPR? Yes.
Do they want risky surgeries? Yes.
Will they fill out an advance directive of some kind? No they will not! They want to be full code, forever.

This is an informed choice they are making. (Probably not the choice I would make, but I dunno, ask me in another three decades!)

But I feel like hospital staff frequently do not really approve of this and don’t treat them the same way they would treat, say, *me* if I were in their various medical situations.

My parents look truly ancient. They are not in good health but soldier on through sheer force of will. Doctors who have just met them look at them and probably think, “they’re in progressive decline, we can do this thing and it may not work and if it did, it would only delay the inevitable by a few months at best.” My parents’ attitude is, why would I forgo a few months of my only earthly existence?! If all they can do is eat some ice cream and look at some birds, they want to do it as long as possible. It does put burdens on other people and I sense a certain amount of resentment of that in the medical field who just want them to go to hospice already.

[Anonymous]

I’m on your parents’ side. They still feel there is value in living. No one has the right to overrule them and decide that their life has less significance because of their age. That’s a terribly slippery slope that I think we should be wary about. If someone can determine that old people might not derive sufficient benefit from their life to justify the possible inconvenience to others, what’s to say that’s where the line gets fixed? What about people with serious illnesses, physical disabilities, mental illness, cognitive impairment, chronic disease, addiction, poverty, people who aren’t likable, people who are just different, people whose death can benefit someone else?

Every life is precious. When we start marginalizing lives and trying to decide which are worthy of continuing, all lives are imperiled.

[Anonymous]

This is the OP and I agree with you. I do everything I can to ensure my parents wishes are met.

I think what I’m talking about is very subtle. I think all doctors would *say* they are respecting their older patients’ wishes. But are they really taking the same stance they would take if the same things were happening to a 50-year-old? I seriously doubt it. In my experience there just isn’t a lot of frank discussion between patients and doctors about what they really want.

My mom will say to me, “they seem to be just giving up on your father!” So I’ll talk to the doctor who will say to me, “Your father says he doesn’t want X.” And I will say, “Did you explain to him that without X he is likely to die very soon? Did you really explain to him what X is, the pros and cons?” And when this happens, surprise surprise my dad chooses X! But I think the truth is the doctors think X is just delaying the inevitable so they mention it in a way that is designed to discourage it. Or they talk about it and death in a way that is so oblique, my parents don’t even fully understand it.

[Anonymous]

I think in an ideal world doctors could give their all to everyone. The reality is they are understaffed, very overworked and many are burned out. Since they are not superhuman, would you rather a doctor give more attention to a mother or father with children at home, one of whom may have special needs or medical issues or emotional struggles or put all their energy into giving your elderly parent a few more months?

[Anonymous]

I would say they haven't experienced a close relative living as a vegetable. Meaning feeding tube, laying in bed, staring at the walls, no commuication, hell, no brain function. Huge medical interventions that lead to nothing but back in the bed, staring at the walls with more tubes and more meds.

We spend more in the last months of life than we do the rest. For me, pull the damn plug and let me go in peace and with dignity

[Anonymous]

Doctors are trained to save lives no matter the cost and reasoning behind it. If they don't do their best, patients' families may come after them.

[Anonymous]

Absolutely terrible thread title, BTW.

[Anonymous]

As a nurse, I definitely wish doctors had more frank discussions about what "doing everything" looks like, especially for the elderly. I've had many a frail patients who I've looked at and wondered "do they really know what CPR will look like and feel like after we do get them back?". CPR is actually really brutal! Or the frank discussion about the impact of anasthesia on an elderly person. Or what rehab will look like.

When my dad had a severe intestinal issue come up, the doctors really weren't 100% honest about the real risks of the surgery. He had fairly advanced Parkinsons and they absolutely did not explain that a colostomy was a VERY likely outcome nor did they explain to him and my mom what life would look like for them with one. My mom would be 100% responsible for it unless she put him in a nursing home. I really had to push the doctors to be more blatant. My dad opted out, fully informed and consented.

I'm not saying all elderly should be DNR/DNI. My mom isnt and while she has health issues I know she has more life left in her. I just think there needs to be more hard truths.

[Anonymous]

My husband is a doctor, other relatives are doctors, and you are entirely wrong, OP. Doctors take the Hippocratic Oath. Saving lives is more than a job. It's a calling. If the patient does not have a terminal diagnosis, then it's the standard of care to do everything possible to save their lives and not discuss palliative care until it's needed.

You are shockingly ageist: just because someone is old and frail, with the normal ills of age, does not mean they're ready to be put out to sea on an ice floe. When patients are in terrible pain and death is certain... that's when they ask for a painless exit, and deserve one, at any age. Pain and hopelessness are the criteria, not age.

I hope you're a troll, actually.

[Anonymous]

Bias against...?

[Anonymous]

This is the OP and how can you say I am ageist? I’m working as hard as possible to fulfill my parents wishes as I respect their right to make whatever decisions they want. I absolutely want my parents to live as long as possible and I spend a great deal of time helping to make their wishes happen. They want to fight as hard as possible—and if the end result is them on a tube unconscious in a bed, that is a risk they are willing to take. But I do not think that is a risk that doctors approve of, That is the point I was trying to make. And I think that this disapproval comes across in many subtle ways in their interactions with my parents.

[Anonymous]

OP, I think I agree with you but your post isn’t very clear. Probably why the PP is calling you ageist.

[Anonymous]

Anonymous wrote:I’m on your parents’ side. They still feel there is value in living. No one has the right to overrule them and decide that their life has less significance because of their age. That’s a terribly slippery slope that I think we should be wary about. If someone can determine that old people might not derive sufficient benefit from their life to justify the possible inconvenience to others, what’s to say that’s where the line gets fixed? What about people with serious illnesses, physical disabilities, mental illness, cognitive impairment, chronic disease, addiction, poverty, people who aren’t likable, people who are just different, people whose death can benefit someone else?

Every life is precious. When we start marginalizing lives and trying to decide which are worthy of continuing, all lives are imperiled.

x1000

[Anonymous]

Anonymous wrote:I’m on your parents’ side. They still feel there is value in living. No one has the right to overrule them and decide that their life has less significance because of their age. That’s a terribly slippery slope that I think we should be wary about. If someone can determine that old people might not derive sufficient benefit from their life to justify the possible inconvenience to others, what’s to say that’s where the line gets fixed? What about people with serious illnesses, physical disabilities, mental illness, cognitive impairment, chronic disease, addiction, poverty, people who aren’t likable, people who are just different, people whose death can benefit someone else?

Every life is precious. When we start marginalizing lives and trying to decide which are worthy of continuing, all lives are imperiled.

+1

Stop being so greedy, OP.

[Anonymous]

Anonymous wrote:This is the OP and I agree with you. I do everything I can to ensure my parents wishes are met.

I think what I’m talking about is very subtle. I think all doctors would *say* they are respecting their older patients’ wishes. But are they really taking the same stance they would take if the same things were happening to a 50-year-old? I seriously doubt it. In my experience there just isn’t a lot of frank discussion between patients and doctors about what they really want.

My mom will say to me, “they seem to be just giving up on your father!” So I’ll talk to the doctor who will say to me, “Your father says he doesn’t want X.” And I will say, “Did you explain to him that without X he is likely to die very soon? Did you really explain to him what X is, the pros and cons?” And when this happens, surprise surprise my dad chooses X! But I think the truth is the doctors think X is just delaying the inevitable so they mention it in a way that is designed to discourage it. Or they talk about it and death in a way that is so oblique, my parents don’t even fully understand it.

Man, I'm going to need a concrete example here to really get my head around this because what I seeing in this write up is an older man who decided he didn't want a treatment until his child twisted the doctor's arm to talk him into it.