Carolyn E. Fiorillo
"By simple virtue of their age, seniors are more likely than others to become sick in the first place, to be confronted with issues of care in general, and life-sustaining care in particular....By the time that seniors come under a doctor's care or enter the hospital, they are far more likely to be significantly debilitated. Often, they have suffered for years from chronic conditions like arthritis, diabetes, and heart or kidney problems, which have taken a significant toll. They are also more likely to manifest what are termed 'toxic metabolic reactions' to illness. For when older people get sick, they look, feel and act very sick, very quickly....The fact that seniors get so severely ill so quickly means that they often cannot effectively advocate for their own careas one must in a hospital. Their voices are weakerliterally and figurativelyso that they may not be readily heard or heeded in the din of the modern medical center. This in turn subtly skews how doctors and nurses treat them...Consciously or unconsciously, doctors, especially those in training, may put older patients lower on the list for attention and treat them less aggressively. A senior patient may be disdained, explicitly or implicitly, despite the admonitions of senior physicians, as a 'GOMER'Get Out of My Emergency Room'that class of difficult, unpleasant, unrewarding, or hopeless patients. GOMER's are the first to be shunted aside, medical pariahs in the whirl of a busy hospital." Montefiore Medical Center Staff Bioethicist Nancy Dubler learned that her own mother was admitted to the hospital labeled as a "LOLFOF"a Little Old LadyFound On Floor. (32)
"The rampant ageism of our larger culture becomes a particular danger in medicine. Care providers may write off the older patient as disabled, confused, or 'senile'; they may believe that chronological age necessarily determines a person's ability to function. In fact, these are useless, unsupported generalizations, medical myths. In reality, a given senior's individual abilities and the rate of psychological and physical aging are unique, and they can vary widely from person to person. Ethically and medically, we are required to assess each individual's function fully as the foundation of her personal care plan. And, for the elderly, even more so than for younger persons, an assessment must include knowledge of the person's level of function before the event or illness that brought the person to the hospital....Some caregivers may simply not be willing to put in the time and effort required for communicating with the elderly. For the older patient, the modern medical center can be a frustrating and dangerous place. No wonder so many older patients slip through the cracks. (33)
"All of these elements combine to remove decisions from the hands of seniors. Families and doctors start talking around them and deciding without them. Older people, if they are not strong, determined and forceful, get bypassed in decision-making all the time. It is standard procedure for doctors to turn to loving and involved relatives to make decisions for the older person, even when that person is perfectly capable of deciding for herself. (34)
"No matter who practices it, whether family or physician, excluding the elderly patient from discussions and decisions is both very common and ethically unacceptable. The golden rule calls for us to do to the one in the bed as we would want done to us were we in that position. That means our first impulse must always be to include, not exclude, the patient in decision-making as long as possible." (35)
The key word here is respect. The day will come, sooner or later, when we are the ones in that bed and we will have earned the right to have our dignity preserved and our opinion respected. "Being old, after all, is no reason to be deprived of the ability to control your life." (36)