F R O M T H E E D I T O R

What is a Life Worth?

E ditorials are the place for opin- ions and, at best, opinions on

issues that matter to numbers of people. I was recently invited to at- tend a conference at the prestigious University of California, San Franc i sco . . . right here in my own backYard. The brochure touting "Doctors and Death in the Modern Era" stated, "Western societies have demonstrated growing accep-

tance of euthanasia, physician-assisted suicide, and selec- tive management of severely disabled newborns, chronically afflicted adults, and the elderly" (italics are mine). I simply could not believe my eyes. Clearly, with no qualifications, being old was sufficient reason to bow out with help. I immediately wrote to the conference or- ganizers expressing my outrage and received no response except confirmation of my desire to attend the confer- ence. I felt quite sure that the person who developed the brochure did not really mean that being old was grounds for assisted sui- cide, but the assumption, no matter how carelessly written, should give us pause. It is a very short step from that statement to the statement "the elderly should die." I was fired up to write to the editor of the San Francisco Chronicle, when I realized my anger would matter little to him, but maybe our readers would become inspired to take ac- tion on their own grounds in response to some of the aberrant thinking that seems to be erupting in the most unlikely places. We are living in dangerous times when one must be of perfect health and full of vigor and youth to be considered fully Viable. For those of you who have been around as long as I, this is somehow reminiscent of the desire to cultivate a pure Aryan race by eliminating everyone who was not tall, blond, and sturdy.

Geriatr Nurs 1997;18:93-4. Copyright © 1997 by Mosby-Year Book, Inc. 0197-4572/97/$5.00 + 0 34/1/81686

We are living in dangerous times

when one must be of perfect health

and full of vigor and youth to be

considered fully viable.

Now, I do not believe that suicide is always couched in depression and desperation, although, more often than we know, an untreated depression may be at the root of it. Sometimes an individual feels a stronger pull to the other side than the motivation to remain in an untenable situa- tion. That individual may, after due consideration and therapeutic efforts, decide on suicide. However, being as- sisted in the act is unnecessary and, in my opinion, dan- gerous. It reduces the assistant to a facilitator of death and, in a few years, undoubtedly an arbiter of death. Even in medieval times the executioners had the grace to keep their identity hidden under a black hood when beheading someone.

This discussion of when to die is becoming ever more prevalent in our society. Fortunately, a particularly cogent article appeared in an Open Forum editorial in the San Francisco Chronicle in February. 1 Robert Salamanca wrote, "I don't want a choice to die. We the terminally ill, need to realize how important our lives are. I have lived with Amytrophic Lateral Sclerosis for seven y e a r s . . .

Euthanasia advocates be- lieve they are doing people like me a favor. They are not. The negative emotions toward the terminally ill and disabled generated by their advocacy is actually at the expense of the dying and their family and friends, who often feel dis- heartened and without self assurance because of a false picture of what it is iike to die, created by

those enthusiasts who prey on the misinformed. What we, the terminally ill, need is exactly the opposi te-- to realize how important our lives are. And our loved ones, friends, and indeed, society, need to help us feel that we are loved and appreciated uncondit ional ly . . . I f physician-assisted suicide is legally available, the right to die may become a duty to die. The hopelessly ill may be subtly pressured to get their dying over wi th--not only by cost-counting providers but by family members concerned about bur- densome bills, impatient for an inheritance, exhausted by care-giving or just anxious to spare a loved one further suffering. In my view, the pro-euthanasia followers' pos- ture is a great threat to the foundation on which all life is based, and that is hope. I exhort everyone: Life is worth

GERIATRIC NURSING Volume 18, Number 3 Ebersole 93

living, and life is worth receiving. I know. I live it every day."

And, finally, if you are not sufficiently stirred now, I will share another piece from the same Open Forum, "There is no 'simple mastectomy, '" by Suzanne Zahrt Murphy, 2 a retired emergency room nurse. "You live in a society that values breasts as a ticket to belonging in the feminine w o r l d . . . A 's imple ' mastectomy. . ~ means that only breast tissue will be removed. O n l y ! . . . There is no simple mastectomy. Never. To say that a woman can have 'up to 23 hours' for this profound loss is to say that each of those hours is all that a breast-- that is, a woman- - i s worth. . Now, men, consider t h i s . . . This could be your testicle! This could be one of your cojones, one of your manly pouches that provides the seeds for the next generation. This could be you. Would you want to be told that you had 'up to 23 hours' to recuperate from this loss?"

To round out this brief treatise, although I detest the overworked phrase, cost is the bot- tom line. How much do you and I cost? Are we an economic debit or credit in the grand social balancing of the books? Osteoporosis is costly, Alzheimer's disease is costly, falls and hip replacements are costly, coronary artery bypass graftings are costly, just being old can be costly. What can we afford and what can we not afford? Can we afford to be humanitarian if it costs too much? If we continue to devolve the economic costs to the next generation, will they be even less humane? What are the answers? What can we as geriatric nurses do? We can and do object, loudly and vociferously at times; but on a more subtle level, all of you who insist on the value of the persons you are caring for and advocate for appropriate levels of assessment and action or express concern for the comfort of an elder, regardless of his or her capacities, are em- phasizing, daily, the intrinsic value of being alive. We can afford quality health care and to support life in all its as-

pects. Excesses that are seldom questioned exist through- out society. We can afford billions every 4 years for po- litical campaigning, much of it touting the excessive costs of Medicare and Medicaid. Both together cost less than the last campaigns. It is all a matter of priorities.

Post Script

What can we afford and what can we

not afford? Can we afford to be

humanitarian if it costs too much ? ff

we continue to devolve the economic

costs to the next generation, will they

be even less humane?

In fairness, I must amend my comments about the con- ference, "Doctors and Death in the Modern Era." I re- cently received a reply to my letter in which Dr. Michael Thaler states, "You are correct in pointing out that of the

three categories of 'pa- tients, ' the elderly alone stand unquali- fied. I wrote the line to spotlight precisely the point you make: that in many Western societies today, just being el- derly makes one a tar- get for selective treatment (or more pre- cisely, non-treatment), a position originally popularized in the pro- nouncements of former Governor Lamm and the writings of the in- fluential bioethicist Daniel Callahan. You are no doubt aware that

in countries with national health coverage, including Britain, Sweden, Denmark and Germany, certain expen- sive procedures are rationed strictly on the basis of age. I was alluding to these trends, which I personally oppose both on medical and moral grounds. However, I admit in hindsight that my meaning might have been clearer had I placed the Word 'respectively' at the end of the sentence. Thank you for pointing out the ambiguity."

I feel compelled to make one final comment: does being old automatically make one a "patient?'; •

REFERENCES

1. Salamanca R. Open forum: I don't want a choice to die. [editorial]. San Francisco Chronicle 1997 February 19;19.

2. Zahrt Murphy S. Open forum: there is no "simple mastectomy" [editorial]. San Francisco Chronicle 1997 February 19;19.

9 4 E b e r s o l e May/June 1997 GERIATRIC NURSING