Refusing medical treatment is an option
Elderly patients have right to consent, should not be forced to receive procedures
My father-in-law was a bit of a rascal. Dad, as he asked me to call him, knew how to have fun.
I remember hearing how he “borrowed” a tank to impress a girl during his time with the British Army in Egypt before the war. He might have got away with it, too, except he drove the tank into a low bridge which didn’t survive the impact. Dad was busted from sergeant to private, losing two stripes and a chunk of his paycheque.
By the time I met him, he’d mellowed considerably. He’d even given up roaring through his village on a motorbike, but only because he could no longer lift his leg over the gas tank.
As Dad entered his 90s, things started to go wrong. After nursing his wife of many years through dementia (and in the process finally learning how to boil an egg and make a cup of tea) he too was afflicted with that dreaded disease. The first symptom was a personality change. This good-humoured, fun-loving man became angry, volatile and violent. Matters came to a head after he hit my sister-in-law.
Dad had always said the only way he was leaving his house was in a box. But he was unable to look after himself, and my brother and sister-in-law could no longer provide the care he needed. The only solution, it seemed, was a long-term care residence. Dad moved, but he didn’t adjust. He was increasingly disoriented and his physical health deteriorated. He walked into the new residence with a cane but, once there, was made to use a wheelchair. This was a problem. He wheeled the chair into furniture, then into staff and other residents. To prevent him from injuring himself and others, the staff lifted the handles of his wheelchair onto a window ledge. He could no longer move his chair.
When Dad tried crawling out of the wheelchair, the staff strapped him in. Dad lived the final weeks of his life strapped to that chair. Death, thankfully, came soon after.
The sad thing is, Dad didn’t have to spend the last weeks and months of his life that way. There was another solution. Like many frail, elderly individuals, he didn’t just suffer from dementia and mobility problems; he had a host of other conditions. Conditions that were treated aggressively with surgery, antibiotics and other medications. Conditions that, left untreated, may have resulted in an earlier, gentler death.
Had we spent the time to hear Dad’s wishes, to let him think about how he wanted his life to end, he may well have declined much of the treatment he was given in the last few years of his life. He would have wanted to be pain-free and comfortable, but why treat a systemic infection with antibiotics when it could cheat dementia? Why take a flu shot when death has become a longed-for friend?
In Canada, as in the U.K., patients have the right to informed consent. We, or our substitute decision-makers if we are no longer capable of making our own decisions, can choose to refuse any test, procedure or medication. Furthermore, refusing a treatment doesn’t mean we will be abandoned; our healthcare system is still required to provide comfort care to palliate our symptoms and ease our dying.
We have the right to say no. Treatment is always an option, never a requirement. But it is the default in our health-care system.
Saying no takes planning and courage, but the stakes are high. It is, quite literally, a matter of life and death.
Like many frail, elderly individuals, he didn’t just suffer from dementia and mobility problems; he had a host of other conditions.