Can we talk about ageing populations?

[Kendodd]

Birth rates around the world are collapsing. South Korea has the lowest birth rate at about 0.7. That means for every 100 people, 35 children will be born. There are predicted to be more people over 65 than under very soon. Many countries are predicted to see their populations half be 2100. While I think this is great for the planet and wouldn't want to change things, it will present problems.

What to do?

There's already a crisis of recruitment in care. Throwing more money at it won't work, we need people to do other jobs as well. Limiting care/health care to the elderly, I can't see how that would work either. Also, most of these countries are democracies, the elderly would be the most powerful voting block.

Anyone any ideas?

Well, I’m elderly, and my worst fear is ending up my mother, who went on to 97 after some 15 years of dementia. For around her last 5 years she was doubly incontinent, didn’t know any of her family, was unable to hold any sort of conversation or understand anything.

I can’t blame medics or anyone else for ‘striving to keep alive’ - although she looked frail, it was entirely down to having the general constitution of a rhinoceros, but a swifter end would have been much more merciful. Her former self - an intensely private person - would have absolutely hated to know how she was going to end up.

If anybody tried to keep me going in such circs, I’d like to think I’d come back and haunt them.

I'd love to answer you in more depth, truly, but there is highly personal stuff that I am unwilling to share on a public forum. However, I can share about one close relative living with a particularly cruel and life-limiting condition who was 'brought back to life' and who went on to live another year of good quality of life during which we were able to make some lovely memories. Because they were old, other relatives would have preferred them to die at the point they were successfully resuscitated - more because of their own discomfort and projections on how difficult was the condition.

But that’s what is already happening in Canada.

The euthanasia law there allow ps anyone to end their life if their suffering is too great.
At the same time, chronically ill and disabled people get no benefit so are in dire poverty. They can’t get treatment due to cost, incl painkillers etc… so the ‘chose’ to die.
The law has just been changed so that children with significant disabilities can be eligible too.

Euthanasia laws are spreading too. The U.K. is looking at introducing them. So is France. Belgium and the Netherland already have them. (Which is why people in France go there for euthanasia. Easier than Switzerland)

So what I’m trying to say is that it’s not a question of ‘maybe we’ll think about euthanasia for older people’. It’s already there. Not wide spread. Not the obvious solution to a problem. But there nevertheless.

Eugenics in action :(:(

Seems like Thanos had a good idea, reading this thread.
Carers should be paid from the beginning of their shift to the end, like home helps use to be in the 70’s. Who wants to be at work 14 hours and only paid for 7/8. With the spare time, taken up walking to next job. I have experience.

So you think people who are left with almost zero quality of life for several years, after a severe stroke for instance, is fine. Okay then .......

My DF had a heart valve replacement a few years ago in his late eighties. He was pretty fit and energetic until his heart started failing, and after the valve replacement had a great quality of life for a few more years until his death from cancer. If he had been a frail old man he probably wouldn't have even made the waiting list for the replacement - and I would have had no issues with that at all, and nor would he.

No-one is suggesting that all treatment is withheld from the elderly, just that sometimes it is better to let people go than try and keep them alive at all costs when the life that they are left with is miserable. My DF knew there was something wrong with him before the cancer was even diagnosed and just wanted to go.

So agree with this ......and a mere 3 months ago I'd be one. But having seeing my relative die recently I wouldn't wish that on anyone.
And that poor man who cried every day for 5 years.
There has got to be a better way.

How would you fancy that applying to babies with disabilities?

sometimes it is better to let people go than try and keep them alive at all costs when the life that they are left with is miserable

The "dog test" applies here. If DCat came home tonight, aged 13, fit and healthy, with an injury that required removal of an eye, I'd pay for it and wince every time I got my credit card bill for the next year or longer. If he was suffering kidney failure, arthritic, had cateracts, was already losing substantial quality of life, I'd have him euthanised for the same injury. Why are we crueler to humans than we are to cats and dogs?

Here's my checklist for having one only...

• bad maternity experience
• poor maternity pay
• expensive childcare
• potential poor health
• declining health and education services

I think there's a lot of debate about assisted dying, but not a lot about creating healthy lives from day one. Meaning better nutrition and better exercise, and better mental health.

Treat poverty as a disease, and enable people to live healthier lives. Smaller burden on health services and social care, and maybe more acceptance of death after living a good life.

We already do apply something similar to babies. I posted upthread, we consider babies viable after 24 weeks gestation and give minimal efforts to 'save' babies born before this. Not all countries use this 24 week cut off.

We already do, when the baby has a permanent condition that requires life support.

Content note: child death.

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A mature student I was at college with told me one night in the bar that his youngest child had been born very badly brain-damaged and couldn't breathe unassisted. On medical advice, he and his wife decided to let their child go, on condition that he switched off the ventilator whilst his wife held their child.

==================

We do make those decisions already. We make them in private, in the side rooms of neonatal ICUs. And because they are so intensely private and heartbreaking, they are often never spoken of, so most people never hear about them.

So you think people who are left with almost zero quality of life for several years, after a severe stroke for instance, is fine. Okay then .......

Who are you to say that they would chose death rather than life?
Who is deciding what is a quality of life good enough to live?

I have ME/CFS.
I hear about other people who have severe or very severe ME. Those people who can’t get out of bed, who struggle with light so have to stay in darkened rooms. People who dint tolerate talking to anyone for weeks or months at a time.
Pretty shit right?
And yet, they still chose life.
They wish for more research. Mainly they wish people would acknowledge their struggles but they dint wish for death.

Anyone who comes here and says ‘that person with a stroke has IN MY OPINION (not the sufferer’s opinion) no quality of life so they should be ‘let go’ is simply advocating for eugenics.
And last time that eugenics were used, you know how it went….

Im not saying that deciding to end your life doesn’t have a place.
But not if we start telling people there is some sort of threshold on quality of life. Not when we decide for other who dint have the capacity to decide for themselves (either too young, the one who have lost capacity etc…) that their life isn’t worth living. Not when we decide ‘it’s fir their good’.

But we are playing God with our medical advances. People do live because of successful medical treatment, that's children who are born with disabilities and the elderly suffering from age related conditions. Plus all the stuff in-between from cancer to diabetes.

The question is, should we prolong someones life regardless or should we have an open discussion about it while we are able to do so?

Like I said upthread, death should be discussed with other end of life decisions like power of attorney, funeral arrangements or the wish against resuscitation

@VitoCorleoneOfMNMafia and yet how often do you also hear about stories of parents who decided to ignore medical advice and had a child that had a pretty normal life when they were told they would be severely disabled/wouldn’t live last 2yo etc…?

Nothing is as easy as that.
Yes pareht take that sort if decisions for their baby. Just like they might decide fir a termination because something was discovered on the 20 week scan etc…

This does not mean it’s ok to generalised it

Like I said upthread, death should be discussed with other end of life decisions like power of attorney, funeral arrangements or the wish against resuscitation

And yet this cannot be discussed in vacuum.
It not just about advance in the medical field. It’s the ACCESS to medical treatment.
Living in pain for life and being treated p, even if not perfectly, is not the same as living in pain with no treatment at all.
It’s about access to social care.
Its about a lot if other things around the person, support in place that will make a difference.

Talking about those directives wo talking about the environment in which those decisions will be made is crazy imo (see the Canada example!)

they should be ‘let go'

You mean medical treatment withdrawn or not offered in the first place? I'm taking that meaning for the rest of my response.

advocating for eugenics

I don't think that you know what eugenics actually means. Luckily, Encyclopedia Britannica do: "the selection of desired heritable characteristics in order to improve future generations". This definition has nothing whatsoever to do with the decisions to offer or withdraw life-prolonging treatment. It is dishonest to pretend that withdrawal of life-prolonging treatment is comparable to forced sterilisation or any of the other horrors associated with eugenics.

we start telling people there is some sort of threshold on quality of life.

NICE already do this.

Not when we decide for other who dint have the capacity to decide for themselves (either too young, the one who have lost capacity etc…) that their life isn’t worth living.

Judges already do this. The Charlie Gard case is an example. Parents do this.

Im not saying that deciding to end your life doesn’t have a place.

Have you confused euthanasia with withdrawal of medical treatment here? They aren't the same thing.

Medicine isn't a certain science because multi-cellular lifeforms are complicated. In an environment with finite resources, you strive for the most "bang for the buck": to get the largest number of high-quality years of life for the money you have. That means making hard decisions on the basis of statistical generalisations.

The Ockenden Review showed that underfunding of midwifery kills mothers and babies and, as a consequence, Shrewsbury and Telford Hospital have since spent £95m on improving those services. That's £95m that they no longer have available for oncology or mental health or any other department. The harsh reality at SaTH is that someone must die from cancer or suicide or some other cause so that a baby can be born alive to a living mother.

Maybe there was a 0.01% chance that that mature student's baby would have recovered. But that ventilator could not be used to help another baby, who might have a 5% of surviving or a 95% chance of surviving, if his baby was using it. We don't have infinite ventilators, nor do we have infinite NICU beds.

Thank you for responding to my questions.

I do think it is so important for people to be able to think and talk about death and dying, about illness, capacity and limitations. And crucially, I think everyone should be strongly encouraged and supported to make some kind of written expression of their own wishes - to say what they personally would like to happen, what they personally would find tolerable or intolerable.

@VitoCorleoneOfMNMafia i agree with you.
But this was not my point.

My point was that it is a decision made by the parents. Sometimes with good reasons and good results.

What it isnt and should never be is ‘this person has X and Y therefore we ASSUME their life isnt worth living and we will decide to use euthanasia’.

Also note that stopping treatment is not the same as euthanasia where you have most of the time people who will carry on living regardless.

Like I said upthread, death should be discussed with other end of life decisions like power of attorney, funeral arrangements or the wish against resuscitation

@DancefloorAcrobatics out if interest, have you sorted out whether you want to be resuscitated or what sort if life saving treatment you are agreeing to?

I agree that death should be discussed. A lot of people have a will. Few (unless they are getting older) have a PoA. Fewer still have a RESPECT form sorted out unless they have some serious medical condition (and even then…).

I don’t agree. Who decides when ‘old’ is? Who decides the cut off point for medications? Many elderly people live a long and useful old age, volunteering their time in the community, looking after grandchildren, giving pleasure to their families, contributing in many ways. I have a family member who is volunteering in his 90s.

As I understand it the poster who originally made the comment wasn't talking about the elderly who are living a long and useful old age, more those who are kept alive after something like a severe stroke where the person is very unlikely to have a good outcome and will live a life they probably wouldn't want to live - sometimes for many years. There were people at my DM's care home four years ago who really had zero quality of life, and some of them are probably still alive now.

@IloveAslan and the question is still who is judging that these people would not want to live that life?

If you want to know what sort if life is worth living, don’t ask abled people. Don’t ask doctors.
You ask the people who are ill, disabled, those who didn’t have a good outcome (whatever that means!! It will mean something different for each of us). Ask those who CHOSE to have that surgery knowing the risks associated with it.

When face with death, right in front of them, people make very different choices than what you’d think they would do.

Have you had a severe stroke which has left you unable to communcate, feed yourself, or do anything at all? No you haven't, you are writing posts on MN. The sort of person I was referring to has no more hope of writing posts on MN than of flying to the moon. I have seen people in that situation, and I'm pretty sure they are not getting any joy from life at all. My friend's mother was in that situation for years, and the only thing she could really do was express frustration or cry - which was pretty shit for her elderly DH, and my friend could see no sign of enjoyment at all in her. There was never going to be a miracle cure for her, or others like her, in her lifetime.

I'm sorry that you have ME/CFS but why must people with any sort of progressive illness or disability jump onto a post which clearly wasn't aimed at them?

You are missing the point. My DF had that expensive surgery because he was deemed to be someone who would benefit from it. The procedure is not offered to everyone, only those who are well enough for it to make a difference. The woman who went in before Dad was in her 90s, but obviously a fit and healthy woman. People don't seem to realise that decisions like this are being made by medical staff all the time. There really isn't enough money for everyone who needs specialised treatment to get it, some just get treatment to make life more comfortable.

I think a lot of the arguing on this thread has been because euthanasia has been elided with withdrawal of, or refusal to offer, medical treatment. Which is understandable because they are adjacent concepts, but they are not the same thing.