I’m a parent. As much as I tried to tell myself I wouldn’t end up this way, I am guilty of battering my kids’ ears with all manner of awful clichés passed on as shorthand life advice instead of providing either better explanations or personal examples.
“Genius is 1% inspiration, 99% perspiration …” (already feeling nauseous).
“In this world nothing can be said to be certain except death and taxes.” (Wait, that’s just something I heard in lots of talk about budgets and other finance stuff that I would not bore the kids with.)
“There’s no business like show business.” (Look, I like Bugs Bunny cartoons.)
Actually I think it’s only the last one I’ve actually used so maybe I’m not doing quite so much damage. But that death and taxes one. If those are the things that are certain, why is it that we seem to spend so much time talking about the taxes, and not nearly enough about death?
This came to mind recently because of a non-answer given by a politician on a panel show. There’s a show in my part of the world called ‘Q and A’ which bills itself as “democracy in action”, giving audience members and people online a chance to ask questions of a showbag of prominent people.
Now I’m not so sure that panel shows in the comfort of suburbia were the exact vision of those first creating democracy as a system of government. What is most obvious when you watch is that when one of the “Qs” in the title is asked of a politician, they all too often try to deliver a “non-A”, scattering soundbites and rehearsed lines without committing to anything.
A few weeks ago an audience member fronted up with this:
“In 2014, the outgoing director of St Vincent’s Hospital, Dr Bob Wright, suggested that we needed to look at the overtreating the elderly at the end of their lives, and I think the key word there is “overtreating”. Given the high personal, social and economic cost of overtreating the elderly, sometimes at the end of a very dignified life, when is enough enough?”
There were two politicians on that night. They were Joe Hockey, the current Treasurer, and Chris Bowen, the guy in the opposition who wants his job. Bowen went first.
“Decisions about end of life I think can only be made by the individual if they’re capable of making that decision, their family and their doctors, together and it’s not something that politicians sitting around Canberra or here, um, can tell people what to do about …”
It’s all about the individual. It’s not for him to say. He couldn’t even.
He was followed by Joe.
“Well, I must say that I find this discussion really quite confronting. The thought that there is a price tag on your last days of life is just unacceptable. From my perspective you need to live with dignity and die with dignity and we have an obligation to ensure that every Australian is in that sort of position, and if we have to spend money to make sure that people die with dignity then we will do it to make sure that they’ve got the best health system available and I understand where you’re coming from but, my God if it was my parent or, or my wife or whoever it may be, I want to make sure they get the very best health system in the world.”
Way to go politicians. Someone poses a question on the topic of death. It could be an opportunity to chat about getting older, end of life care or even euthanasia. And the best on offer is a platitude.
The Private Death
In quieter moments, I’d confess I have a bit of respect for our politicians. I think most of them probably first get interested in representation because they really do want to engage in a way that makes a difference and they make sacrifices to be there. I’m not always sure what ends up keeping them there.
How is it that a person who’d like to get into government can say with a straight face that end of life care is an entirely personal decision? Of course no one pulled him up on it. “Democracy” moved on.
There isn’t a decision in health care that is taken in a vacuum. Every decision that a patient makes, every option a family considers and whatever advice a doctor can provide happens within a system that is pretty much set up by politicians. Don’t sit in the house that makes the legislation and pretend you have nothing to do with the options available for people actually having the conversation. If the only option available in a system that you are part of creating is “there is hospital and there is care in a home designed by modelling with cardboard boxes”, you’re in the discussion .
And if Joe reckons the best health system in the world is what is needed to deal with this, and that “if we have to spend money to make sure that people die with dignity then we will do it”, then he probably needs to explain how that matches up with his government’s actions.
It seems like those noble words don’t really fit with the reduction in projected funding to state hospital systems, cuts to aged care funding, cuts to the Dementia and Aged Care Services Fund and an absence of community palliative care in any forward planning. If you’re the one who can make decisions that influence everyone else’s options, maybe don’t treat everyone like idiots by talking big and pushing in the other direction.
Bringing Them To Water
On a show pretending to be the living version of democracy, those we presume started with a goal to be representative can’t even approach universal issues that the rest of us are talking about.
Maybe it’s not that surprising. Dragging politicians to catch up with the public is getting a bit like trying to force water on something big that you can ride. Like a giraffe or something.
Honest discussions about what sort of care offers what people actually want at the end of their life is just one example. Euthanasia is another where the political discussion lags behind public opinion. Put marriage equality in that list as well.
In a rich country with the luxury for studio democracy we can talk about anything and everything. Including killing Johnny Depp’s dogs. So maybe it’s time our politicians stopped treating us like dolts who can’t spot when they’re dodging essential discussions.
People will face those difficult choices and discussions today. They’ll face them tomorrow.
When will the politicians pick up their part of the discussion?
A note: I transcribed those quotes off the program directly. There are lots of good places to go and read about the failures of modern health systems to tackle both what works and what we need from end of life care. I read “Being Mortal” by Atul Gawande a little while ago. It’s a good place to start.