I work in Dementia care research and manage human rights charity Capacity Australia. I have long been aware of the major problem we have treating our elders with the care and respect they deserve, so clearly evidenced by the ongoing Royal Commission into Aged Care Quality and Safety. Despite this, I am still shocked by the way society’s foibles in regards to ageism have unfolded in the current COVID-19 pandemic.
Talking to friends and acquaintances and trying to allay anxieties, what is striking is the way in which psychological distancing (“it doesn’t affect me”) is used to deal with overwhelming statistics of cases and more frightening, deaths. The common question asked when there is another death is, “But how old was she?”
The closer the answer gets to our own age, the more anxious we become, or conversely, the younger we are, the more invincible we feel. Perhaps this explains the apparent disregard of social distancing by younger people.
However, while psychological distancing may be behind many of our responses to the increasingly alarming reports of deaths, I suspect that ageism too plays a large part. How long has society, at least our Western society, held the view that the value of life diminishes with age?
Does it matter if she was 82 or 56 or 95?
While writing this article an even more appalling demonstration of this type of ageism and stigmatisation was evidenced at a press conference with the Prime Minister and the Chief Medical Officer. A journalist asked the PM to comment on the “noisy critics out there who believe, or don’t understand why, the government may be unnecessarily causing economic destruction to save the lives of predominantly older Australians.” (Press conference Friday 3rd April 2020)
Those older Australians are our parents and grandparents, the next door neighbour who minds our kids or makes muffins for the school fete, the war vet who sacrificed everything for his country and paid taxes and worked hard for over 50 years.
Distributive justice is an important concept in crises such as the COVID-19 pandemic and refers to the “fair distribution of scarce resources”. We have seen this come into play in other countries such as Italy, where there has been a devastatingly high mortality rate and we see health jurisdictions, hospitals and clinicians forced to make decisions about who will get the benefit of the minimal lifesaving resources available and who will be left to succumb.
Ethical approaches to prioritisation for resources allocation include first-come, first-served, allocating to those most likely to benefit, or those worst off, or those most able to contribute (e.g. health workers).
Do we save the most lives possible or the most life years?
Age is not a criterion per se amongst any of these options, but tends to correlate with poorer outcome, less life years and less benefits of invasive treatments. As we see distributive justice put in place in health care systems overwhelmed by the pandemic, and make preparations for doing so ourselves, I wonder if some cultures find this more acceptable or repugnant than others.
It is important to use the momentum gained by the ongoing Royal Commission into Aged Care Quality and Safety and the interim report to develop human rights-based aged care policy. An international initiative to develop a specific human rights instrument for older people, similar to the Convention on the Rights of Persons with Disabilities (CRPD), has been afoot since first adopted in 2006 at the United Nations Headquarters in New York.
Is now the time to suspend human rights principles, including Article 25 of CRPD, the equitable right of people with disability – including those with dementia in residential care who are most vulnerable in this pandemic – to quality health? The reality is, as we progress further into the depths of the COVID-19 pandemic in Australia, where other countries are right now, and where we might be heading, scarcity of resources mandates rationing on some grounds, equitable access being impossible.
We can expect to face ethical decisions regarding access to these healthcare resources and treatments when ICU beds, ventilators and ECMO machines are in short supply.
What matters now is that we revert to extraordinary ethical stances only when they are needed. Most importantly, we must ask ourselves are we making decisions solely based on ‘how old she is”?