By Dr. Michael Wasserman
Texas Lt. Gov. Dan Patrick recently suggested older adults should sacrifice themselves amid the COVID-19 pandemic. This brings forth my greatest fear: that ageism in society will lead leaders and others to look the other way while we die of preventable causes in large numbers.
Patrick must not talk to his grandchildren very much. If he did, he would know that they want his love and not his money. Our society is being given the ultimate ethical test.
Would I forgo my own life to save the life of my grandchild? I would. Would I offer my life for the economy, as they claim? You’ve got to be kidding me.
This is America. While we believe in the free market, we also believe in each other. To throw in the towel at this early stage of the pandemic and offer older adults to the altar of COVID-19 is unconscionable.
The important question for anyone over the age of 60 isn’t whether they want to sacrifice their lives, but whether or not they’ve created and shared an advance care plan. That means making our own personal, individualized choices regarding our health.
Those choices are usually related to how we feel about our cognition, function and quality of life. For instance, I may want my family and my health-care providers to know that if I can no longer recognize my family or continue my love of writing, I wouldn’t find value in my life.
Or, to put it in current terms, if I’m at that level of cognitive function and I get hit with COVID-19, then keep me comfortable. Don’t send me to the hospital and above all, don’t waste valuable ICU resources on me.
That’s not just me. It also happens to be the overwhelming majority of the patients whom I’ve cared for over my 32-year career as a geriatrician.
But someone else may well choose to “have everything done,” as is their right. To repeat: This is America. We’re not supposed to ration health care here. During debate over the passage of the Affordable Care Act, the very notion that we might have “death panels” lit conservatives’ hair on fire.
So we all have a right to say how we want our health managed as we get up there in years. We just have to make it clear.
The good news is the government has actually encouraged physicians and health systems to offer advance care plans to patients. Unfortunately, there’s been little public education about creating one.
There are digital platforms like MyDirectives.com that make it easy to do, and at no cost. Because we are isolating older adults to protect them from the virus, the need for an advance care plan to be readily available through the internet is critical.
Such a plan is not a means to avoid treating an older adult. It’s a means to assure that our health-care wishes are heard. It’s a way to assure that we’re treated with dignity and respect.
What I am fearful of in our society is that ageism will define the care that is delivered to older adults in the coming weeks and months. If an older adult gets COVID-19, starts getting short of breath and ends up in an emergency room, what should happen? Right now there are three scenarios.
If I have an advance care plan filled out and available to the emergency room doctor, and my wishes are to not be put on a ventilator if a poor outcome is expected, then I expect to be treated with palliative and hospice care for comfort.
If I don’t have an advance care plan, and the emergency room doctor assumes that I want everything done, I may end up on a ventilator with prolonged suffering until I die.
Alternatively, because I’m old, I could be assumed to have little value to society, or less value than someone younger than me, and be “allowed” to die.
That is not the health-care system that I was trained in. That is not consistent with the Hippocratic Oath, or the country I love.
Wasserman is a geriatrician and president of the California Association of Long Term Medicine.
View the op-ed in New York Daily News here.