KEY POINTS:
Last week I bemoaned the fact that the materialism generated by politicians and business over the past 20-odd years has so corrupted our national psyche that we put profits before people and have ended up with bean-counters in charge of essential social services.
I used as a perfect example the chairman of the Auckland District Health Board, Wayne Brown, the man who confessed to trying to turn the hospital under his control into "a big factory"; and trying to "remove the emotion, just run it as a productive unit".
Now I didn't expect for a moment that Mr Brown would take any notice of this columnist - and I was right. Because on Sunday, in his usual blunt fashion, Mr Brown made it known that his board considers it is spending too much on keeping old people alive and it would be cheaper simply to ease their dying.
An article in the Sunday Star-Times revealed that an Auckland District Health Board paper is calling for fewer "invasive, intensive or even aggressive or heroic treatments" to older, seriously ill patients as part of new thinking on how to manage patients with incurable diseases. It is also calling for fewer "code red" rescues - or resuscitations - of older patients.
Mr Brown is quoted as saying that end-of-life decision-making is one of the most serious issues facing the health system, and if the public does not engage in how it should be managed, district health boards will have to make decisions based largely on cost.
"We really do have to talk about this as a country," Mr Brown is reported as saying. "Half the people think they're going to live forever. People honestly think life is like [hospital TV drama] ER, which it is not ...
"Healthcare resources are finite and insufficient to allow for all patients who conceivably might benefit from various treatments to receive them."
The story quotes Dr Anne Callaghan, chief of palliative care at Auckland Hospital, as saying it is not a matter of cost saving but of improving the quality of life for patients with incurable illnesses, letting them decide whether they want to be in hospital undergoing uncomfortable treatments with little likelihood of success, or free to live their last days in palliated peace.
The Waitemata DHB's palliative care chief, Professor Rod McLeod, pointed out that a difficulty was recognising when a patient was dying, and medical students needed better training in that.
Interventions on dying people often resulted in increased suffering but society had been conditioned by TV hospital dramas to expect hi-tech operations to produce perfect results.
Now I have little to argue with in any of that, except, perhaps, that such decisions should be made on humanitarian and medical grounds rather than financial ones.
I have never believed that life should be prolonged when it is obvious that someone is irretrievably on the way out, and I agree wholeheartedly that nasty, invasive, painful, humiliating and sometimes disfiguring treatments are inappropriate.
But the fact is, as Mr Brown says, that a lot of people do really believe they are going to live forever - and will suffer anything to stay alive.
I'm not one of them. I have no fear of death, only of the manner of it, and if I am stricken with a fatal and incurable disease, or so smashed up in an accident as to be beyond repair, then all I hope for is that those who care for me, and those who love me, will ensure that my passing is as painless and dignified as they can make it.
My real concern is that this move by the Auckland DHB is being made by people who are afflicted with the sort of tunnel vision that comes from perpetually staring at bottom lines.
It's all very well for them to say that spending money on "heroic" treatments that have little chance of success is a waste of limited resources, but are they prepared to invest the savings in A+ palliative care?
The board's paper recommends that doctors stop using words and phrases such as "withdrawal of care", "futility", "terminal care" and "passive euthanasia".
Instead, the paper says, doctors should use phrases such as "comfort care" or even "gentle care" - and "it may or may not be necessary to acknowledge explicitly that this care will not entail the use of specific treatments".
Now that gives me the heebie-jeebies.
For perhaps in the not too distant future, one of the Wayne Browns of this world will tell us that "comfort care" or "gentle care" are too expensive and it would be cheaper and better for all simply to administer a needle ... And will set about devising another set of dissembling circumlocutions for "euthanasia".
