Rau Williams (64), right, and his nephew Jim Shortland outside Whangarei hospital after Williams was refused kidney dialysis.
Rau Williams (64), right, and his nephew Jim Shortland outside Whangarei hospital after Williams was refused kidney dialysis.
COMMENT
In the year we arrived in New Zealand, there occurred a disturbing medical event that haunts my memory still.
Mr Rau Williams was a 63-year-old Northland man with failing kidneys. He asked to have dialysis to keep him alive. The medical authorities refused on several grounds. Notably,the clinical guidelines they had created, withheld such treatment when the patient, like Mr Williams was said to be demented.
I'm not a kidney specialist but it occurred to me that a certain amount of cognitive dysfunction would occur in the presence of the accumulated ammoniated materials that the failing kidney could not filter and excrete. To bolster my own knowledge I consulted with a renal surgeon/friend who confirmed my understanding.
Despite his "dementia" Mr Williams clearly stated, "I want to live. I want dialysis". Regardless of any formal diagnosis of impaired mental functioning, that statement establishes his competence for this issue.
Rau Williams (64), right, and his nephew Jim Shortland outside Whangarei hospital after Williams was refused kidney dialysis.
The way the matter was handled was explained by the medical authorities as a good example of medical rationing. It was difficult for my naive eyes, new to New Zealand and to the history of its medical "reforms" of 1993, not to see this as anything but a public execution.
At a subsequent London medical meeting the matter was presented positively, as a good example of medical rationing.
The more things change, the more they remain the same.
Last year the Health Ministry rolled out a new campaign of screening for colorectal cancer.
Colorectal cancer is the second highest cause of cancer death in New Zealand.
Some 3000 New Zealanders are diagnosed with bowel cancer every year and more than 1200 die from it. As with many cancers, early diagnosis is essential to survival.
Patients whose cancer is found in the early stages have 90 per cent survival rate, while for those whose cancer is found in the late stages, that survival rate drops to 14 per cent.
Colorectal cancer rarely causes any symptoms in early stages. Hence the need for screening.
In former years the screening test called the gFOBT involved collecting faeces over three days, then testing it for occult (invisible) blood. The new test (FIT) requires just one sample and is about as accurate as the old one. It's the relative lesser inconvenience that is different, and hopefully more useful for screening a large population.
A screening test is just that, a screen, or a net. There may be false positives and, presumably, a few false negatives.
A positive result indicates a need for the more definitive colonoscopy, which has some risks, higher in older patients. But that allows the surgeon direct visualisation for cancer or precancerous polyps that can then be removed.
So far so good.
Whanganui's Greg Ratana was one of the lucky ones to receive home dialysis. Photo / File
Except that the screening is only for those between 60 and 74 years of age. And the chance of having cancer doesn't stop at 75. It actually rises.
In the US the test is recommended for those between 50 and 84. It's hard to escape the conclusion that the difference is money and that this campaign is yet another form of medical rationing.
The Inuit people of Alaska have long been said to put their non-contributing elderly on an ice-floe to die. Urban legend. Historically, in times of extreme starvation, an entire village might move to new fishing/hunting grounds. The elderly left behind, to catch up if they wanted to and could. The ice-floe thing was sheer make-believe. Impossibly dangerous. The last known case of such leaving behind was in 1939.
We're not starving. What's our excuse for putting our elderly at risk?
