PROLONGING DEATH Capitalism and Old Age

I.                    Who wants old people?

I’d like to be working up to 3 days before I die. But I am not likely to. I envied my father because he died at the age of 80 and still was managing his affairs on his own. On the other hand, my mother was incapacitated for many years and the last few months she developed bedsores and died in misery, and every one was happy to see her go! I am 62 year old and it scares me (like it does so many of us) that I may have the same fate as my mother had. From the age of 50, I have been on asthma medicine, from the age of 60 I am on blood pressure and cholesterol medicine and now my knees are getting really painful. What triggered this essay was the news coverage of deaths in France.

Deaths in France

Sometime back about 15,000 old people died in France during an unusually hot summer. France has a longevity figure of 84 years. Most of these old people lived in old age homes. Most doctors and relatives had gone for vacations to ‘hotter’ climates. The bodies stayed in morgues for weeks. Even after after their return, many relatives did not want to claim these bodies and let the state State arrange the funeral. Everybody blamed everybody including global warming. One unstated loud fact was that everyone was relieved that they died, perhaps including some of the old people themselves.

What happened in France is, of course, an extreme case. In most affluent countries the number of old people is increasing at an alarming rate. In developing countries, too, the rich and the middle class are living longer. India has an average longevity figure of 67 years. Communities are dying and so are the traditional support systems for the old people. There are not enough old-age homes and few of them are adequate.

II.                 Old age is a new phenomenon

Till the 19^th century most people died before they reached the age of 50. Even today most poor people in Asia, Africa and Latin America die early. Thus, the longevity figure of 67 years for India actually means that the affluent here are living much longer than 67 years and that the poor are still dying before they reach 50 or so. Today, in India, there are about 75 million old people above the age of 60 years, which is about 7.5 % of India’s population. In the ‘developed’ countries this percentage is higher and in the poorer countries it is lower.

These The phenomenon of old people age on the whole are is a burden on the earth.  (This includes the present author also.) Most of them the old people (this includes the present author also) are pure consumers. And since they are from affluent societies, their consumption levels are far above average. In the market it is the young who are sought after. Older people are forced to retire. They do not find any productive or meaningful work. But now the reverse is also true in the West – because of the pensions crisis people are being warned they will have to work till 70, like it or not! Possibly the pension fund managers want people to die before they can claim their pensions!

A few old people are of course very rich and powerful. Most of these are corrupt politicians and business people. At the other end, there are a few old people who are ‘nice’ people, that is, wise, caring, lovable and respected. But the overwhelming majority of old people are ordinary unwanted people!

III.               Old age is a racket!

The Medico-industrial complex

Old age is a racket created by the medico-industrial complex. This is the second largest business after the armament industry. Both control people and nations. The medico industrial complex controls people and nations by creating dependencies. Just as the military-industrial complex survives on small-scale continuous warfare, the medico-industrial complex also survives in rich people having prolonged illnesses, involving expensive treatment, but not dying. People above 60 years of age ideally suit this purpose and they pay nearly 70% of the medical bills.  This is a nexus of loot between the health care system, medical technology, drug industry, pension and insurance schemes and housing industry. Britain is an exception, where the National Health provides health services free at the point of delivery.

Capitalism survives on individualism and insecurity. A fear of old age is generated right from the day one starts work. Social security, pension and insurance scheme vultures arrive with one’s first paycheck. Credit cards, loans for consumer durables and housing loans follow. A big chunk of one’s paycheck vanishes into pension and insurance scams. Lovely media images are created as to how a wise old man is enjoying his old age with children and grandchildren! Now each of these is a well-known racket. Everyday somewhere or the other a pension or insurance scam is being exposed.

When old age actually arrives the problems show up. The house has to be repaired regularly because the construction is poor. With Eevery breakfast you are swallowing half a dozen pills to keep this or that symptom under control. And your pension is not enough.

And as we said above the old people are unwanted, lonely, unhealthy, depressed and unhappy. They are living in what the naturalists call ‘zoo conditions’. For example, in nature a sparrow lives about 3 years. In a cage, however, it can live upto 13 years! But a bird in a cage is also lonely, unhealthy, depressed and unhappy. Just like our old people.!

The abuse of medical ethics

Books have appeared about how rapacious the drug industry is. Irrational tests and surgical procedures take a big toll on money, health and sometime life too. However, it is in the interest of the industry to keep the patient ill but alive.

One of the worst abuses of the health care system is prolonging death. As Ivan Illich has said, death is defined as the stage when the patient is unable to pay. A new culture has come into being saying that life per se is precious and that a person has to be kept alive no matter how much he is suffering or whether he himself wants to live such a life. Some time, the converse can also be true. Recently, a man with incurable disease went to the Court of Human Rights to make sure that doctors don’t stop life support systems. In other words, he wants to go on existing, even in a vegetable state. In this, the religious organizations, and particularly the Catholic Church, have played a powerful role. This has led to an enormous amount of suffering to the patients and their families. In many cases it has also financially broken the families. On the other hand, millions of young people are dying all over the world from ‘curable’ diseases like malaria, tuberculosis, leprosy, cholera and diaorrheadiarrhea. But they cannot pay and hence they have to die!

IV. A ‘natural’ life!

What is a typical natural life? We just have to see a tribal family, which is not yet seriously affected by ‘modern’ life. Up to the age of five or so the child stays near mother and the family. Many children died at childbirth or a few years later if they were weaklings. Then, the child starts going out with the elders and helps in some activities that helps the family. This can be food gathering, carrying and fetching. It is also an apprenticeship. The child learns a lot. By twelve years s/he starts venturing alone or ‘gangs’ of children begin moving on their own, exploring, learning and getting to be self-sufficient. By eighteen, the young adults start their own families, by thirty all the children are born and by the time they are forty they are ready to go! Most ‘old’ people in their forties continue to work till a few days before they die. They usually die with very few days’ illness or none. The causes of death are more ‘natural’ and not ‘zoo condition’ deaths of contemporary old people. These can be hunger and famine, encounters with wild life, poisonous insects, reptiles, bacterial and viral disease and accidents.

Such a life does not face the diseases of our time, such as cancer, heart attack, backache, diabetes or even menopause. Most of these occur after 50 and are related to lifestyle patterns. Their life cycles are similar to other living beings in nature. Most people till the 19^th century lived this kind of life. Until 200 years ago, there was no population problem. In 10,000 B.C. the population of humans on earth was less than a million!

Lessons from the past

What was the basis of life in the past? One was that every one was working, although they worked much less than we do. This was so because there was no leisured class (which consumed enormous resources) to be supported, and the natural resource base available was much higher. Today there are huge wasteful industries such as armament, pharmaceuticals, cosmetics, tobacco, alcohol and so on, which guzzle natural resources. They also demand human labour and consumerism, all of which cause much of our problems today. Secondly, individualism and consumerism in modern society is breaking down communities. In the past, the family and community provided much of the caring needed in illnesses. Physical labour, reviving communities and reducing consumerism is the main lesson we can learn from the past.

IV.              Living with dignity

Reviving communities/ communities of a new type

To revive communities, first we have to understand why communities are breaking down. They are breaking down because the old society was unfree in many ways and curbed people’s aspirations. Now that cannot be reversed. Old type of communities havetypes of communities have to go.!

The driving forces are individualism and cash economy. If you have money in your pocket you are free to do what you want to do! Now, individualism has come to stay because people cannot give up the freedom they have achieved. But dependence on cash economy and consumerism can be reduced. The need for community will always be there because the human species is is a social species. What we need is a new type of community. A community not based on power and authority but on freedom. A free association of free people! In such a situation the insecurities will be less and one can avoid, to a large extent, the rapacious nexus of medical industrial complex, insurance scams and housing loans.

A rational health care

The rational health care will essentially be based on community care. It will be based on caring and not fleecing. It will be based on a healthy life style – a good mix of mental and manual outdoor work, a healthy diet and a stress-free, peaceful tranquil life! Illnesses and diseases can and will still occur but they can be more effectively dealt with in such a situation.

In health care there are three components – knowledge based reassurance, relief and cure – in decreasing order of importance. A well-trained and experienced doctor can indeed play a very important role. However, he will be much more effective in delivering health care in a community based health care system than in the present market based system.

VI. Dying with Dignity: Doctors and Death

Most classics in medical literature, in all systems of medicine, ask the doctor to respect people, reduce their sufferings and when death is inevitable, not to prolong the misery. However, as we have seen above, a new culture has come into being where prolonging life at all costs has become a lucrative business at the cost of the patients and their families. Often, doctors are helpless because of the pressure of this culture and the possibility of the patient’s families taking them to court. Family members, in turn, feel helpless lest their neighbours say that to save money these people let the patient die! We need to restore the concept of living and dying with dignity.

Euthanasia and the Living Will

There are many cases where it is no longer good to prolong life, which in fact amounts to prolonging death. In some countries medically assisted death is legal. However, in most countries it is not and many may not want it. For such cases, a ‘Living Will / Advance Directive’ is useful. It is made when the person is of sound mind and gives his/her directive to doctors, relatives and friends for such situations. Essentially, it asks them not prolong their death with medical intervention or treatment, not to put them on life support systems and manage their last hours with painkillers only, even if it shortens their life.

Cultural and Religious Traditions

In most societies there is a tradition and ritual of meeting death with dignity and peace. In essence it is similar to the living will. However, here it is not solely dependent on individual will but there is a community support. The Christian tradition of Hospice comes closest to the living will, where medical care is provided to reduce suffering but not to prolong death. Some Hindus build a cottage next to a holy river and spend their last days peacefully.  Jains have a tradition of systematic fasting to death with religious rituals. Some tribes in Fiji believe that after death they will live eternally at the age at which they died. So they prefer to die in their prime! In the polar region some communities send their old on a boat with provisions. It is possible to build secular traditions too. In Hyderabad, there is an old-age home run by the Communist Party!

ADD LIFE TO YOUR YEARS AND NOT YEARS TO YOUR LIFE!

Published in Calcutta, Frontier, June 26, 2005 also in Medico Friends

Circle Bulletin, October, 2005.