LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionneL Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deji paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Stop wasting health care dollars on dying seniors, physician says D
r. Fraser Mustard's com-
ments in the article by
David Heiwig (Can Med Assoc J 1990; 143: 653-654) and his response to the letter by Dr. Donald B. Wilson (Can Med Assoc J 1991; 144: 540) may not revitalize or enthral the elderly or energize medical students to rise to the challenge of modem geriatric medicine and hospice care. Many specialized centres have been engaged in the hospice movementl"2 since Dame Cicely Saunders first opened St. Christopher's Hospice Care in 1967.3 Politicization of this issue by a physician of Mustard's calibre could lead to a surreptitious re-
For prescribing information see page 1560
duction of resources to the elderly by policymakers. The sheer magnitude of the future problems of seniors calls for the establishment of a charitable organization such as the Center for Policy on Ageing in Britain.4 The purpose of this organization is to conduct research, give advice and information on issues affecting the elderly, carry out formal investigations into treatment and provide the background information required by health care providers. Sir William Osler's suggestion that men over the age of 60 should retire into a college for a year of contemplation before a peaceful departure by chloroform drew a widespread adverse reaction. This was regrettable, because Osler's real attitude was one of compassion in the care he gave to retired vicars in Ewelme, near Oxford.5 Mustard's advice to divert resources from dying elderly people to children may have overestimated the cost-effectiveness of preventive measures and underestimated that of caring for the elderly sick. Besides education and poverty there are other formidable obstacles in childhood, such as poor nutrition, poor housing, unplanned pregnancy, smoking, excess use of alcohol and other drugs, abuse, handicap and disability, congenital malformation and environmental pollution. There is no guarantee that 70 to 80 years of high-quality life can be expected for a young person. Even today the needs of the elderly are being overlooked. Occasionally physicians who are capable of treating pneumonia turn the other way, yet still allege that they practise geriatric medicine. Not surprisingly, elderly patients
with multiple symptoms receive polypharmacy instead of the skill required to unmask the medical, psychiatric, psychologic and social problems that can be effectively treated.5 The problems of dying elderly patients range from treatable acute disorders to chronic disorders that can be successfully rehabilitated. Correction of these problems is less expensive than rectifying the long-term disability and misery that may result from their neglect. Hospice care is a subspecialty of the general medical care that most of us hope will be administered by a knowledgeable and caring physician as we approach death.6 Bhubendra Rasaiah, MD, FRCPC Consultant clinical pathologist and director of laboratories
General Hospital Sault Ste. Marie, Ont.
References 1. Mount BM: The problem of caring for the dying in a general hospital; the palliative care unit as a possible solution. Can Med Assoc J 1976; 115: 119121
2. Hospice care [EJ. Lancet 1978; 1: 1193 3. Saunders DC: Principles of symptom control in terminal care. Med Clin North Am 1982; 66: 1169-1183 4. Centre for Policy on Ageing. Lancet 1983; 2: 60 5. Livfsley B: Cause of confusion [BR]. BMJ 1978; 1: 37 6. Quill TE: Death and dignity. N Engi J Med 1991; 324: 691-694
[Dr. Mustard responds:] Dr. Rasaiah has misunderstood the issue, which is not whether you provide compassionate care for the elderly but, rather, the kind of care you provide. CAN MED ASSOC J 1991; 144 (I 1)
1379
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionneL Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deji paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Stop wasting health care dollars on dying seniors, physician says D
r. Fraser Mustard's com-
ments in the article by
David Heiwig (Can Med Assoc J 1990; 143: 653-654) and his response to the letter by Dr. Donald B. Wilson (Can Med Assoc J 1991; 144: 540) may not revitalize or enthral the elderly or energize medical students to rise to the challenge of modem geriatric medicine and hospice care. Many specialized centres have been engaged in the hospice movementl"2 since Dame Cicely Saunders first opened St. Christopher's Hospice Care in 1967.3 Politicization of this issue by a physician of Mustard's calibre could lead to a surreptitious re-
For prescribing information see page 1560
duction of resources to the elderly by policymakers. The sheer magnitude of the future problems of seniors calls for the establishment of a charitable organization such as the Center for Policy on Ageing in Britain.4 The purpose of this organization is to conduct research, give advice and information on issues affecting the elderly, carry out formal investigations into treatment and provide the background information required by health care providers. Sir William Osler's suggestion that men over the age of 60 should retire into a college for a year of contemplation before a peaceful departure by chloroform drew a widespread adverse reaction. This was regrettable, because Osler's real attitude was one of compassion in the care he gave to retired vicars in Ewelme, near Oxford.5 Mustard's advice to divert resources from dying elderly people to children may have overestimated the cost-effectiveness of preventive measures and underestimated that of caring for the elderly sick. Besides education and poverty there are other formidable obstacles in childhood, such as poor nutrition, poor housing, unplanned pregnancy, smoking, excess use of alcohol and other drugs, abuse, handicap and disability, congenital malformation and environmental pollution. There is no guarantee that 70 to 80 years of high-quality life can be expected for a young person. Even today the needs of the elderly are being overlooked. Occasionally physicians who are capable of treating pneumonia turn the other way, yet still allege that they practise geriatric medicine. Not surprisingly, elderly patients
with multiple symptoms receive polypharmacy instead of the skill required to unmask the medical, psychiatric, psychologic and social problems that can be effectively treated.5 The problems of dying elderly patients range from treatable acute disorders to chronic disorders that can be successfully rehabilitated. Correction of these problems is less expensive than rectifying the long-term disability and misery that may result from their neglect. Hospice care is a subspecialty of the general medical care that most of us hope will be administered by a knowledgeable and caring physician as we approach death.6 Bhubendra Rasaiah, MD, FRCPC Consultant clinical pathologist and director of laboratories
General Hospital Sault Ste. Marie, Ont.
References 1. Mount BM: The problem of caring for the dying in a general hospital; the palliative care unit as a possible solution. Can Med Assoc J 1976; 115: 119121
2. Hospice care [EJ. Lancet 1978; 1: 1193 3. Saunders DC: Principles of symptom control in terminal care. Med Clin North Am 1982; 66: 1169-1183 4. Centre for Policy on Ageing. Lancet 1983; 2: 60 5. Livfsley B: Cause of confusion [BR]. BMJ 1978; 1: 37 6. Quill TE: Death and dignity. N Engi J Med 1991; 324: 691-694
[Dr. Mustard responds:] Dr. Rasaiah has misunderstood the issue, which is not whether you provide compassionate care for the elderly but, rather, the kind of care you provide. CAN MED ASSOC J 1991; 144 (I 1)
1379
