[Opinion] Important ethical questions for all of us

A few weeks ago, I wrote about a death in a retirement village in Sydney that went unnoticed for five days [A Death in the Village – 29 Jan 2016] and some of the challenging questions that inevitably arise around privacy, surveillance, risk, responsibility and sacrifice.

It was interesting to subsequently read a coroner’s report about a similar scenario that took place in a retirement village in New Zealand in 2010. In that case the man was estimated to have been dead for almost two weeks before he was discovered.

…the question that is almost as an accusation: shouldn’t older people living alone be monitored somehow?

The coroner’s inquiry in this case heard remarkably similar questions and concerns to those my friend had raised in relation to her mother’s ‘death in the village’ experience.   The dead man’s wife and family want to know, why didn’t anyone notice anything sooner? Things like lights left on or an uncleared mailbox?

And following on from this, the question that is almost as an accusation: shouldn’t older people living alone be monitored somehow?

The right to remain independent

Personally, I was pleased to read the responses of both the man’s private doctor and the village operator’s regional manager, defending the man’s right to live independently, free from any system of unsolicited surveillance.

The regional manager of the village group described the optional safeguards that were in place – the option to have a village staff member to make a daily check on a resident, for a small additional fee; or the opportunity to have a meal delivered daily – another approach that “acted as an effective check on the individual”.  The man in question had declined both options.

The man’s apartment was also fitted with a 24 hour monitored nurse-call alarm.  The man did not or was not able to activate it.

The coroner also heard that the village did operate a neighbourhood watch scheme, in which residents were encouraged to participate, and in fact it was this scheme that led to the eventual alert and discovery of the man.

The coroner heard from both the doctor and village management that there was no apparent reason for the village operator to monitor the man closely.  In fact, management believed he would have been “mystified and potentially insulted if they insinuated that he needed checking or needed someone to look after his affairs”.

These included regular weekly checks on all new residents on an ‘opt-out’ basis, rather than ‘opt-in’; face to face reviews of all residents every two years and then annually from age 80; and a proactive notification system for reporting to the resident’s next of kin.

But what to do?

The coroner was satisfied that the village operator provided a good service and could not be held responsible. Nevertheless, he found that a death in these kind of circumstances was unacceptable and he offered a number of ‘suggestions’ for the village operator and for retirement villages generally, which he believed should be considered.

These included:

• regular weekly checks on all new residents on an ‘opt-out’ basis, rather than ‘opt-in’;
• face to face reviews of all residents every two years and then annually from age 80; and
• a proactive notification system for reporting to the resident’s next of kin.

Responding to the coroner’s findings, legal counsel for the village operator expressed a contrary view.

Outlining a number of small, respectful policy changes on the part of the village operator – involving greater promotion of the existing checking services already on offer – the Queens Counsel concluded that his client, “believes that a formal review process would be perceived by residents as a threat to their independence.”

While his client was very keen to avoid such a situation arising again, he said, it was their experience that, “the vast majority of independent residents are fiercely independent and it is important to them that their independence and privacy are respected.”

“Independent residents do not like to think they are living in a rest home and they would not expect to be told they will receive a check-up service unless they decide to opt out.”

This case attracted a lot of media attention both at the time of the death and in 2013 when the coroner’s report was handed down.  Having read both the full coroner’s report and some of the media coverage I feel strongly that the village operator was indeed, not to blame.

Time for some difficult conversations

But what it also casts into sharp relief is that, right across the community, from bereaved family members to senior figures in the justice system (such as the coroner in this case), we need to get better at having some of those thoughtful, honest and yes, ‘difficult’ conversations.

It is very easy to leap to a position of outrage when we are confronted with grief, guilt and unanswered questions, and we want to find people, processes or organisations to blame.  But we need to pause and think about these things rationally and ethically, putting ourselves in the situation.

Would I tolerate a village environment where annual checks were mandatory and a family reporting mechanism implemented that is beyond my control? How much freedom, independence and dignity would I be prepared to sacrifice to satisfy someone else’s idea of keeping me safe?

This is ethical territory we need to explore as a community and we need to stop pretending that it relates to ‘other people’. It relates to all of us.  Neighbour Day is coming up next month so more on this next week.