For Immediate Release:

Wednesday, September 7, 2016

Every so often, a picture hits the internet and goes exponentially viral. Usually, these images are of cats playing banjos or one of the Kardashian sisters reading a book but the most recent image causes everyone to stop and think. The image is of an elderly couple, both in wheelchairs, saying good-bye to one another. They are holding hands, crying, wiping their tears with tissues.  So touched when I saw this I had to ask about medical ethics and insurance – wondering where this is all going.
Wolf and Anita Gottschalk have been married for 62 years. Wolf is drifting into dementia and also has lymphoma as well as congestive heart failure. Anita is growing feeble as well. You would think they would be comfortably settled into an assisted living home and living their last year’s side by side.  But no!  Issues related to medical ethics and insurance is creating another outcome.
They have been admitted into separate nursing homes. For the past eight months, family members have been driving Anita to see her husband on an every other day basis. Insurance keeps putting them off from the apparent; they deserve to be together. It is obvious that the Gottschalks have a wonderful family; the trip, one way, is 40 minutes yet the family understands well the importance of their act of mercy of keeping the couple together. The family has been pleading with their provider to reunite husband and wife. The insurance provider said that they may be able to make the arrangements over the next few weeks. We’ll see.  Seems to me that an obvious solution should be easily accomplished, but then again when you deal with medical ethics and insurance one never knows.
In the interest of transparency
To be perfectly clear, the Gottschalk’s are Canadian and are obviously a part of the Canadian healthcare system. Nevertheless, there are numerous cases here in the United States where the same lack of empathy occurs with married couples who are separated and forced to live apart. Our health insurance system often doesn’t know how to accommodate a couple in an assisted living environment.
The situation is bound to get much worse before it gets better. The Baby Boomer generation is aging. How will the healthcare system handle the challenge of a couple that has grown old and dependent upon both the system and one another? These are ethical arguments that must take place sooner rather than later.  Medical ethics and insurance needs to grapple with this issue sooner rather than later.
On one hand, life expectancy has been growing; medications and surgery enable us to not only grow older, but much more active as well. What will happen when active couples in their 80s or 90s have varying medical needs but a strong desire to remain close? Will insurance companies tell them they cannot live together, such as with the Gottschalk’s or allow them the dignity and peace of mind of spending their final days with one another?  Considering the state of medical ethics and insurance today, I would not expect a quick response to that question.
Decisions in front of us
From an ethical point of view, I strongly advocate a series of ethics conferences on addressing how America is going to deal with these decisions over the course of the next decade. The discussions must quickly take place to arrive at solutions that will protect the dignity of the elderly.  Medical ethics and insurance need to come together on this issue for the good of all concerned.
Anyone who has a parent in assisted or even in independent living understands how difficult the transition from is from fully independent to assisted living may be. However, the challenges will be taken to a whole new level if the insurance system forces couples to artificially separate if the level of care shows a disparity from one partner to the other.
From the point of view of facilitation, as a keynote speaker and ethics seminar leader, I would advocate a series of regional meetings with insurance providers and healthcare professionals to discuss the ethics of how to handle issues such as the avoidance of separation in elderly couples.
I would propose that providers develop policies and established procedures that would honor ethics over expediency so that couples would not have to be put through the misery of what the Gottschalk’s must currently endure. While it is obvious that Wolf Gottschalk is failing, it is impossible to not wonder how much more quickly his health is declining because the system itself does not care. They deserve a much better fate – medical ethics and insurance should help make that so.
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