Different standards adopted for those who want to put lives at risk

OVER the weekend, thousands of people in this country will have put themselves in danger. Some of them will have risked life and limb by engaging in extreme sports, like rock climbing and cliff walking, which don’t usually come under that category heading.

The search and rescue helicopter passed over my home at least once, and will have been ready to scramble at all times.

The RNLI lifeboats will have been on standby. The gardaí were undoubtedly called out in every county.

In their case, the life-and-limb issues included collisions on the roads. The fire brigade and that fast-and-furious arm of the HSE, the ambulance service, will have switched on their lights and their sirens and sped off on rescue missions.

All of the accidents that happened cost individuals, families and friends immeasurable stress and suffering. The cost to the State is financial, equally difficult to pin down, but undoubtedly enormous.

Each and every weekend’s toll of death and injury underlines the complex and utterly contradictory attitude we have to self-endangerment.

On the one hand, we have in recent years gained a new understanding of the grief caused by people taking their own lives, and while we formally re-state the right of anybody to end their existence, we strive to reduce the numbers and the causes. On the other hand, we accept as a kind of rite of passage the right of individuals and groups to engage in activities — including alcohol consumption — that endanger not only themselves, but others, too.

It was interesting, in this context, to note the non-reaction to comedian Dave McSavage’s revelation that he is back on the booze after a decade of sobriety.

“I went back on the drink to feel good. You have more fun when you’re drunk than when you’re sober,” he says. “And at the moment I am having lots of fun and it’s a pleasant distraction.”

This from a man who had bad times, in public, during his drinking years, and who has acknowledged that it is dangerous for him to go back to alcohol. But, he adds, “if the same thing happens again, I can always go back to AA”.

AA members — being anonymous and mutually supportive — didn’t publicly react to these observations from their once-and-possibly-future member. The rest of the coverage treated McSavage’s comments as nothing more than the legitimate self-revelation of a man publicising an upcoming show: Sure, it’s his own business and if he chooses to endanger himself, he’s all grown up, let him at it.

Yet in the same week, a story surfaced about a hospital seeking, and getting, permission to force-feed a woman in her twenties suffering from anorexia. The details of her current and ideal weight were given, as was the likelihood of her death if she were allowed to continue to starve herself. Anorexia, particularly if the patient has suffered it for a long time, is a recognised illness. Alcoholism, likewise. Yet in the case of the first illness, the sufferer can be — albeit with the assistance of their concerned family — effectively committed to a hospital which can seek state permission to interfere with their right to endanger their life, whereas in the case of the second illness, the very concept of such action would sound like an egregious infringement of the rights of the sufferer.

One of the differences, of course, is that the female anorexia sufferer has been travelling through the healthcare system since she was 12. This classifies her as ill and puts the healthcare system in a quasi-parental role it does not and cannot adopt vis-à-vis a person who abuses alcohol.

Which raises the question: Does engagement with any state healthcare system inevitably impinge on your right to put yourself at risk? In some cases, the answer is an unequivocal ‘no’. Someone diagnosed with Type I diabetes can choose, if they so desire, to eat sugar by the kilo and never take insulin, yet they will not find themselves committed to hospital or, if they enter a hospital as a result of self-care failure, will the hospital or any other health carer go to court to seek the right to enforce insulin on them.

On the other hand, involvement with the healthcare system as you age does tend to restrict your freedoms. Much was made, in the last few days, of Bernard Jordan, aged 89, who, when told by the staff of the National Health Service home where he lives in Hove that it wouldn’t be possible to get him to France for the ceremony commemorating the D-Day landings in which he had participated, decided he wasn’t having any of it. He escaped the home, pinned on his medals, persuaded someone to help him get onto a coach for France and turned up at the event. He met up with old friends who had climbed the bloodied sand on that historic day and booked into the same hotel with them. By the time he came back, the building where he lives was bedecked with flags congratulating him on his adventure. What a guy. Showing the courage that carried him and his colleagues through the Second World War. Lift your heart, his story would.

Maybe. But maybe it should also raise questions about his need to “abscond” from the home in the town of which he had once been mayor. Any reader who has visited an aged relative in a nursing home in this country will have unwillingly witnessed benign incarceration, often in the form of one of the residents — usually a newcomer — beg a visitor to take them home, out of “this place”. They may even have witnessed that resident making a run for it when the door from the main sitting-room was opened for them, the departing visitor. Glancing over their shoulder, they will have seen the staff engage in kindly distraction of the would-be absconder.

The family and friends of demented elderly people in care will tell you that they live, every day, with the guilt of knowing their mother or father or friend is in such a home. They inevitably add that the resident in the home has to be there to protect them, because their dementia means they would wander the neighbourhood in the middle of the night, forget to eat, or put the electric kettle on the gas stove.

The curious thing is that, in the past, every neighbourhood had elderly isolates who behaved oddly and probably endangered themselves on a daily basis. They were probably demented, but were not cared for in warm bright Hiqa-inspected nursing homes. They were free. Free to live in confused misery, perhaps, but free, nonetheless.

Dylan Thomas, who wrote that wonderful line “do not go gentle into that good night”, himself went into that night of death relatively young. Had he reached the age when he found himself looking down the barrels of his own dementia, he might have written “do not go gentle into that comfortable, caring, warm, clean prison”.