5 ms·

"The decision to provide end-of-life care to many older adults is highly questionable; very few elderly have been hospitalised for COVID-19. Appropriate (potent

by deng 5y ago

"The decision to provide end-of-life care to many older adults is highly questionable; very few elderly have been hospitalised for COVID-19. Appropriate (potentially life-saving) treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission. [...] there was only limited public outcry in Sweden when this came out, the common narrative being that those in care homes are expected to die soon anyway. [...] Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives." This is quite shocking. I didn't think this would be possible in a country like Sweden.

marginalia_nu 5y ago
I think this slipped by mostly unnoticed because the heavily polarized debate climate didn't really permit admitting fault or mistakes, it had turned into a trench war mostly about on whose side you are on. Really toxic dynamic.
tored 5y ago
In the early stages of the COVID-19 pandemic 9 out 10 deaths in Sweden was on persons over 70 years of age and half of them lived in a nursing home. I'm not sure what the current statistics says but probably within the same ballpark. This is why Sweden has had a such a high death toll, because of bad care given to the elderly. One big problem is that nursing homes in Sweden is often run by the kommun (city) whereas the hospital is run by the landsting (region), kommuns lacks the medical expertise on nursing homes to handle that kind of sickness, no oxygen or iv therapy. And there has apparently been a reluctance to send patience from the nursing homes to the hospitals instead treating them at place, which increased the risk of dying. Many elderly suffers from malnutrition in these nursing homes, malnutrition increases the risk of early death drastically. I would also argue that it culturally exists ageism in Sweden, Swedish core belief is state sponsored individualism, you don't have any responsibility on others because your maximal individual freedom is guaranteed by the state, thus you basically dump the elderly on a nursing home never to be seen again, it is not your responsibility, it is the state. Much of the Swedish society is very youth centric, it is not uncommon to find arguments a long the line, "it is good if the elderly dies off because they are holding us back". This also explains why Sweden is so eager to jump on every new trend there is, progressivism in a nutshell.
- emj 5y ago
  This is not Sweden. While a lot of it rings true; like the strange mix of fierce indivudalism and collectivism in Sweden, and how we really did mess upp early elder care. I only have anecdata about elder care; my relative just now died in an one such home from brain damage + malnutrition the amount of care, happines and grit that was done to make her eat was heart warming. The same place hade been hit very hard by Covid, which ment they now had extreme proceedures in place that limited our visiting possibilities, that ment they had zero Covid cases during the peaks in 2021. I think most of the care homes learnt after the first wave, at least I hope that my experience was representive.
  - saiya-jin 5y ago
    While your personal experience is heartwarming, others here point to what I would describe state-approved cruelty of effectively euthanizing elderly who got seriously sick with covid earlier. That's not cool at all and even if now things are different its a right thing to point to these widespread failures that caused a lot of unnecessary death.
    - thematrixturtle 5y ago
      Few elderly patients who end up on ventilators for COVID survive, plus the process is very painful and causes permanent damage if you survive. So morphine actually sounds like a pretty good way to go, assuming there's some form of informed consent.
      - emj 5y ago
        The problem was that there were cases were consent was not given and of healthy 70 year olds having to fight for ventilators at least in the beginning. From what I understood a lot changed when people realized what was happening in June 2020, the paper is pretty vague about this it talks mainly about the first half of 2020.
    - emj 5y ago
      That is a pretty extreme interpretation of the paper. That view is also not helpfull if you want to talk about the regional problems around Sweden, it has been mentioned in other comments here. The paper is just bringing up a discussion we have had since june 2020 in Sweden, I sure do not think we will not stop discussing it.
Giorgi 5y ago
So they simply put their elderly population to sleep like a rabid animal and claimed it was effective strategy against COVID19 to not lock down.
UrsaMedius 5y ago
"Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives." This is from the abstract, but as far as I could find, this is never mentioned in the actual text of the paper? Certainly there's no reference to "oxygen", "morphine", or "administer" on the linked web page. So I guessed this had something to do with "end-of-life care", which is discussed in Supplement 6. But I could not find any explicit reference to morphine or oxygen there or in the sources of the supplement, either. Maybe it's in (Habib, 2020), but the link is broken.
- sampo 5y ago
  > Maybe it's in (Habib, 2020), but the link is broken. It's easy to find the article, you just google search with the article title. https://www.bmj.com/content/369/bmj.m2376 https://www.bmj.com/content/369/bmj.m2376 > Yngve Gustafsson, professor of geriatric medicine at Umea University, noted that the proportion of older people in respiratory care nationally was lower than at the same time a year ago, despite people over 70 being the worst affected by covid-19. He expressed concern about the increasing practice of doctors recommending by telephone a “palliative cocktail” for sick older people in care homes. > “Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting,” he told the Svenska Dagbladet newspaper [5], “It’s active euthanasia, to say the least.”
  - UrsaMedius 5y ago
    Thanks!
  - pvaldes 5y ago
    Is murder, not euthanasia. Euthanasia requires the explicit desire of being killed, clearly expressed by the patient, normally with the family knowledge and after legal consultation that proves that there is excruciating pain are there is not a better alternative for treatment. And this is killing a helpless person unable to defend his life or will, and blocking their relatives to help him/her in this task. And it was not exclusive from Sweden, probably.
- deng 5y ago
TazeTSchnitzel 5y ago
From the perspective of someone living in Sweden: considering how the elderly care sector seems to be organised to extract as much privatised profit as possible, rather than to make efficient use of money to help the people in care, I am not surprised that the pandemic response was so uncaring.
daneel_w 5y ago
"This is quite shocking. I didn't think this would be possible in a country like Sweden." None of us living here thought it would be possible either. These irrational procedures, and the fact that the social democrats have repeatedly been stating in no unclear terms that Sweden's biggest problem is the elderly/geriatric demographic "who provide nothing and just cost us a lot of pension money", is why people think the strategy was entirely deliberate.
- thematrixturtle 5y ago
  Would you have a cite for that? I would expect any politician admitting to that (as opposed to merely thinking it) to get crucified even in Sweden.
cinntaile 5y ago
I think it sounds worse than it is. The number of oxygen machines is limited and the chances of survival even with an oxygen machine are not good for elderly people. If your projections say that you will get a certain number of younger people that will also need an oxygen machine then it makes sense to reserve those machines, they have a much higher chance of survival when using an oxygen machine. Not doing a proper medical examination on the other hand is irresponsible imo.
- mike00632 5y ago
  You're overlooking the fact that Sweden's policies encouraged the spread of COVID. It wasn't inevitable that so many people got COVID before the vaccine.

by deng 5y ago

marginalia_nu 5y ago

I think this slipped by mostly unnoticed because the heavily polarized debate climate didn't really permit admitting fault or mistakes, it had turned into a trench war mostly about on whose side you are on. Really toxic dynamic.

tored 5y ago

In the early stages of the COVID-19 pandemic 9 out 10 deaths in Sweden was on persons over 70 years of age and half of them lived in a nursing home. I'm not sure what the current statistics says but probably within the same ballpark. This is why Sweden has had a such a high death toll, because of bad care given to the elderly. One big problem is that nursing homes in Sweden is often run by the kommun (city) whereas the hospital is run by the landsting (region), kommuns lacks the medical expertise on nursing homes to handle that kind of sickness, no oxygen or iv therapy. And there has apparently been a reluctance to send patience from the nursing homes to the hospitals instead treating them at place, which increased the risk of dying. Many elderly suffers from malnutrition in these nursing homes, malnutrition increases the risk of early death drastically. I would also argue that it culturally exists ageism in Sweden, Swedish core belief is state sponsored individualism, you don't have any responsibility on others because your maximal individual freedom is guaranteed by the state, thus you basically dump the elderly on a nursing home never to be seen again, it is not your responsibility, it is the state. Much of the Swedish society is very youth centric, it is not uncommon to find arguments a long the line, "it is good if the elderly dies off because they are holding us back". This also explains why Sweden is so eager to jump on every new trend there is, progressivism in a nutshell.

emj 5y ago
This is not Sweden. While a lot of it rings true; like the strange mix of fierce indivudalism and collectivism in Sweden, and how we really did mess upp early elder care. I only have anecdata about elder care; my relative just now died in an one such home from brain damage + malnutrition the amount of care, happines and grit that was done to make her eat was heart warming. The same place hade been hit very hard by Covid, which ment they now had extreme proceedures in place that limited our visiting possibilities, that ment they had zero Covid cases during the peaks in 2021. I think most of the care homes learnt after the first wave, at least I hope that my experience was representive.
- saiya-jin 5y ago
  While your personal experience is heartwarming, others here point to what I would describe state-approved cruelty of effectively euthanizing elderly who got seriously sick with covid earlier. That's not cool at all and even if now things are different its a right thing to point to these widespread failures that caused a lot of unnecessary death.
  - thematrixturtle 5y ago
    Few elderly patients who end up on ventilators for COVID survive, plus the process is very painful and causes permanent damage if you survive. So morphine actually sounds like a pretty good way to go, assuming there's some form of informed consent.
    - emj 5y ago
      The problem was that there were cases were consent was not given and of healthy 70 year olds having to fight for ventilators at least in the beginning. From what I understood a lot changed when people realized what was happening in June 2020, the paper is pretty vague about this it talks mainly about the first half of 2020.
  - emj 5y ago
    That is a pretty extreme interpretation of the paper. That view is also not helpfull if you want to talk about the regional problems around Sweden, it has been mentioned in other comments here. The paper is just bringing up a discussion we have had since june 2020 in Sweden, I sure do not think we will not stop discussing it.

Giorgi 5y ago

So they simply put their elderly population to sleep like a rabid animal and claimed it was effective strategy against COVID19 to not lock down.

UrsaMedius 5y ago

"Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives." This is from the abstract, but as far as I could find, this is never mentioned in the actual text of the paper? Certainly there's no reference to "oxygen", "morphine", or "administer" on the linked web page. So I guessed this had something to do with "end-of-life care", which is discussed in Supplement 6. But I could not find any explicit reference to morphine or oxygen there or in the sources of the supplement, either. Maybe it's in (Habib, 2020), but the link is broken.

sampo 5y ago
> Maybe it's in (Habib, 2020), but the link is broken. It's easy to find the article, you just google search with the article title. https://www.bmj.com/content/369/bmj.m2376 https://www.bmj.com/content/369/bmj.m2376 > Yngve Gustafsson, professor of geriatric medicine at Umea University, noted that the proportion of older people in respiratory care nationally was lower than at the same time a year ago, despite people over 70 being the worst affected by covid-19. He expressed concern about the increasing practice of doctors recommending by telephone a “palliative cocktail” for sick older people in care homes. > “Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting,” he told the Svenska Dagbladet newspaper [5], “It’s active euthanasia, to say the least.”
- UrsaMedius 5y ago
  Thanks!
- pvaldes 5y ago
  Is murder, not euthanasia. Euthanasia requires the explicit desire of being killed, clearly expressed by the patient, normally with the family knowledge and after legal consultation that proves that there is excruciating pain are there is not a better alternative for treatment. And this is killing a helpless person unable to defend his life or will, and blocking their relatives to help him/her in this task. And it was not exclusive from Sweden, probably.
deng 5y ago

TazeTSchnitzel 5y ago

From the perspective of someone living in Sweden: considering how the elderly care sector seems to be organised to extract as much privatised profit as possible, rather than to make efficient use of money to help the people in care, I am not surprised that the pandemic response was so uncaring.

daneel_w 5y ago

"This is quite shocking. I didn't think this would be possible in a country like Sweden." None of us living here thought it would be possible either. These irrational procedures, and the fact that the social democrats have repeatedly been stating in no unclear terms that Sweden's biggest problem is the elderly/geriatric demographic "who provide nothing and just cost us a lot of pension money", is why people think the strategy was entirely deliberate.

thematrixturtle 5y ago
Would you have a cite for that? I would expect any politician admitting to that (as opposed to merely thinking it) to get crucified even in Sweden.

cinntaile 5y ago

I think it sounds worse than it is. The number of oxygen machines is limited and the chances of survival even with an oxygen machine are not good for elderly people. If your projections say that you will get a certain number of younger people that will also need an oxygen machine then it makes sense to reserve those machines, they have a much higher chance of survival when using an oxygen machine. Not doing a proper medical examination on the other hand is irresponsible imo.

mike00632 5y ago
You're overlooking the fact that Sweden's policies encouraged the spread of COVID. It wasn't inevitable that so many people got COVID before the vaccine.