Allowing older people to make decisions.

It has been an interesting time over the last few weeks listening to the very public debate about a usually very private matter: the intimate care of elderly people. In making my response, I am taking as a given that the sponsors and the photographer behaved ethically and that patients, families, caregivers and rest-homes engaged in a full and appropriate consent procedure. The photographs were part of an essay in our professional nursing journal, not in a general public newspaper and it was in that context they were to be viewed. This is an important consideration and a fact seemingly overlooked by the media and some of the commentators on the subject, including members of NZNO's Gerontology Section. The photos are to be viewed in the context of a complete set of photos, in a photographic essay published in an issue of the journal that focused on aged care. I wonder if the response would have been the same had it appeared in New Zealand Doctor or the New Zealand Medical Journal?

The offence seems to be threefold: firstly, that the photos (the ones that really offended) featured people without their clothes; secondly, that older people, whether they gave their consent or not, were used for an industrial purpose; thirdly, that older people were unwittingly being exploited (and remember I am assuming full consent was obtained). The issues are all linked. Firstly, the nakedness. Society has historically been shy about the human body, perhaps less so in the case of children and nubile young people. However, more and more the human body in all its forms (scarred, amputated, reconstructed) is being used to tell stories and raise issue. The current "Dove" advertisements use the body to make a statement about female shape and size. So what is the problem in the current Kai Tiaki context? I wonder if it's not something to do with societal discomfort with the older body?

Secondly, caring work and being valued for it. While the media portrayed this as a deliberate act of industrial campaigning this is less clear if one reads the journal. That aside, the controversy highlights the public discomfort with caring work linked to industrial action. The public ambivalence towards intimate work makes it difficult for caring to be valued. The message is strong: we want you to do it; "we just don't want to know about it". While caring work remains invisible, it will remain under valued. Again the public discomfort seems worse when linked to the older patient.

Thirdly, the thorny issue of consent. My mother, aged 86, objects to people making assumptions about older people's competence. Does the article trigger prejudice about the ability of older persons to make decisions for themselves? Of course my thoughts are opinion, like all the thoughts raised recently and whatever the "facts" of the case may be, without having seen the article and the context in which it is published, the public is left worrying about one aspect of the safety of older people. This is a pity as I don't presume this was the intent of any of the people involved in the production or publication of the article.

Consciousness-raising about care and context is an important part of creating the conditions by which change can occur. Such consciousness-raising should rightly start with our own members who don't work in aged care and in which out of sight may mean out of mind. If older people and their families want to participate in consciousness-raising in the same way as other consumers of health care and other members of the public have, and, if this is an adult, informed decision, then surety this is their right and our privilege.

Jane O'Malley, RN, Runanga, West Coast