AGING AND DIGNITY

"Cast Me Not Off in Old Age"
By Eric Cohen and Leon R. Kass
Although growing old is a natural part of being human, the circumstances in which most Americans age and die are increasingly "unnatural" and surely unprecedented. Death comes on the doctor's watch and in high-tech surroundings, almost always following years of chronic illness, typically preceded by decisions about further medical intervention, increasingly made on behalf of patients incapable of making decisions for themselves. Thanks to medicine's prowess in sustaining life on the edge, it is harder than ever to know when it is "time to die." [Commentary, January 3, 2006.]

The Aging Self
A new report from the President’s Council on Bioethics -- entitled Taking Care: Ethical Caregiving in Our Aging Society -- addresses one of the gravest ethical and social questions now facing us: living well with the burdens of mass aging and extended decline, and caring well for those who suffer debilitating diseases like Alzheimer’s. This excerpt reflects on what it means to be an aging person in the modern world, for better and for worse. [The New Atlantis, Number 10, Fall 2005, pp. 101-113.]

The Human Face of Alzheimer’s
By Colleen Carroll Campbell
As our population ages, more of us can expect to encounter the ravages of Alzheimer’s. The death of Ronald Reagan put this disease into the national spotlight—bringing us face to face with the suffering patient, the loving caregiver, and the possibility of dignity amid decline. Colleen Carroll Campbell looks at the medical, ethical, and personal aspects of living with dementia. [The New Atlantis, Number 6, Summer 2004, pp. 3-17.]

AGING AND DEPENDENCE

The Caregiving Society
By Peter Augustine Lawler
As America ages, we will confront the dilemmas of caregiving on a mass scale, living long enough to suffer cognitive and physical decline in a culture that values the vigor and freedom of youth. It can be humiliating for those who think of themselves as autonomous individuals to confront the human realities of familial dependence. These are the tensions and paradoxes of caregiving in the age of individualism, writes Peter Lawler, and the "ownership society" is only one dimension of living well with aging in America. [The New Atlantis, Number 8, Spring 2005, pp. 3-13.]

What Living Wills Won't Do
The limits of autonomy
By Eric Cohen
For decades, we have deluded ourselves into believing that living wills would solve our caregiving problems; that healthy individuals could provide advance instructions for what to do if they became incompetent; that such a system would ensure that no one is mistreated and that everyone defines the meaning of life for himself until the very end. But it is now clear that living wills have failed, both practically and morally. [Weekly Standard, Volume 010, Issue 29, 18 April 2005.]

AGING AND HEALTHCARE

Conservatives, Liberals, and Medical Progress
By Daniel Callahan
Throughout the developed world, healthcare systems are in crisis—with unsustainable costs, aging populations, and misguided priorities. The usual solutions—more markets, more government—are inadequate to the challenges we will face in the years ahead. Instead, conservatives and liberals alike need to rethink their assumptions about the benefits of medical progress and the struggle against death. Better medical technology, says Daniel Callahan, does not always mean better medicine, and a sane medical system needs to face up to the realities of our mortal condition. [The New Atlantis, Number 10, Fall 2005, pp. 3-16.]

The Politics and Realities of Medicare
By Eric Cohen
Despite the bitter disagreements over Medicare, liberals and conservatives share two basic assumptions: the ideal of self-determination and the ideal of medical progress. They both want more choice for the aging, and they both believe that more drugs for more people is an unequivocal good, even if they disagree about how best to achieve these goals. And so they are both, in different ways, prone to utopianism, believing that the right policies will create a world where the Medicare crisis is largely solved. This is a fantasy shared by liberal and conservative thinkers alike, whether packaged in the rhetoric of new vouchers or new entitlements. [The Public Interest, Issue #156 (Summer 2004).]

CONFERENCE

Religious and Ethical Perspectives on the End of Life
The purpose of this June 2005 conference was to bring together Catholic, Protestant, and Jewish perspectives on caring for patients who can no longer speak for themselves. As America ages, the challenges of caregiving -- both ethical and social -- will only become more serious and more difficult. The questions before us are both very practical and very theoretical: we must think about what gives human life its worth and dignity; about the meaning of death in the age of modern medicine; about the relationship between the generations in a world where the incidence of dementia and long-term dependence are much-increased, while the ties of family and community have often weakened. We face difficult life-and-death decisions for the persons entrusted in our care, difficult legal and policy decisions about how such decisions should be made, and difficult theological and philosophical questions about the nature of human dignity and human equality.

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