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Ethics in an Aging Society

What to Do About Care for the Sick and Dying

WASHINGTON, D.C., OCT. 10, 2005 (Zenit) - Older people are our brothers and sisters in Christ. This was one of the points raised by Ireland's bishops as part of the Day of Life, observed last Sunday. The theme for this year's event was "Cherishing the Evening of Life."

A pastoral letter for the occasion was published in union with the bishops of Scotland and England and Wales. Released by the Irish bishops' conference Sept. 30, the letter dealt with what should be the proper attitudes toward older people. It also talked about the theme of euthanasia.

Euthanasia, the text noted, violates the divine law: "God is the giver of life, and he alone has the right to decide when a life should end." Moreover, the bishops warned: "The right to be able to choose to die can too easily become a duty to die."

The Canadian bishops' conference also intervened on the question of euthanasia recently. In a Sept. 23 press release, the conference expressed concern over a proposal before Parliament, Bill C-407, which could open the door to euthanasia.

United in their annual plenary meeting, Canada's bishops called upon Parliament and the government to reject the proposal. A better move, they said, would be to promote palliative and end-of-life care. "Our legal system should be inspired by a culture of life in which each person feels responsible for the well-being of others until their natural death," the bishops said.

U.S. report

End-of-life issues were also dealt with in a U.S. report published by the President's Council on Bioethics. The document, "Taking Care: Ethical Caregiving in Our Aging Society," was handed to President George Bush on Sept. 28.

We are on the threshold, the report warned, of a "mass geriatric society." On the one hand, advances in health care and life spans have given us a gift for which we should be grateful. On the other hand, "[s]uch a reshaping of the lifecycle will create enormous challenges for nearly every family and for the entire society."

This transition presents society with a variety of challenges. These include protected debility and dependence by an ever-larger group of people; an economic challenge for welfare and health programs; and a looming shortage of long-term care for the incapacitated.

Four in 10 people die only after an extended period of worsening debility, dementia, and dependence, the bioethics council report observed. Many millions of people already look after elderly parents, but medical advances that prolong lives mean that patients require more extensive, and expensive, care than before. As well, smaller families reduce the number of children available to care for parents, and the increasing participation of wives in the workforce further reduces a family's ability to look after the elderly.

The report concentrated on the ethical challenges of an aging society. "As individuals and as a society," it said, "we will need deeper wisdom and resources of character if we are going to age well in the years ahead." This involves reflecting on the mutual obligations between the young and the old, as well as combining an acceptance of the limits of medicine and economic resources, "while never abandoning conscientious and compassionate human care."

Even in the best circumstances, the bioethics council noted, with a loving family, competent doctors and a supportive community, we will still face hard decisions about how to care for the elderly. "Without some ethical compass to guide us," the council cautioned, "the effort to provide social and economic supports for caregiving will lack a clear foundation and guiding purpose."

Those in charge of looking after the elderly "are not saints," the report commented. For this reason, "we need to ensure that certain moral boundaries are firmly in place and that the necessary freedom to act exists within a social world where certain kinds of actions are unthinkable because they are ethically out of bounds."

And, the report continued, "it is precisely because of the heartache that accompanies seeing those we love suffer the ravages of dementia that we need to guide compassion with ethical reason, so that our compassion does not unwittingly lead us astray."

The text also noted the "complicated relationship between the legal and the ethical." The modern liberal society tends to give individuals the greatest possible freedom to make moral choices. This situation does not mean, however, "that free choice is the only or highest moral aim of our society."

Inhuman solutions

Getting down to details, the President's Council on Bioethics warned about a number of dangers in facing up to the problems posed by aging.

First, "we must erect firm and permanent safeguards against certain inhuman 'solutions' to the challenges of caring for the dependent elderly -- such as active euthanasia or the promotion of assisted suicide, solutions that define a category of persons as 'life unworthy of life' or as persons deserving of abandonment and beyond the scope of our care."

Second, "we must avoid allowing long-term care for the elderly and medical care in general to crowd out every other civic good."

Third, "[w]e must never betray our elders, but we must also recognize that we cannot (and should not) always do everything conceivable on their behalf."

Fourth, we must avoid both the danger that some old people will be abandoned or impoverished, with no one to care for them, and the other danger that is efficiently looking after people's physical needs, "but their deeper human and spiritual needs are largely ignored, because those with the closest ties are unable or unwilling to be with them."

Fifth, we need to avoid the medicalization of old age. This means seeing it just as a series of needs that can create a discontent with aging itself, leading to "an insatiable desire for more and more medical miracles," and creating an "illusion that we can transcend our limitations and that death itself may be pushed back indefinitely."

Members of the community

The final chapter of the report presents a number of conclusions, including:

-- "Human beings who are dwindling, enfeebled, or disabled in body or in mind remain equal members of the human community." This means, the report insisted, that they should be treated with respect and care.

-- Euthanasia and assisted suicide should be opposed, not only for moral reasons, but also because they are inconsistent with good care. "One cannot think wholeheartedly about how best to care for the life the patient now has if ending his or her life becomes, for us, always an eligible treatment option," the report warned. But we are not obliged to always choose treatments that prolong life at the cost of imposing undue misery.

-- Living wills "are not a panacea," noted the report. At best, they deal with just a fraction of the decisions caregivers must make for incapacitated persons. Many situations remain where decisions have to be taken, and perhaps what is more needed is to provide a directive specifying who should make crucial decisions on our behalf.

In their letter, the Irish bishops called to mind the example of Pope John Paul II, who "reminded us with his own painful witness that we can never say that a person, weakened by sickness or age, is useless and is no more than a burden to society." An example to keep in mind for future years.


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Ethics, Aging, Sick, Dying, Euthanasia

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