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No Easy Answers: Ethical Dilemmas and Care for the Aged
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13866 |
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MODERN THOUGHT
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12 / 1988 |
5,957 Words |
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Harry R. Moody
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Are there any educated people not familiar with the Greek myth of Oedipus, made world-famous in the plays of Sophocles and the theories of Freud? But there are few indeed who know the myth of Tithonus, the Greek hero who craved immortality. Tithonus was granted his wish by the gods but then discovered that he had failed also to ask the gods for immortal youth. Thus Tithonus achieved his long life, only to survive in the miserable frailty and weakness of advanced age until finally the gods took pity on him and converted him into a grasshopper. The story of Tithonus has a resemblance to the Sorcerer's Apprentice, another cautionary tale about the perils of getting what one wishes for. In fact, both tales today are being played out in the field of medical technology: More and more people are living to advanced old age. But the results, in too many cases, are not exactly what we had hoped for.
No one can work for long in the fields of geriatrics (medical care of the aged) or gerontology (the study of the aging process) without occasionally harboring dark and dismal thoughts that are conveyed by the myth of Tithonus. A walk through a nursing home or a brief trip to the tinsel town of Miami Beach brings the unwelcomed thoughts: is this what we really wanted? Is this what medical science hath wrought? But ambivalent feelings about longevity are easily set aside. "This is no country for old men," wrote the poet W.B. Yeats, and modern America has cheerfully heeded his advice. We quickly put aside any ambivalence about old age and move on to brighter topics.
And yet, the professionals in health care cannot move on. Indeed, as children of aging parents, as citizens and taxpayers, all of us are in the same boat with the professionals. The myth of Tithonus is enacted before our eyes. The same advances in biomedical technology that now enable increasing numbers to reach old age also confront us with inescapable and difficult choices, decisions studied by the contemporary field of bioethics.
The most dramatic questions of bioethics are the ethical dilemmas of death and dying—for example, to prolong life or hasten dying—perhaps by terminating treatment or nutritional support. Who is to make such decisions and under what principles or authority? These problems are not unique to the elderly. But because more than two-thirds of deaths now occur among those over 65, the dilemmas arise disproportionately with elderly patients.
In addition, there are distinctive problems of diminished mental capacity that are very common among those of advanced age. We may point to Alzheimer's disease and other forms of mental impairment that occur disproportionately among older people, in turn raising questions about informed consent under conditions of diminished capacity. Beyond mental capacity, there are related questions posed by physical frailty. The frail elderly living at home or in the community are vulnerable to threats of many kinds, as we know from the phenomenon of elder abuse. But it is not always easy to know when protective intervention on their behalf is justified.
Then too, there are collective health-policy issues, particularly those tied to the escalating cost of health care. Comprising 11 percent of the population, the elderly now account for 30 percent of expenditures on health care. The figure is likely to grow in the future. Efforts at cost containment have already highlighted serious problems about justice and
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