Taking care: Our aging society
Part Four of Four

By Susan Brinkmann
CS&T Correspondent

The coming geriatric age will test us as a nation, a society, and a people.

The President’s Council on Bioethics puts it very simply in its report, “Taking Care: Ethical Care- giving in Our Aging Society.”

“The kind of society we are will be measured in the years ahead by how well (or how poorly) we care for those elderly persons who cannot care for themselves; by whether we support the caregivers who devote themselves to this noble task; and by whether we sustain a social world in which people age and die in humanly fitting ways.”

As the report suggests, we may soon find ourselves forced to ask some hard questions, such as, “What makes a diminished life worthy of our care, or worthy of life at all, or worth the resources society must expend to sustain it?”

Public discussion of end-of-life issues today is too frequently framed in the context of “quality of life,” the report states. Instead of asking how we should care for the vulnerable among us, we often find ourselves questioning why we should care for them, especially people who are no longer “useful” to themselves or others.

Although the quality of life is certainly one of the fundamental principals that should guide caregivers, it is not the only one, nor is it the most important, the report says: “Valuing only the healthy, wealthy or competent seems to deny the worth that all individuals possess equally, simply by virtue of our shared humanity.”

When it comes to matters of life and death, “the most basic commitment of our society is and has been to human equality,” the Council states. “In a society dedicated to the proposition that all men are created equal, we must ensure that we do not allow the genuine inequalities of human capacities and human character to blind us to the equal humanity of all human beings.”

Rumblings are already being heard about the need to pass laws allowing physician-assisted suicide as a way to handle the coming tsunami of baby boomers who will reach the age of 85 within the next 50 years. But the President’s Council makes it quite clear that assisted suicide or euthanasia is not an option, much to the consternation of some of its own members.

For instance, Dr. Janet Rowley added a letter to the appendix, stating that she believed the ruling out of euthanasia was “scary” and “draconian,” and suggested that demented grandparents would actually be stealing resources from their grandchildren.

As shocking as that statement sounds, it nevertheless is considered by some to be to the answer to some very tough questions: What is considered good care for people in diminished physical or mental conditions? What should be the relationship between good care and a good death? What should we do when caring for an aging parent makes it much harder to care for our own children?

But assisted suicide is certainly not the only answer — in fact, some believe it may be a signal that the health care industry needs to do a better job with end-of-life care.

“We believe that what physician-assisted suicide is doing is offering an alternative to what health-care systems should provide,” said Sister Karin Default, executive director of the Supportive Care of the Dying Coalition.

Located in the heart of the physician-assisted suicide movement in the United States, Portland, Ore., that coalition consists of Catholic health care organizations that are striving to stay on the cutting edge of the science and the art of end-of-life care. The 16-member Coalition brings Catholic principals of respect for life in all its phases to health-care operations in 48 states.

“Our best way of speaking to the whole issue of physician-assisted suicide is to provide excellent end-of-life care, and to reduce the reasons for which people are saying that physician-assisted suicide ought to be allowed,” Sister Dufault said.

“Health-care professionals need to be educated in the art and science of palliative and end-of life care, because there is so much more that we know today that people didn’t learn when they went through school,” she added.

The supportive care coalition collaborates with professional groups to provide their members with educational resources and information about the medical and technological advances in the art and science of end-of life care.

The Catholic Health Care System of the Archdiocese of Philadelphia is the only diocese in the country to join the coalition. Other coalition members include the Catholic Health Association of the United States, Catholic Healthcare Partners, CHRISTUS Health, and Catholic Health Initiatives.

Sister Dufault sees care ethical issues surrounding end-of-life, particular by the coming geriatric age, as an issue that has will have no easy solution.

“Among the problems that need to be addressed is [that] there is a lot of confusion with regard to decision-making for end-of-life treatment,” she said. “We also live in a culture that is both death-denying and death-defying.”

People deny the reality of death by delaying discussions about end-of-life care until it is too late, or until the family is forced to deal with the death of one of its members under great stress.

We defy death by resorting to technology that enables us to postpone or prolong dying, even to the extreme. When end-of-life decisions need to be made, either we do not want to let go or we let go too soon.

That is why people should take the time to educate themselves while they have time. Church documents are an important source of information, particularly for those who want guidance about how to make those difficult decision in a way that will bring peace both to themselves and their loved one who is dying.

“People should read the Declaration on Euthanasia, and Pope John Paul’s encyclical on the Gospel of Life, as well as the ethical and religious directives, which offer wonderful guidance that has been a part of our tradition for a long, long time,” Sister Dufault said.

Those resources contain basic principals “that just make sense,” she said. “We’ve been looked to, in the circles of palliative care, until recently, as being among the most enlightened. Our ethical principals have guided many organizations.”

Educating ourselves and changing our attitude is only part of the solution, however. We must also learn how to present our beliefs better to a secular society that doesn’t always share them, and in a way that makes sense to them.

“We can’t just be against something,” Sister Dufault said. “For instance, we are against abortion, but we also must be for a society that supports young women, and helps them take care of their children. The same is true for physician-assisted suicide. Many people choose this because they don’t want to burden their family, or feel their family won’t be able to cope.’

And for good reason. There are too few family support systems available for those who want to take care of their loved ones until the day they die. “Instead of legislation for physician-assisted suicide, we need legislation that is going to support families, and help fund the palliative care and hospice programs,” Sister Dufault said. “We can’t ignore that part of it.”

The President’s Council agrees that our first priority is to make our society a place where all life is respected: “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.”

For more information about the Supportive Care of the Dying Coalition, visit www.careofdying.org or call 503-215-5053.

Contact Susan Brinkmann at fiat723@aol.com or (215) 965-4615.