Table Of ContentAging and Ethics
Contemporary Issues
in Biomedicine, Ethics, and Society
Aging and Ethics, edited by Nancy S. Jecker, 1991
New Harvest: Transplanting Body Parts and Reaping the
Benefits, edited by C. Don Keyes, in collaboration with
coeditor Walter E. Wiest, 1991
Beyond Baby M, edited by Dianne M. Bartels, Reinhard
Priester, Dorothy E. Vawter, and Arthur L. Caplan,
1990
Reproductive Laws for the 1990s, edited by Sherrill
Cohen and Nadine Taub, 1989
The Nature of Clinical Ethics, edited by Barry Hoff-
master, Benjamin Freedman, and Gwen Fraser, 1988
What Is a Person?, edited by Michael F. Goodman, 1988
Advocacy in Health Care, edited by Joan H. Marks, 1986
Which Babies Shall Live?, edited by Thomas H. Murray
and Arthur L. Caplan, 1985
Feeling Good and Doing Better, edited by Thomas H.
Murray, Willard Gaylin, and Ruth Macklin, 1984
Ethics and Animals, edited by Harlan B. Miller
and William H. Williams, 1983
Profits and Professions, edited by Wade L. Robison,
Michael S. Pritchard, and Joseph Ellin, 1983
Visions of Women, edited by LindaA. Bell,1983
Medical Genetics Casebook, by Colleen Clements, 1982
Who Decides?, edited by Nora K. Bell, 1982
The Custom-Made Child?, edited by Helen B. Holmes,
Betty B. Hoskins, and Michael Gross, 1980
Medical Responsibility, edited by Wade L. Robison
and Michael S. Pritchard, 1979
Contemporary Issues in Biomedical Ethics, edited by
John W. Davis, Barry Hoffmaster, and Sarah Shorten,
1979
Aging
and
Ethics
Philosophical Problems in Gerontology
Edited by
Nancy S. Jecker
University of Washington School of Medicine,
Seattle, Washington
.. Springer Science+Business Media, LLC
DEDICATION
For my mother,
Mae Anna Driscoll Silbergeld
November 23, 1923-November 22, 1990
Ubrary of Congre .. Cataloging in Publication Data
Main entlV under title:
Aging and Ethica: philosophical problems in gerontology I edited by Nancy S. Jecker.
p. cm. - (Contemporary issues in biomedicine, ethics, and
society)
Includes index.
ISBN 978-0-89603-255-2 ISBN 978-1-4612-0423-7 (eBook)
DOI 10.1007/978-1-4612-0423-7
,. Gerontology-Moral and ethical aspects. 2. Aging-Moral and
ethical aspects. 3. Death-Moral and ethical aspects. 1. Jecker,
Nancy Ann Silbergeld. II. Series.
HQ1061.A4555 1991
305.26-dc20 91-10792
CIP
© 1991,1992 SpringerScience+Business Media New York
Originally published by Humana Press Ine. in 1992
Softcover reprint of the hardcover 1s t edition 1992
AII rights reserved.
No partof this book may be reproduced, stored in a retrieval system, ortransmitted in any
form or by any means, electronic, mechanical, photocopying, microfilming, recording, or
otherwise without written permission from the Publisher.
10 9 8 7 6 5 4 3 2
Preface
The Aging Self and the Aging Society
Ethical issues involving the elderly have recently
come to the fore. This should come as no surprise: Since
the turn of the century, there has been an eightfold in
crease in the number of Americans over the age of sixty
five, and almost a tripling of their proportion to the
general population. Those over the age of eighty-five-
the fastest growing group in the country-are twenty
one more times as numerous as in 1900. Demographers
expect this trend to accelerate into the twenty-first century.
The aging of society casts into vivid relief a num
ber of deep and troubling questions. On the one hand, as
individuals, we grapple with the immediate experience
of aging and mortality and seek to find in it philosophical
or ethical significance. We also wonder what responsi
bilities we bear toward aging family members and what
expectations of others our plans for old age can reasona
bly include. On the other hand, as a community, we must
decide: What special role, ifa ny, do older persons occupy
in our society? What constitutes a just distribution of
medical resources between generations? And, How can
institutions that serve the old foster imperiled values,
such as autonomy, self-respect, and dignity?
Only recently have we begun to explore these
themes, yet already a rich and fruitful literature has
grown up around them. The essays in this volume address
a wide range of concerns, incorporate a multiplicity of
disciplines, and afford a broad perspective for viewing
the many timely and important issues members of an
v
vi Preface
aging society face. Somewhat procrusteanly, the issues
dealt with here can be viewed at four levels. The first
level is that of the individual experience of personal ag
ing, anticipation ofd eath, and understandingoffinitude.
Sally Gadow depicts these aspects vividly, describing the
experience ofl iving in an aging body and the reaction an
aging body prompts from others. The essays by Baier
and Moody explore the meaning ofa ging by calling attention
to the whole-life perspective later years afford and the
opportunity for self-knowledge and discovery this per
spective creates. Thomas Cole's paper also treats the
individual experience of aging, by elucidating its his
torical expression in the metaphor of life as a journey.
The incompleteness of this motif for raising larger
questions about the social significance of aging suggests
the need to transcend personal aging and consider aging
in a social context.
Moving then from a phenomenological and per
sonallevel to an interpersonal and public second level,
Hagestad describes the change in family structure an
aging society implies. English and Callahan attempt to
say what exactly grown children owe their elderly par
ents, as distinguished from what it would be kind or
salutary for them to provide. Fry considers concrete
problems of medical decision making with elderly patients.
She illustrates the significance of the elderly patient
adult offspring and elderly patient-nurse relationships
for safeguarding autonomous choices. Finally, Barker
and Jecker touch on the ways that patient-family rela
tionships can enable (or disable) responsible medical de
cision making.
The third level is oriented less toward the intimate
and interpersonal aspects of aging and more toward social
consciousness of and collective responsibility for it. One
Preface vii
issue that arises at this level is whether it is ever ethi
cally appropriate to disenfranchise the elderly from pub
licly financed life-extending medical care. Callahan and
Daniels suggest that it is, and delineate the conditions
where limiting health care for older persons is consistent
with standards of justice. Waymack rejects their argu
ments and attempts to show that using age as a criterion
of exclusion from medical care is not ultimately defen
sible. J ecker likewise casts doubt on the proposal to
exclude the elderly from life-extending medical care. She
challenges the concept of a "natural life span" upon which
this proposal rests. A related issue is how to define gen
eral health care goals for older Americans. Menzel shows
that figuring the costs of meeting health care goals is
enormously complex. Boyajian points out that a large
gap exists between initially stated goals and their
achievement in political and administrative processes.
A fourth and final level brings us full circle to the
general philosophical level with which our inquiry began.
Jonsen considers the salience of age and argues that the
elderly occupy a privileged position by virtue of their
collective past contributions. Schneiderman and Jecker
ask, What is a fitting stance toward human finitude and
aging? A final essay, by Nagel, suggests that coming to
terms with our "cosmic unimportance" requires learning
to feel at home with certain ironies in human existence.
Nancy S. Jecker
Acknowledgments
The Role of Intimate Others in Medical Decision Making, by Nancy S. Jecker
originally appeared in The Gerontologist, vol 30, 1990, eGerontological Society
of America
Umiting Health Care for the Old, by Daniel Callahan originally appeared in Setting
Umits, Simon & Schuster, Inc., 1f>1987 by Daniel Callahan
Families as earegivers: The Umits of Motality, by Daniel Callahan originally
appearad in The Archives of Physical Medicine and Rehabilitation, vol 69, 1988
The Meaning of Ufe and the Meaning of Old Age, by Harry R. Moody originaly
appeared in What Does It Mean to Grow Old?, Durham, NC, Duke University
Press 1986, Thomas R. Cole and Sally Gadow, ads
The Absurd, by Thomas Nagel originally appeared in the Joumal of Philosophy,
LXIII:20 (1971)
The Aging Society as a Context for FamUy Ufe, by Gunhild O. Hagestad was
reprinted by permission of Daedalus, Joumal of the American Academy of Arts
and Sciences, "The Aging Society," Winter 1986, Vol. 115, No.1, Cambridge, MA
What Do GroMl Children 0w8 'Their Parents?, by Jane English originaDy appearad in
Philosophical and Lsga/ Reflections on Parenthood, New York: OxfoJd University
Press, 1979, Onora O'Neill and Wi.iam Rudcick, ads.
Contents
v Preface
Contributors
Xl
The Aging Individual
3 The Meaning of Life
Kurt Baier
51 The Meaning of Life in Old Age
Harry R. Moody
93 Oedipus and the Meaning of Aging:
Personal Reflections and Historical Perspectives
Thomas R. Cole
113 Recovering the Body in Aging
Sally Gadow
Aging and Filial Responsibility
123 The Aging Society as a Context for Family Life
Gunhild O. Hagestad
147 What Do Grown Children Owe Their Parents?
Jane English
155 Families as Caregivers: The Limits of Morality
Daniel Callahan
171 Health Care and Decision Making
Sara T. Fry
187 Rethinking Family Loyalties
Evelyn M. Barker
199 The Role of Intimate Others in Medical
Decision Making
Nancy S. Jecker
ix
x Contents
Distributive Justice in an Aging Society
219 Limiting Health Care for the Old
Daniel Callahan
227 A Lifespan Approach to Health Care
Norman Daniels
247 Old Age and the Rationing of Scarce
Health Care Resources
Mark H. Waymack
269 Appeals to Nature in Theories ofA ge-Group Justice
Nancy S. Jecker
285 Paying the Real Costs of Lifesaving
Paul T. Menzel
307 Intent and Actuality:
Sacrificing the Old and Other Health Care Goals
Jane A. Boyajian
Philosophical Reflections on Aging and Death
341 Resentment and the Rights of the Elderly
Albert R. Jonsen
353 Ancient Myth and Modem Medicine:
Lessons from Baucis and Philemon
Lawrence J. Schneiderman
367 The Meaning of Temporality in Old Age
Nancy S. Jecker
375 The Absurd
Thomas Nagel
389 Index
