GESTIÓN EN SALUD PÚBLICA: BioEdge: The ethical complexities of ageing

BioEdge: The ethical complexities of ageing

Bioedge

The ethical complexities of ageing

by Xavier Symons | 28 Apr 2018 |

The “ethics of ageing” has become a pressing concern in recent years, with many nations around the world experiencing the profound effects of an “ageing population”. Debates over assisted suicide and euthanasia have also led many scholars to explore the meaning and significance of frailty and vulnerability at the end of life.

It is not surprising, then, that two major medical ethics journals have recently published themed issues on the ethical complexities of ageing.

The May edition of the journal Bioethics addresses a range of topics related to ageing, including the meaning of dignity in the context of old age; the ethics of dementia; the nature of vulnerability as experienced by older persons; and the meaning of a “successful” or “flourishing” end to one’s life. Philosopher John-Stewart Gordon, the editor of the special issue, writes that ageing raises a series of “important” and “perennial” issues that are in need of further discussion: “The last phase in human life is as important and valuable as any other period of human existence”.

Two of the papers in the issue offer a phenomenological critique of the concepts of dignity and ageing, with the authors arguing for a more precise definition of the terms that maps on to the lived-experiences of older persons.

Other papers in the edition discuss issues related to the autonomy and welfare of dementia patients.

A special edition of the journal Perspectives in Biology and Medicine addresses the topic of ageing from the perspective of a fourfold taxonomy, namely, ageing “as a time of robust health, of dementia, of frailty, or of advanced illness that ends in death”.

Historian and theologian David Barnard opens the edition with a poignant reflection on ageing as a “mystery”. Barnard argues that the influence of Western individualism and the “technologisation” of human experience has led us to treat ageing and death as a “technical problem” to be “fixed”. Yet according to Barnard, the proper response to frailty is not to seek to obliterate it by conquering aging itself, but rather to accept some of the losses associated with aging as part of the human condition.

“Die, my dear Doctor! That's the last thing I shall do,” said the 19th Century British foreign secretary Viscount Palmerston, not long before he slipped his cable. For all of us, dying is the last and perhaps most significant moment of life. Which is why recording the exact cause of death is a matter that calls for scrupulous accuracy – not just for epidemiological purposes, but also as part of our personal and social history.

But our disturbing lead story today – that Flemish doctors under-report euthanasia by a mind-boggling 550% -- throws all this to the winds. The most common practice, at least according to the latest research into the topic, is that most Flemish physicians who practice euthanasia lie on the death certificate.

Perhaps their offence is more understandable than jurisdictions which require doctors to lie. In many, like Oregon, they are told to record the patient’s underlying disease as the cause of death – as if JFK died of Addison’s disease rather than an assassin’s bullet.

Perhaps we should keep in mind the wise words of the author of a study on death certificates: “Death certificates are really important. We owe it to our patients to be able to accurately record why they die” — and thus to “help the living.”