For decades, bioethics scholarship, empirical research, and recommendations concerning older adults has focused on decisions and care in patients nearing the end of life. Until recently, bioethics work on aging itself was limited. A focus on health care settings and policies also excluded bioethical analysis of a broader range of social determinants and policies that shape experiences of health and wellbeing in the decades before life ends.

To broaden this focus and speak to real-world challenges, The Hastings Center launched a two-year, grant-funded planning project in 2016 to learn how to look anew at ethical questions arising in the context of population aging. Our initial and continuing questions were: What does it mean to live a good life in late life? And, what does it mean to be a citizen of an aging society – one in which more people are over 65 than under 15?

This initial planning work has evolved into a research and public bioethics and humanities initiative – Bioethics for Aging Societies. This line of work is supported by grants from the Robert W. Wilson Charitable Trust, the National Endowment for the Humanities, the Retirement Research Foundation for Aging, and the National Institute for Aging (NIA). Hastings Center research scholar Nancy Berlinger oversees this widely interdisciplinary initiative. It builds on earlier project collaborations, including a series of age-focused projects with the Centre for Biomedical Ethics in the Yong Loo Lin School of Medicine at the National University of Singapore and the Ethox Centre at Oxford University that were funded by the Lien Foundation.

The two major areas of focus for Bioethics for Aging Societies are 1) dementia and caregiving and 2) housing equity for older adults. Social gerontologist Kate de Medeiros of Miami University and Jennifer Molinsky, Director of the Housing an Aging Society program at the Joint Center for Housing Studies (JCHS) at Harvard University have been early and continuing research collaborators. Critical analysis of how cultural narratives convey values and obligations concerning older adults, and tapping the human capacity for moral imagination to come up with better narratives about aging and care in relation to place is a cross-cutting theme in this work.

Key publications

N Berlinger, EA Largent, M Buchbinder, and MZ Solomon, eds., Facing Dementia: Clarifying End-of-Life Choices, Supporting Better Lives, special report, Hastings Center Report 54, no. 1 (2024): SS1-SS50
https://onlinelibrary.wiley.com/toc/1552146x/2024/54/S1
Special Report
Funder: Robert W. Wilson Charitable Trust 

N Berlinger, K de Medeiros, and MZ Solomon, eds., What Makes a Good Life in Late Life? Citizenship and Justice in Aging Societies, special report, Hastings Center Report 48, no. 5 (2018): SS1-SS84
https://onlinelibrary.wiley.com/toc/1552146x/2018/48/S3
Edited volume of essays
Funder: Robert W. Wilson Charitable Trust

N Berlinger, K de Medeiros, and L Girling, “Bioethics and Gerontology: The Value of Thinking Together.”
The Gerontologist 2022 Vol. 62, No. 8: 1-7.
https://doi.org/10.1093/geront/gnab186

Research network: Housing, Aging, and Health Research Network

Project: Housing America’s aging society: a bioethics standpoint for policy development
January – December 2023

Funder: Greenwall Foundation Bridging Bioethics Research & Policy Program

Project: Covid Responses for Equitable Community-based Aging Policies and Practices (Covid RECAPP)
2021-2022
Funder: Retirement Research Foundation for Aging

J Molinsky, N Berlinger, and B Hu, Advancing Housing and Health Equity for Older Adults: Pandemic Innovations and Policy Ideas. Joint Center for Housing Studies, Harvard University. October 6, 2022. https://www.jchs.harvard.edu/covid-19-recapp-report

Advancing Housing and Health Equity for Older Adults: Report Summary & Key Recommendations, Harvard University Joint Center for Housing Studies and The Hastings Center, 2022. https://www.jchs.harvard.edu/sites/default/files/interactive-item/files/RECAPP-Summary-Recommendations_0.pdf,

Webinar Series

N Berlinger, “The Place in “Aging in Place”: Housing Equity in Late Life.” Hastings Center Bioethics Forum, September 30, 2022. https://www.thehastingscenter.org/the-place-in-aging-in-place-housing-equity-in-late-life/

Aging in [a] place: Planning, design & spatial justice in aging societies. Harvard University Graduate School of Design. Public symposium, October 18, 2019.
Agenda and videos: https://www.gsd.harvard.edu/event/aging-in-a-place-planning-design-spatial-justice-in-aging-societies/
2019-20
Funder: Robert W. Wilson Charitable Trust

Dementia and caregiving: projects and publications

Project: Dementia and the Ethics of Choosing When to Die
2019-21
Funder: Robert W. Wilson Charitable Trust
Final report forthcoming in 2023

Project: The Meanings of Dementia: Interpreting Cultural Narratives of Aging Societies
2022-24
Funder: National Endowment for the Humanities Collaborative Research Program

Project: Living Alone at Home with Dementia: Ethical Considerations for Inclusion
2019-20
Funder: National Institute on Aging, Administrative Supplement for Research on Bioethical Issues

K de Medeiros, N Berlinger, and L Girling, “Not Wanting to Lose the Dignity of Risk: On Living Alone with Dementia,” Perspectives in Biology and Medicine, Spring 2022
https://muse.jhu.edu/article/861779/pdf

K de Medeiros, L Girling, and N Berlinger, “Inclusion of People Living with Alzheimer’s Disease or Related Dementias Who Lack a Study Partner in Social Research: Ethical Considerations from a Qualitative Evidence Synthesis,” Dementia, March 1, 2022: https://doi.org/10.1177/14713012211072501

Other publications on population aging

N Berlinger, “With No Dementia Cure in Sight, It’s Time for Communities to Become Dementia Friendly,” August 14, 2019, https://www.statnews.com/2019/08/14/dementia-friendly-projects-communities/

J Chin, N Berlinger, M Dunn, M Gusmano, eds. Caring for older people in an ageing society: a Singapore bioethics casebook, volume II (NUS, 2017) www.bioethicscasebook.sg

J Chin, M Dunn, N Berlinger, M Gusmano, Good care at home for older people in Singapore (NUS, 2017) https://bit.ly/2BAcWJ3