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A Preview of Our New Research Agenda: Ethics of Population Aging

In a new essay in the Health Affairs Blog Grantswatch, Hastings Center research scholar Nancy Berlinger and president Mildred Z. Solomon offer a glimpse of the Center’s new research agenda on the ethics of population aging, with a focus on the precarity of older adults, questions of justice, and issues of personal choice. This new research is made possible by a major grant to The Hastings Center from The Robert W. Wilson Charitable Trust as part of its visionary support for the Center’s research and public engagement on ethical challenges facing aging societies.

“The field of bioethics has worked hard to promote patient choice, especially in the context of end-of-life care,” they write in “The Ethics of Population Aging: Precarity, Justice, And Choice.” “Yet ethical challenges near life’s end are not limited to bedside decision making.” Berlinger and Solomon discuss two new projects funded by the Wilson Trust.

One of them is focused on “unequal aging,” drawing on empirical findings on how social determinants of health shape the experience of older adults and family caregivers. “By late life, people who are not already wealthy have little opportunity to accrue more ‘options,’ such as the ability to pay out of pocket for amenities-rich assisted living,” they write. “This new work will examine how community values and processes of deliberation—including perceptions and biases concerning affordable housing and competing priorities concerning the built environment—are social factors that may limit who has the opportunity to age in a place, whether this place is a home, a neighborhood, or other desired environment.”

The other new project, “Dementia and the Ethics of Choosing When to Die,” is examining the concept of choice to a person facing the dementia trajectory. “When older adults are asked to consider their preferences for care near the end of life, questions focus on whether they choose to use or forgo life-sustaining interventions,” write Berlinger and Solomon. “However, there is no treatment for dementia, and decisions about other end-of-life conditions (such as whether someone with a life-threatening heart condition would want to use an implantable device to support heart function in the context of dementia) do not directly speak to the situation of a person facing dementia but no other terminal condition.”

This new project asks which choices matter to a person facing the dementia trajectory. “Should these choices include a way to say ‘enough’ in a way similar to—but not the same as – stopping cancer treatment or refusing mechanical ventilation? What would these choices look like?”

“These grants have afforded the opportunity to work across fields that have rarely, if ever, collaborated, to consider how bioethics can help to engender new ideas and moral imperatives for our aging societies, and to help people in the United States to see themselves as citizens of our aging society, whether they are older adults, caregivers, or members of communities that include people in the last stage of life,” write Berlinger and Solomon. “Thinking anew about precarity, justice, and choice in our aging society has been an exhilarating process, and we have only just begun.”

Published on: June 28, 2019
Published in: Aging, Chronic Conditions and End of Life Care, End of Life

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