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The Last Stage of Life

A Planning Process for The Hastings Center’s Program Area, Aging, Chronic Conditions, and End of Life

Principal Investigators: Mildred Z. Solomon and Nancy Berlinger

Funders: Robert W. Wilson Charitable Trust, and the Boger, Callahan, and Gaylin Funds at The Hastings Center

In the United States and other wealthy nations, older adults make up a greater proportion of the population than at any time in history. People are living longer, but with more years of chronic illness and frailty. Many lack the financial, community, or health care resources they need to age with dignity and to support their well-being.

In fall 2016, the Robert Wilson Charitable Trust enabled The Hastings Center to undertake a two-year planning process to determine how best the field of bioethics in general, and The Hastings Center in particular, can meet the new and complex needs of our aging society, and of aging people and their caregivers. The Hastings Center convened a multidisciplinary team of experts across disciplines and professions concerned with aging. They included health policy experts, demographers, architects, philosophers, gerontologists, physicians, nurses, advocates, grant makers, and urban planners. Together, the team helped the investigators to develop an agenda that will set priorities for The Hastings Center’s next three-to-five years of bioethics research on population aging.

Examples of background questions that this process explored include:

  • What makes for a good life for people living with age-related illnesses and frailty and limited resources? How can we broaden our public understanding of the social as well as the health care needs of an aging population?
  • What resources and services do older adults need at the local level to live a good life? How should communities respond to these needs when setting priorities and making investments?
  • How can the needs and rights of unpaid family caregivers, and of paid caregivers, be kept in view when thinking about social obligations in an aging society?
  • How should thinking, policy, and practice about planning for the last stage of life evolve beyond current frameworks for medical decision-making? For example, how may the prospect of reliable predictive testing for increased risk of Alzheimer’s disease influence thinking about end-of-life choices?

In addition to setting research priorities, products of this planning process included scholarly papers and public engagement activities. A major product is a special report, What Makes a Good Life Late in Life: Citizenship and Justice in Aging Societies.

To our knowledge, this initiative represents the first opportunity for people from across so many different disciplines to gather together to identify and address ethical issues faced by our aging society.