Setting Limits: Medical Goals in an Aging Society
A wise man, according to Spinoza, does not think about death. In our day, however, he would be regarded as very unwise if his failure to think about death led him to neglect making provisions for his family by leaving a proper will, arranging adequate insurance, and in some metropolitan centers even choosing where to live. Modern society, at least American society, confronts a problem, a whole series of problems, resulting from increasing longevity, changes in the pattern of family life, and a greater concern about the quality of life of the aged. Scientific medicine has been able not to renew life but only to prolong it. In a world of finite resources, physical and human, the public costs of prolonging life at some point become disproportionate to the social benefits. This is especially so when choices must be made about the investment of research funds and medical services for different age groups in the population, and for the study and treatment of different ailments.
Most human beings take for granted that since life is a good, if not an intrinsic good, then at least as a necessary condition for any other experienced good its preservation and extension are always a good. This assumption also seems to be behind the unsophisticated desire for immortality.
For many years, when I would ask my classes whether they would accept the gift of immortality, students would invariably respond that they would, until I reminded them of the Greek myth about the goddess Eos or Aurora, who fell in love with the mortal Tithonus. Eos besought the gods to make her lover immortal. They refused, but to console her they bestowed on Tithonus never-ending life. Not until Tithonus had become aged and feeble but could not die did the goddess and her lover discover what a poisonous gift they had accepted.
It is clear not only after a moment’s reflection but from a study of the representations of immortality in all ages and in virtually all the visual arts that when human beings desire immortality it is not eternal life they seek or yearn for but eternal youth. William Blake’s Reunion in Heaven shows a man and his wife in the prime of life, their small children, and even the family cat. The denizens of Heaven in all paintings I have seen seem hale and hearty even when gray-bearded, never in the last stages of doddering decay.
The progress of scientific medicine and industrial society has led to a changing conception of old age and of its place in society. It is still true that biology sets limits on what can be done, yet it is not biology but society that determines the place of old age in a culture, its authority, what is to be regarded as appropriate for the elderly, and the time and degree of retirement from active life because of old age. Regardless of what we deem desirable for the aged in our society, we must take our point…
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