Nancy Berlinger, Mildred Z. Solomon

The field of bioethics has worked hard to promote patient choice, especially in the context of end-of-life care. In 1987 The Hastings Center published consensus guidelines affirming the right of patients to forgo the use of life-sustaining technologies when the patient (or family, in the case of incapacitated patients) deemed such care more burdensome than beneficial. These guidelines, which were revised and expanded in 2013, were informed by a 1983 US presidential commission’s report on patients’ decision-making rights. These norms, central to patient-centered care, are now in place throughout the United States and in many countries around the world.

Yet ethical challenges near life’s end are not limited to bedside decision making. As humans live longer than ever before, longevity introduces a decades-long process of chronic progressive illness, age-associated frailty, and cognitive decline. Bioethics has contributed greatly to enhancing the rights of patients to guide treatment decisions, but it has fallen short in addressing population-level concerns that aging societies now face. We wondered what bioethics research can do for an aging society beyond continued improvements to provider–patient communication and treatment decision making.

In 2015 The Hastings Center began to discuss this question with the trustees and advisers of the Robert W. Wilson Charitable Trust, a New York City–based grantmaker funded by the estate of Robert Wilson, who died in 2013. While Wilson’s philanthropy during his lifetime was focused on issues outside of health care, he had personally reflected on the consequences of aging and illness.

…continue reading ‘The Ethics Of Population Aging’

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