Sunday, March 22, 2009

Family support could affect medical decisions about prolonging life, as life spans increase; a "demographic winter" problem?


Medicine has often been able to prolong life greatly, and lifespans for the elderly seem to be rising quickly, as many newer drugs are very effective in preventing death from cardiac arrest. Women may be “benefiting” from this development more than men, because women have always lived several years longer, and are more likely to use publicly funded medical services. Men may be more likely to feel a kind of “shame” in doing so.

A lot of written is about the “sandwich generation”, but the explosion in eldercare demands is likely to affect those who have never married and/or had children, including but certainly not limited to LGBT people. (Remember the exception that I took to a suggestion in a book by Nancy Polikoff, that an unpartnered gay person be willing to become “it” among siblings and move in with an elderly parent reviewed on the books blog in September 2008.) Eldercare, as a specific problem, may do more than any issue to make us rethink the idea of what generates “family responsibility.”

I’ve covered filial responsibility laws (or “poor laws”) extensively on the blog before, and the current financial crisis may well bring these to the fore; but the biggest issue could become something or subtle and emotional. Our culture has indeed become more individualistic and, until the Internet “reconciled” us, culturally segregated. Many single people invest in their own “work” rather than in familial and communal relationships for their own sake (what my father had called the “seeing people as people” problem). In short, our modern culture has come to see choice of intimacy and refusal of unwanted intimacy as a fundamental right (for the most part now built into the legal system), but that was not always so. Suddenly they are faced with caring for elders who have lived in a culture that rewards functioning in a family social structure and that expects attention on demand. And medicine must cope with the idea that an elder who does not have an emotionally supporting family structure immediately available may not survive life-prolonging treatment.

One technique that single people expecting such responsibility could use is to provide the facility themselves, to own a house large enough to care for parents and to plan for the need to have such a capability; in that way, they keep more "personal sovereignty".

But it seems that the medical world barely, if at all, has a grip on this ethical problem. One could look at this as an early frost or warning sign of "demographic winter".

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