Aging: Decisions at the End of Life

Volume 12 of the series International Library of Ethics, Law, and the New Medicine pp 107-137

Challenges and Dilemmas in the “Aging and Euthanasia” Policy Cocktail

  • Roger S. MagnussonAffiliated withFaculty of Law, University of Sydney

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There can be few more volatile policy debates than that of aging and euthanasia. If AIDS has come to be seen as the disease that “most justifies” the right to die (Magnusson 2002, 49), then old age must surely be one of the most difficult contexts in which to consider a policy of assisted death. Apart from the usual arguments about personal choice, pain and suffering, and compassion, versus arguments about palliative care, the role of medicine and the “slippery slope” (Miller 1996), looms the troubling issue of health care rationing (Callahan 1996). As the costs of chronic and end-of-life care continue to rise, some fear that even a well-intentioned policy permitting voluntary assisted death would become corrupted (Santamaria 1996). Depression and dementia, where evident in later life, further complicate the policy equation. Tobin predicts that doctors would become emboldened “to act on ascribed ‘autonomous wishes’, that is to say, on ‘what the patient would have wanted if only he [or she] were able to tell us”’ (Tobin 1995). Together, these factors generate a bleak (albeit imagined) scenario: one where death in old age becomes a subtly “persuaded act,” a choice disproportionately made by the vulnerable and self-effacing, those wishing to conserve the family silver and to spare loved ones the agony of waiting.