"Do not cast me off in the time of old age; do not forsake me when my strength fails." This is the prayer of the Psalmist in Psalm 71:9. Like so many before and after him, the Psalmist fears being forsaken when he is old. In our own times, this concern takes on an entirely new magnitude, as the ranks of the elderly and aged grow at an unprecedented rate.
This is the concern raised by Eric Cohen and Leon R. Kass in their essay, "Cast Me Not Off in Old Age," published in the January 2006 edition of Commentary. Cohen, director of the program in biotechnology and American democracy at the Ethics and Public Policy Center, and Kass, the former chairman of the President's Council on Bioethics, have combined to write a most compelling essay on the challenge represented by millions of the aged among us. [...]
Cohen and Kass see a coming "perfect social storm" represented by a fast-growing proportion of the elderly and a shrinking number of younger adults who will be able to care for family members, loved ones, and others. Americans are living longer, but the process of death now often involves an extended period of enfeeblement and, in all too many cases, dementia. The authors cite a recent Rand study that indicated that approximately forty percent of current deaths in the United States are now preceded by a period of physical, and often mental, debility that may last as long as a decade. Of course, this may include the onset of Alzheimer's disease. At present, an estimated four million Americans suffer from Alzheimer's. Cohen and Kass report that the number is expected to rise to over thirteen million by the middle of this century, "all of them requiring many years of extensive, expensive, and exhausting full-time care."
One of the benefits of the analysis offered by Cohen and Kass is the focus on how the rise of a "mass geriatric society" is complicated by the decline of the natural family. Put bluntly, Cohen and Kass recognize that "precisely as the need is rising, the pool of available family caregivers is dwindling. Families are smaller, less stable, and more geographically spread out." Beyond this, most women are now employed outside the home, and there are already shortages of trained medical personnel available to tend to those who can't afford such assistance.
Thus, an explosion in the number of older Americans needing assistance and care comes at the very moment that finds the family weakened by ideological, cultural, economic, and social forces. The problems of old age are now routinely assigned to institutions, nursing homes, hospitals, and other settings – a far cry from when most Americans aged and died at home surrounded and aided by family members. [...]
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