In this symposium, we will discuss the changing attitude towards death and dying in late life, bringing together insights from different disciplines, such as sociology, philosophy, (bio)ethics and thanatology. The question will be raised: what is the impact of the growing emphasis on individual choice regarding death and dying on the way we – as individuals and as a society – live towards the end of life?
Over the last decades, dying is increasingly conceived as a controllable act, approached in a rather individualised way. Fuelled by the fear of ‘disabled life-expectancy’, a disappearing identity and eventually an ‘untimely and undignified death’, a growing group of older adults are determined to exercise choice and control over the place, manner and time of death. In particular, in developed Western countries, important questions for a growing group of older people are: Where, how, with whom and (even) when do I prefer to die?
This new death awareness is reflected in healthcare policies that focus on choice, end-of-life decision-making and advance care planning, resulting in bioethical practices like advance directives, do-not-resuscitate medallions and – in some countries – ‘euthanasia requests’ not only regarding ‘the foreseeable future’ but also ‘in due time’.
From different perspectives, during this hybrid seminar, we will explore underlying societal developments, the impact on people’s personal lives, and the ethical consequences. To what extent can the policies and practices concerned indeed improve end-of-life care and, respectively, good dying? What are important challenges, dilemmas, concerns and needs that should be addressed?
Allan Kellehear is Clinical Professor at the University of Vermont (US). He is a medical and public health sociologist with interests in death, dying and end of life care. He received his PhD in Sociology from the University of New South Wales in Sydney, Australia and is a Fellow of the Academy of Social Sciences. Most of Professor Kellehear’s work examines behaviour at the end of life in palliative care, intensive care and aged care contexts. He has conducted major sociological and social psychological research on the human experience of dying. He has also developed public health models for care of the dying, the bereaved and caregivers. These models are based on the application of health promotion, community development, and social ecology ideas and principles. Government policy interests in Australia, India and the UK have taken up his particular adaptation of these models for end of life care. In the UK, the Department of Health, the NHS in England, the NHS in Scotland, the National Council for Palliative Care, and the major charity Help the Hospices have adopted these ideas in their current end of life care policies.
Ashley Moyse is a McDonald Postdoctoral Fellow in Christian Ethics and Public Life, at the University of Oxford. He is also the Humanities and Healthcare Fellow on the Wellcome Institutional Strategic Support Funded project ‘Advancing Medical Professionalism: Integrating Humanities Teaching in the University of Oxford’s Medical School’ as well as a research associate and sessional lecturer in Christian Ethics for Vancouver School of Theology at the University of British Columbia. He has a particular expertise in bioethics and medical humanities. In his work, he studies the crisis of our late modern age, where persons are enamored by the promises of progress and disciplined to form by the power of technology—the ontology of our age. He criticizes the dominant late modern anthropology that favors the ‘individual self’ that in his view leaves especially older adults at risk for despair. In his contribution, he will provide several philosophical reflections on the role of choice in dying in late life, and argue the orthodoxy of autonomy, the significance of self-determination and of control has not only elevated the risk for persons to succumb to despair, but also may be an important driver to solicit Medical Aid in Dying (MAiD).
Nancy Berlinger is a Research Scholar at The Hastings Center, an independent, leading bioethics research institute based in Garrison, NY. Her research interests include ethical and societal challenges arising from population aging. She has longstanding research interests in decision-making and care in serious illness and near the end of life. She is one of the principal investigators of a current research project on dementia and the ethics of choice. In her contribution, she will reflect on foundational questions associated with the dementia trajectory. In particular questions regarding choosing when to die in a terminal illness context of dementia, as well as on the question how a society can choose to give people with dementia other choices concerning a good life in late life, mindful that most people will not decide to end life.