Loving Later Life: An Ethics of Aging

By Frits de Lange

Is loving later life possible? In our youth-obsessed culture, nobody enjoys growing old. We normally fear our own aging and generally do not love old people -- they remind us that death is inescapable, the body frail, and social status transitory. In Loving Later Life Frits de Lange shows how an ethics of love can acknowledge and overcome this fear of aging and change our attitude toward the elderly.

De Lange reframes the biblical love command this way: “We must care for the aging other as we care for our own aging selves.” We can encourage positive self-love by embracing life as we age, taking good care of our own aging bodies, staying good friends with ourselves, and valuing the last season of life. When we cultivate this kind of self-love, we are released from our aversion to growing old and set free to care about others who are aging -- our parents, our relatives, and others in their final season of life.

• Language: English
• Publisher: Eerdmans
• Release date: Apr 23, 2015
• ISBN: 9781467442947

Frits de Lange

Frits de Lange is professor of ethics at the ProtestantTheological University in the Netherlands and ExtraordinaryProfessor in Systematic Theology and Ecclesiology at theUniversity of Stellenbosch, South Africa.

Book preview

Frits de Lange explores the ethics of growing old with theological insight and hopefulness. His challenge to care well for ourselves and others in the midst of our finitude and increasing frailty and vulnerability — and to care with love and without fear — is a clarion call in our current age.

— Keith G. Meador

Center for Biomedical Ethics and Society, Vanderbilt University

In this soulful work of theological reflection, Frits de Lange explores the spiritual complexity of ‘deep old age’ in ways that gerontologists in general tend to shy away from doing. . . . Especially appealing about de Lange’s ethics of aging is, first, its reminder that advanced old age is a once-­in-­a-­life adventure and, second, its insistence that we love our own aging selves.

— William L. Randall

Department of Gerontology, St. Thomas University

Loving Later Life

An Ethics of Aging

Frits de Lange

William B. Eerdmans Publishing Company

Grand Rapids, Michigan / Cambridge, U.K.

© 2015 Frits de Lange

All rights reserved

Published 2015 by

Wm. B. Eerdmans Publishing Co.

2140 Oak Industrial Drive N.E., Grand Rapids, Michigan 49505 /

P.O. Box 163, Cambridge CB3 9PU U.K.

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Lange, Frederik de, 1955-

Loving later life: an ethics of aging / Frits de Lange.

pages cm

Includes bibliographical references and index.

ISBN 978-0-8028-7216-6 (pbk.: alk. paper)

eISBN 978-1-4674-4294-7 (ePub)

eISBN 978-1-4674-4254-1 (Kindle)

1. Christian ethics. 2. Aging — Moral and ethical aspects. 3. Aging —

Religious aspects — Christianity. I. Title.

BJ1231.L36 2015

248.8´5 — dc23

2014049873

www.eerdmans.com

Contents

Introduction

1. Good Aging: Toward an Ethics of Aging

2. The Ethics of Love

3. Why We Do Not Love the Elderly

4. Taking Care of Your Old Self

5. Love for Aging Neighbors

Bibliography

Index

Introduction

Louis Begley, seventy-­eight years old, is a fiction writer who has written three novels on the aging of Albert Schmidt, a retired lawyer. Now, on the edge of deep old age himself, Begley reflects on Schmidt’s experience as well as his own:

Life has not been kind to him, but so far, Schmidt enjoys excellent health, marching up and down the Atlantic beach in Bridgehampton and New York City’s avenues, and doing laps in his pool. Although he worries about performance, his libido is intact. Nevertheless, the reflection of his face in the window of a shop is frightening: he sees a red nose and bloodshot eyes, lips pursed up tight over stained and uneven teeth, an expression so lugubrious and so pained it resists his efforts to smile. My appreciation of my own charms is not very different. Like Schmidt, I see that nothing good awaits me at the end of the road, and that passing years will turn my life into a Via Crucis.

Until now, Begley has been an example of the so-­called New Old Age: in his late seventies, he is doing quite well, contradicting all the earlier stereotypes of old age, such as physical decline and social disengagement. He is a role model for the vital senior individual:

My body, like Schmidt’s, continues to be a good sport. Provided my marvelous doctor pumps steroids into my hip or spine when needed, it runs along on the leash like a nondescript mutt and wags its tail. My heart still stirs when I see a pretty girl in the street or in a subway car, but not much else happens. Except that, since by preference I stand leaning against the closed doors, she may offer me her seat.

Begley still has no reason to complain. But he is nonetheless frightened about his future. In his novel, he grants Schmidt another ten years, having a similar estimate of his own longevity. What will these remaining years be like? He remembers his mother’s final stage of life and how lonely she felt. Most of her friends were dead, and, one by one, those who were still alive became homebound or bedridden or suffered from dementia. Begley recalls T. S. Eliot’s poem Little Gidding (which Eliot wrote when he was in his early fifties): The end of all our exploring/Will be to arrive where we started/And know the place for the first time. Begley then concludes with wrenching honesty: The closer that place — the human condition — is to home, the harder it is to take in. I could speak movingly of Schmidt’s loneliness after the loss of his daughter, calling his existence an arid plane of granite on which she alone had flowered. But it has taken me until now, at age 78, to feel in full measure the bitterness and anguish of my mother’s solitude — and that of other old people who end their lives without a companion.1

This book deals with the Begleys among the aged — the frail elderly, those on the brink of deep old age. Their lives may still be going fairly well, like those of Begley and Schmidt, but they fear the years to come. Though one can live beyond 100 in good health and then die in a split second, for most of us eventually — if we are lucky enough to live that long — the blessings of old age go together with the hardships of physical and/or mental impairments and often social isolation. Geriatrics coined the technical — though it is much more than just technical — term frailty for this vulnerable condition in the final stage of life. The frail elderly, according to a definition shared by gerontologists, are those elderly, mostly the oldest old, who depend on others for the activities of daily living or who are at high risk of becoming dependent.2 My question is this: Which ethics best promotes the good of the frail elderly? Writing from a theological perspective, I will examine the contribution of theological ethics in particular.

How should one write an ethics of aging? In the first chapter I start by arguing that we need such an ethics for demographic reasons alone, and that the existing ethical perspectives — whether they bear a Kantian, utilitarian, or eudaemonistic stamp — cannot stand up to a critical assessment: they all assume an individualist and activist understanding of the course of life and underestimate the moral impact of the fundamental relationality, dependence, and vulnerability of being (very) old.

In the second chapter I present the outline of an ethics of love that takes the biblical command to love your neighbor as yourself as its starting point. Not only does love form the heart of Christian morality, but also speaking of love touches on a dimension in the ethical discussion on aging that is often neglected. Furthermore, the biblical command to love exhorts us to love our neighbor as we love ourselves. In line with this intriguing and puzzling relationship between self-­love and love of neighbor, I presume that God commands us not only to love old people but also to love our aging selves. Caring for and about ourselves as we grow older functions as a steppingstone toward love of the old other.

In chapter 3, I show that love for old age isn’t easy: there seems to be a built-­in aversion toward aging in our natural makeup. Old people make me feel sick, a young student told me. The old evoke distaste and disgust, and that has been the case throughout history. The elderly remind younger people of their own mortality. When younger people are close to the elderly, the former are confronted with the prospect of their own physical and mental decline. This intuition has recently been taken up by social theorists who argue that ageism, the stereotyping of and discrimination against people for the simple reason that they are old, functions as a kind of terror management strategy that helps silence our fear of decay and death.

If self-­love is inextricably related to the love of the other, it is worth asking what taking care of an old self entails. If we hate ourselves as we age and don’t want to practice self-­care, we cannot love others. Love of one’s own later life, as I argue in chapter 4, implies that one still wholeheartedly says yes to life, cares for one’s own frail body, stays good friends with oneself, and values one’s last season of life — not as the best that is yet to be but as a new opportunity to experience the gift of life.

Finally, in chapter 5, I focus on love of the neighbor. A heart no longer filled with aversion to growing old itself is set free to care for the aged neighbor. To love someone is to want to be near her or him, to be fond of dwelling in her or his presence. Old people are often kept at a distance as ugly and distasteful. Can old people be beautiful? I argue that they can be, but that, in order to be so, we need to challenge our shallow understanding of beauty. Besides love as attraction, there is also love motivated by attachment. Ideally, parents and children love each other, but what happens when children become adults and their parents depend on their care? Chapter 5 tries to unravel some strands of the complicated predicament of filial love. The love for aging others should not, however, be limited to our relatives. Home and institutional care of the elderly depends heavily on the compassionate love of both informal and professional caregivers. And what does compassion for the elderly mean when they are no longer successfully aging but are suffering from old age?

1. Louis Begley, Age and Its Awful Discontents, New York Times, March 18, 2012, p. 7.

2. See Kenneth Rockwood, Roy A. Fox, Paul Stolee, Duncan Robertson, and B. Lynn Beattie, Frailty in Elderly People: An Evolving Concept, Canadian Medical Association Journal 150, no. 4 (1994): 489-95, 492: We can define frail elderly persons as those in whom the assets maintaining health and the deficits threatening it are in precarious balance. Though the concept of frailty in gerontology has become very common, there is no consensus on its definition. However, it is sufficient for our purposes to take note that in all definitions frailty implies that the frail elderly (1) still can live independently, but (2) in their independence heavily rely on others; and that (3) at the slightest event, the vulnerable balance breaks down. For a medical assessment, see L. P. Fried, C. M. Tangen, J. Walston, A. B. Newman, C. Hirsch, J. Gottdiener, Frailty in Older Adults: Evidence for a Phenotype, Journal of Gerontology:

MEDICAL SCIENCES

56A, no. 3 (2001): M146-57.

I would like to express my gratitude to the Center of Theological Inquiry in Princeton, New Jersey, which gave me the opportunity to do the research for this book as its member in residence during the spring of 2012.

Chapter One

Good Aging: Toward an Ethics of Aging

Old Age Is Here to Stay

There are several reasons why theological ethics should contribute to the subject and experience of aging. The first is demography. Today there are more old people in the world than ever before, and they are getting older than ever before. The demographic transition that the world population is facing is driven by two factors: increased life expectancy and declining fertility rates. Population aging is unprecedented: it has no parallel in the history of humanity, a United Nations report says. It is also pervasive and profound: it not only affects the lives of aging persons themselves but also has a direct bearing on the basic structures of society. Finally, population aging is enduring: the trend looks irreversible.1 In short, old age is here to stay.

It is an illusion that graying societies are a luxury issue caused by the postwar baby boom in affluent Western countries, an issue that will resolve itself as soon as that generation is gone.2 In developing countries with much higher birth rates and a higher number of younger people, the demographic transition is occurring more slowly. But they have fewer means to prepare themselves for it. Their development means increasing mobility of the population and rapidly changing family structures. Indeed, community networks that formerly provided support to the older generation have been weakened and often destroyed by rapid social and economic change.3 These changes in social structure have a greater impact on the lives of the elderly than the soaring numbers of those people above sixty or eighty: what counts is not the absolute numbers but the relative ratios of young versus old. The important question is how many people are effectively able and available in a given society to earn money and care for its elderly.

The old-­age dependency ratio (the number of individuals over 64 divided by the number of individuals from 15 to 64, expressed as a percentage) indicates what happens in developed societies, whereas, for the time being, the destruction of traditional social structures in developing parts of the world as a result of urbanization will represent the most significant thread for the well-­being of the elderly. In the European Union, the old-­age dependency ratio is projected to more than double by 2060, from 25.4 percent to 53.5 percent. This means that the EU would move from having four persons of working age for every person over 65 to a ratio of only two to one. These population trends will have far-­reaching effects on the labor market, social security and pensions, and the availability of health care.4

How are we to prepare for the graying of society, the tsunami of elderly that will flood the world in the next decades? Our societies are being challenged economically and ethically as well. Intergenerational justice, social security, health-­care access and distribution, filial responsibilities, the quality of life, and the human dignity of the oldest elderly — all these issues are in need of normative orientation and ethical reflection.

Successful Aging and the Fourth Age

The second reason why ethics is needed in this area is — perhaps surprisingly — gerontology. Gerontologists usually avoid normative claims. Different old people have different ideas about how to live out their lives, they say. And why should we expect miracles from ethics at that age? Old age isn’t so bad when you consider the alternative, the entertainer Maurice Chevalier once said. A vast body of gerontological knowledge has become available since 1904, when Élie Metchnikoff, interested in the possibilities of prolonging human life, coined the term gerontology and laid the basis for a new scientific discipline.5 The hard data of empirical research have taken over the well-­intended advice passed on by centuries of wisdom, self-­help, and consolation literature, starting with Cicero’s De Senectute. But the positivism of much gerontology makes it easy prey for ethical naïveté. There is normativity in gerontology, but it is mostly implicit. Deliberately unaware of values and ideals, gerontology easily becomes an uncritical follower of prevailing biopolitics.6

Gerontological paradigms that are explicitly normative — such as successful, healthy, active, and productive aging — offer an optimistic and activist view of what old age can be. It tells people that, whoever they are, they can attain successful aging, which is defined almost exclusively in terms of physical and mental vigor, through individual choice and effort. Elder policies of governments and international health organizations, joined in a powerful political coalition, willingly adopt these paradigms, glad that their strategies have been scientifically legitimated by gerontological science. Emphasis is put on self-­management, prevention, and empowerment. In the risk society, old age is considered to be a personal risk instead of a common fate.

Nonetheless, it is noteworthy that, however justified these political strategies may be in their aim to slow down the decay of old age, the models of successful, productive, healthy, and active aging have a strong anti-­aging tendency.7 The oldest old are especially at risk of being neglected by policies that are focused on keeping the vital senior vital. How can we respect age if we do everything in our power to deny it? gerontologists Martha Holstein and Meredith Minkler ask critically. What most assume as a matter of course in youth and middle age — that is, health and activity — cannot be the critical measure of success in old age, they justifiably object.8 And Chris Gilleard writes:

Achieving at an advanced age the accomplishments of youth is little short of achieving the appearance of youth. The goals of government and gerontology are not to venerate old age because of its agedness, the way we might venerate an old wine or an old building, nor do they seek to make old age successful by the number of years lived. Successful old age is old age without old age.9

Positivist gerontology and health-­care policy presently join together in trying to concentrate the majority of the physical and mental decline of old age into the shortest period (called compression of morbidity).10 They work on better aging (How can we make you live healthily up to 100?), but they refrain from asking what — if anything — makes a life marked by frail old age, dependence on others, and an accumulation of chronic diseases still worth living.

The distinction between a Third and a Fourth Age, introduced by the gerontologist Bernice L. Neugarten in 1974 and taken up by the historian Peter Laslett in his seminal book A Fresh Map of Life (1989), now in common parlance in gerontology, does more than just introduce a further chronological differentiation within the stages of an extending life, made necessary by life extension and the progressive reduction in late-­life disability in affluent societies during the twentieth century.11 The Fourth Age is an embarrassing rest category of the Third Age, a shadowland of diminishment and the portal to death, the result of our inability to eliminate the impairments at the end of life and to push the vital and healthy Third Age until the very moment of death. In Laslett’s terms, the Fourth Age is an unwanted condition whose onset, and hence . . . duration, should be put off for as long as possible by appropriate behavior during the Third Age.12 Staying in good shape, for example, is rewarded with the extension of the Third Age and the postponement of the Fourth.13

As long as the compression of morbidity does not result in the rectangularization of the life curve, however, the Fourth Age attracts all the fears and anxieties of old age of former times. Paul P. Baltes and Jacqui Smith bring the optimistic message of the happy gerontologists into a more accurate balance with the bad news for the oldest old. There is positive news about aging, especially in the developed countries. Life expectancy has risen, and today’s seventy-­year-­olds are comparable to sixty-­five-­year-­olds of thirty years ago. Today’s elderly have fewer physical disabilities, and are overall physically and mentally fitter than earlier cohorts of the same age range. More and more people are aging successfully. But the good news about aging, Baltes and Smith note, is news about the Third Age; the not-­so-­good news concerns the Fourth Age, when the self shows itself to have reached its limits of functioning and adaptive plasticity. The gain in longevity has negative consequences for the quality of life for the oldest old. With Alzheimer’s disease in mind, Baltes and Smith write: Living longer seems to be a major risk factor for human dignity.14 But even without succumbing