The Business of Ageing and Caring – Towards a Manifesto

This Guest Post is by Ms. Janet Ferguson (Ph.d), Executive Director of the Seniors’ Learning Centre (SLC) at Bermuda College, Bermuda. For over 25 years the SLC has served Bermuda’s fifty-five plus population, and there are currently over six hundred active members.  This post first appeared on the SLC blog, and reflects Dr. Ferguson’s personal opinion, not the position of the SLC.

Over a year ago, in the care of two Cuban surgeons, my ninety-seven-year-old mother underwent a complicated surgical procedure.

Setting aside the agonizing personal moral dilemma that signing-off on this undertaking provoked for an only child, this experience has made me stop and reassess much of my taken for granted assumptions about living, dying, and the care of bodies and spirits that will inevitably age. Thankfully, knowing that the decisions reflected my mother’s disposition and firmly held values made things easier. Yet, please indulge me as I share some of my thoughts.

The militant anti-discriminatory position adopted by the Cuban surgeons profoundly affected my thinking. They explained that while age is influential in medical decision-making, it is not the primary consideration. That certainly challenges the frequently offered: “Well, considering her age….”  Rather, the doctors explained, it is the person’s physiological state that determines whether or not to move forward with a particular medical intervention.

This perspective upends our common assumptions about what bodies should or should not be able to do according to unexamined beliefs about chronological age.  It challenges our established perceptions of the old, ageing, the provision of care, decline, and dignified exits. It is an invitation to explore.

For example, I question the sub-text of the growing popularity of “living wills” and the often implicit apologetic “I don’t want to be too much trouble” position. What might modernity’s preoccupation with agility and newness be bundling the ageing into? If we are progressive, successful societies, then we must be judged by our ability—or lack thereof—to extend equal consideration to all, irrespective of race, class, gender or age.

What is the purpose of surplus if not to ensure that this goal of equal consideration is consistently achieved? Is it really an exercise of autonomy and independence when physiological differences brought about by the inevitable passage of time convince us that we have a moral right obligation to plan swift and uncomplicated exits in the name of choice? After a lifetime of declaring “the sanctity of life,” why should self-erasure become the exercise of personal “choice” because we can no longer ‘strut our stuff’?

If we fear marginalization, isolation or redundancy, then ageing, a rather non-selective process, is not the culprit. Rather, the true source of the problem is popular perceptions of ageing, fuelled by a widespread and exponentially increasing “death anxiety.” The sags, the droops, the stumbles, the drools and the incontinences of the ageing body are all evidence of the inevitable degeneration of the corporal. And so, as the truly anxiety-saturated societies that we have become, rather than face and courageously engage with our fears, we obliterate them with the strangest acts of pseudo-bravery, particularly those that promise certainty and control to the end—as if that were possible.

What if the rising clamour for the right to assisted suicide before we “become a burden”—choices cloaked in the drapery of freedom and autonomy—reflect being on the receiving end of widespread, largely unacknowledged age-based prejudice? This seems to me a classic example of avoiding the core issue and resorting to a sleight of hand that turns collective defeat into personal and individual triumph. The effect is to draw attention away from the real reasons for the ever-growing levels of discomfort with the by-products of ageing; the indicators of approaching death.

Instead we can choose our own way out, mediated of course by all the economic and social variables that shape our lives.  As always, the poor and disadvantaged seldom have the opportunity to voice their experiences, their perceptions, or their aspirations for their ageing years; they remain, as ever, doubly silenced. We have made substantial inroads on naming, shaming, and protesting discriminatory practices based on race, gender and sexual orientation. Perhaps age is the final frontier; how very ironic.

So yes, let us look forward to a time when people over sixty, seventy, eighty and ninety no longer need to feel self-conscious, defensive or concerned about their age; when services are no longer framed as compensatory, special, owed to, or are experienced as downright patronizing.  There must come a time when services and care are no longer denied or withheld because of largely irrational assumptions about physical and mental states of health based solely on chronological age.

Most importantly, we must move towards an open acceptance and celebration of the ways in which ageing offers the possibility of embracing and celebrating diversity and difference. Our declining years provide opportunities for giving and receiving care. What is the point, if we spend our time avoiding or plotting our escapes from opportunities for truly caring for each other? Will this really make us a better society or better people?

If we placed considerations about caring at the centre rather than the margins of lived experience, strong, sustainable interdependent and cross-generational relationships would be the norm; the valorisation of youthfulness and the assumption that only the young are virile and vibrant would be replaced or even eclipsed by a broader recognition and celebration of the full spectrum of  traits that make us human and invaluable to each other along the entire the life course.

Most importantly, each and every stage of human life and development would be respected and treasured for its own sake and for its contribution to the collective energy and meaning of community life. Then, perhaps, descriptors like retirement and post-retirement will become as obsolete as “whites only” or “no coloureds”!  And the performance of life-saving surgery on a ninety-seven year-old body would be quite unremarkable.

4 thoughts on “The Business of Ageing and Caring – Towards a Manifesto

  1. My thoughts on aging have changed over the past 10 years. At 72 I am definitely slowing down physically. This like everything is relative. I’m still running the small horse ranch I retired to.

    But the big change in my life has been watching friends die and I don’t want to linger. It has nothing to do with not wanting to be a burden. It has everything to do with the quality of life.

    So yes denying some one something because they are too old isn’t good. On the other hand, I think that is unrelated to the right to die. You seem to be combining the two things.

    1. I agree with the Janet Ferguson that they are related, Mary. This society barrages older people with the message that they are less valuable members of society and less deserving of support and resources. In the absence of affordable healthcare and decent subsidized caregiving, it’s become common to hear even healthy middle-aged people wondering whether suicide will be the ethical alternative to asking for help. That is internalized ageism of the the most lethal sort.

  2. I accompany my mother to her doctor appointments because she has “white coat syndrome” and gets nervous, so it helps to have a second person there to hear, digest info, and ask questions. Mom is vibrant, but she’s 91. She needs pain meds for a chronic condition but fears taking them due to family history of kidney failure ( which the meds can lead to). The doctor explained everything thoroughly and then said (paraphrasing) use the meds. Don’t suffer. If you eventually get to a point where your kidneys shut down and you don’t want dialysis, we now have the right to help you die. I thought it was good for her to say it. I also think there is no GOOD way to say it. Luckily Mom didn’t focus on it, as she may have interpreted it in the most negative way. OTOH, I was delighted. My greatest fear is getting some fatal disease and having to let it run its course. My point is that this topic is entirely fraught.

    1. I couldn’t agree more, Lynne. My working subtitles for this part of the book were “It’s really complicated” and “It’s realy f__king complicated.” I am a longlong member of Compassion & Choices and believe that assisted suicide should be legal in more places. I also think it’s incredibly important to acknowledge that we are mortal – pretending otherwise is the logical result of a life spent denying that we are aging— because it gives life meaning and gives us a better crack at the kind of death we want. But as an anti-ageism activist, I emphasize that older people have as much right to want to stay alive as younger ones, and that much of the “burden” narrative occurs because our government provides so little social & economic support for caregivers and families.

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