The Bio-Ethics of Aging

Bio-Ethics of Aging

I wonder how many of my readers have managed to avoid the quandary that surrounds the health care needs of so many of our aging parents:

  • Should you respect their desire for independence or insist that they live where their medical needs will be taken care of?
  • Should you approve surgery or chemotherapy for an Alzheimer’s parent who has a malignant tumor?
  • Should you insist on insertion of—or removal of—a feeding tube for a stroke victim who will never regain even minimal intellectual or physical function but is in no immediate danger of death?

These issues loom large in my mind as I revise the syllabus for a class I teach on the Bio-Ethics of Aging.  What I see is that our lives have become ever more complicated as medical technology and innovative drugs have provided more sophisticated—and more expensive—ways to keep aging and death at bay.  Where once diminished capacity and ultimate death were considered to be inevitable stages of life, they are now increasingly challenges to be overcome.

The problem, as any reader of the daily newspaper will know, is that we as a nation are resource constrained. We do not have enough money or enough geriatricians or enough kidneys or enough antibiotics to treat every single older person who wants to be treated.  While we are only one of many countries facing rising health expenditures as the baby boomers age, we are unique among the developed countries in our lack of a consensus on what kind of health care should be provided, to whom, under what circumstances, and who should pay for it.

In practice, the United States rations health care based primarily on who can pay rather than who has the greatest medical need.  Even with the passage of the Affordable Care Act, access to health care depends on the ability to meet co-pays … to meet defined income limits … to meet state-by-state Medicaid criteria for income and co-pays.

I am teaching this course because I believe that both the baby boomers and their children desperately need to understand the ethical, legal, and pragmatic choices they will face in the next decade or two.  From a bio-ethical perspective, not all health care is the same.  From a bio-ethical perspective, each of our decisions about health care for us and for our parents has worrisome implications for the health care, education, and employment of the generations to come.

A key question addressed in the Bio-Ethics of Aging is not whether we should ration health care—we already do—but whether we should allocate it in a way that is more transparent and more equitable than our current system. I believe the answer is “yes,” but I challenge my students to define what that more equitable system might be.

Bio-Ethics of Aging
Senior College of Greater Des Moines
September 8, 15, 22, 2014 – 10:00 – 11:30 am
Pappajohn Center, Room 218

To register for the course, please google

From the Perspective of A Reader


moral-dilemma-empathic-concernShortly before A Fitting Place came out, a friend asked how I would measure the book’s success.

My answer was unhesitating: I wanted it to prompt readers to re-examine the way in which we all make relationship choices.  I hoped that A Fitting Place would:

  • give readers more empathy and understanding—for themselves and for others—of the way in which circumstances, habitual behavior patterns, and societal stereotypes influence the relationships that we choose, and
  • recognize that every relationship reflects a series of choices that we could have made differently, and that we can change if we ourselves are willing to change and grow.

My first clue that I might achieve my goal came one day last week when a middle-aged acquaintance said, in passing, “I loved your book. But I have to tell you, I wouldn’t have read it if I’d known what it was about.”

Straining to keep my jaw from dropping, I asked, “Why did you read it?”

Sailing Down the Moonbeam was wonderful.  So I bought this when it came out. I never checked to see what it was about.”

My reader went on to say that her religious objections to homosexuality had stopped her from ever thinking about the emotional dynamics of a same sex relationship. When she realized what the book was about, she almost put it down.  “But I had to keep reading. I had to know what happened to Lindsey.”

As the conversation continued, she noted that, unlike Lindsey, she’d had multiple sources of emotional support in the wake of her own failed marriage. But now, my reader could empathize with someone who was emotionally bereft.  “Lindsey was reaching out for a relationship that was supportive and nurturing. I could understand that. It made me realize,” she said, “that I needed to be open to alternative ways of dealing with life.”

I had a virtually identical conversation with a woman in her 70’s a few days later.

I was fortunate that both women were willing to speak so openly with me.  From the book clubs I’ve met with so far, I know they are not the first readers to object to the same sex love affair on religious or social grounds.  But they were the first to acknowledge that A Fitting Place pushed them to think differently and even empathetically.  And because these two women were willing to “step outside their comfort zone,” they understood that A Fitting Place was about relationships, not about sex.

On a related note, I’ve had a lot of readers—and reviewers— refer to A Fitting Place as “a page turner” or say that “I couldn’t put it down.”  To my delight, I’ve heard repeated stories of readers who planned to peruse “just one more chapter,” but stayed up into the wee small hours or went to work late in order to finish the book.

A Fitting Place seems to be a good read as well as a thought-provoking book.

For a writer, that has to count as success!

Redefining Success


My blog this week is reprinted from “Live, Write, Thrive,” the website of Susanne Lakin, a West Coast novelist, copyeditor, and writing coach.  Her comments on the author’s effort to stay sane while trying to generate book sales offer a wonderful perspective on the broader human question of how each of us defines success.


Photo Credit: Lakbay 7107 via Compfight cc

Photo Credit: Lakbay 7107 via Compfight cc

Have you ever asked: “What on earth possessed me to want to be a novelist?” Are you starting to realize this journey of being an author is not a short sprint but a marathon—and often a grueling one at that?

When you hear of the numbers of novels submitted to agents and publishers each year (in the six figures), you sometimes think winning the lottery offers better odds than getting traditionally published. But then . . . you finally break through and get a contract, and months later are holding your brand-new brilliant release in your hand, feeling like you’ve finally arrived.

Not Even Fifteen Minutes of Fame . . .

Yet . . . if you’re like me, the flashbulb moment of that exhilaration lasts a very short time, only to turn into something akin to another stark, depressing realization—that the odds your book will become a huge hit or best seller is . . . well, about the same odds as winning the lottery, and you’re back to the same place (or almost the same place emotionally) as you were when you first starting sending out your first queries to agents.

I don’t mean to dive right into depressing statistics and start you into a tumble toward negativity. Quite the opposite. When considering that the novelist’s life is more a marathon than a sprint, I thought of the one thing that we all really need to focus on to keep going in this writing life, and that’s a fresh attitude.

The Desire for Success Can Wear You Down

In the twenty-eight years of my publishing journey, I’ve seen some authors who I would call plenty successful—with many wonderful published novels under their belt, having won some awards and getting great acclaim—suffer from continual disappointment, frustration, and even despair over their writing career. While I waited for my first “breakthrough” novel to go to press, I had foreboding nigglings in the back of my mind, telling me that would never happen to me. I would be on the NY Times best-seller list out the gate!

Yet, four published books later, I found myself crying for a week at the completion of my latest novel. Why? Because I knew it was the masterpiece and apex of my writing life and ability, and I knew the book would never sell big and get the acclaim I felt it deserved. Why? Because it was wholly imaginative, original, untraditional, and broke “all the rules.” I knew that I was risking much by writing the book pressing upon my heart, yet even a couple of years later, I don’t regret a second that I spent writing that novel. I wouldn’t change a word.

A Challenge to You to Change the Picture

So, where is all this whining and negativity leading to? I spent a long year stepping back and evaluating the writing life. And I would like to challenge you to stop and think a bit about your goals, dreams, hopes, and beliefs.

We have been programmed to believe many things that, I feel, contribute to our disappointments, frustrations, and feelings of failure as writers. I believe it’s time to redefine, truly and in our hearts, what success means and looks like to us. Rather than give you a list of practical things your can do like blogging, tweeting, scheduling your time better, and improving your writing craft, I’d like you to think about making this your primary goal for this day, this month, this year: to have a fresh, new attitude about your writing journey.

These are the truths I am learning to embrace, and I hope you will post these and think about them often:

  • Success is not defined by numbers or money earned. Instead of trying to be successful by worldly standards, think about significance. How can you deepen your writing and reach out to readers in a significant way? Believe that what you have to say through your words is significant and important. And put the care and attention into your writing that you and it deserves.
  • You are not writing to please the masses. You may never please the masses. And writing to please yourself is not the goal either. We write for an audience, and know the kind of hearts we want to touch. Write, then, for that audience in all sincerity and passion, and trust that from that place your voice will ring out.
  • Don’t validate yourself based on others’ opinions of you or your writing. Accept helpful criticism and critiques and keep improving your craft, but know you will never please everyone and it’s foolish to try. In my former writers’ group we used to applaud loudly when an author got her first scathing review. It’s a badge of arrival.
  • Find a few really supportive writer friends to be on this journey with you. Encourage one another, promote one another, critique for one another. One way to stop focusing on your own sense of failure is to help others. I find great joy in helping my editing clients get agents and publishing contracts, and their success brightens my day. There is nothing wholesome in jealousy, envy, or a competitive spirit. Believe your audience is out there waiting for your books and write for them. There will always be terrible writers enjoying incredible success with terrible books. It’s easy to want to throw your hands in the air and say “I give up!” when you see the awful stuff getting praised as great writing. Right, it’s not fair. Now, get over it. Really. If you don’t, it will drive you nuts. I tell this to myself a lot!
  • Know that traditional publishing is undergoing radical changes. This is actually great news for authors, for now, with the trend of ebook publishing and social networking and marketing, any good author can get known, grow a true fan base, and connect with readers who love her books. And that’s what we need remember—that we are writing for that connection between writer and reader. The future never looked so bright to be able to accomplish these things.

So take heart and a deep breath and think about redefining success with a fresh attitude—one of optimism, enthusiasm, and a renewed dedication to write the best novels you can, knowing that your readers are out there and in time you will find them—and they will find you. To me, that is the only way to stay sane.

Any thoughts on keeping your sanity by the way you define success? How do you define success?

Redefining Success - Susanne LakinIn addition to being a novelist, copyeditor, and writing coach, Susanne Lake is a mom, a backpacker, and a whole bunch of other things that she loves to write about.

Based in San Francisco, she teaches workshops on the writing craft at writers’ conferences and retreats. She also enjoys guest blogging, and would be delighted to do a post on writing and editing.  To read Susanne’s blogs or make a request for teaching or guest blogs, click here.

Susanne is also on Facebook and Twitter

Feather in a Hurricane


feather in a hurricaneMy guest today is author BC Brown, who explores the painful consequences of subordinating her own needs to her husband, a pattern she had in common with Lindsey Chandler, the protagonist in my just-released novel, A Fitting Place.


Feather in a Hurricane 

Three months driving between St. Louis and Indianapolis. Working all week and driving all weekend. Sleeping on waiting room floors and eating out of machines. My mother now recuperating after major surgery.

I was weary, leaden, and spent. Just when there seemed a light at the end, my husband of a decade calls.

“How quick can you come back?”

It’s ten p.m. I’ve been awake for more than 48 hours with only catnaps. Perhaps after a million hours of sleep. All I said was, “I don’t know. I have to pick up mom’s meds tomorrow, wait for the nurse, and do her grocery shopping. Why?”

“Can you be here by noon?”

An hour time change, a three-hour drive, and a mountain of errands beforehand. Uh, no.  “I could be home by two. What’s this about?”

A hesitation. “I’ll see you at two. I can’t talk about it on the phone.” Click.

I should have gotten a speeding ticket, a Driving Under the Influence of Fatigue ticket, but I was lucky. Despite my lack of sleep and my complete lack of focus, neither I nor anyone else was harmed.

I arrived home to have my heart ripped from my chest. My husband was leaving. What I thought was a happy marriage had been a sham. He’d had an ongoing affair. Within an hour, he’d gone.

I was left with a minimum wage job that couldn’t support the life we lived. I had no schooling, having supported him in school and helped work his business.

I did what any self-respecting woman would do. I called family.

My sisters drove from southern Indiana to St. Louis in almost the record time I’d done it only hours before, packed everything I owned, and took me home. Where things went from devastating to destitute.  It took more than a month to stop bursting into random tears.

The best part of it all? Expectations of job searching and of being an independent, strong person. With what skills?

My husband and I met at seventeen. The instant I was legal, we had the dream: jobs, one of us in school, a business, dogs, and a mortgaged picket fence. My life was very much ‘my husband’. With the exception of my writing and my love of karaoke, I didn’t have my own opinions, my own interests, or my own skills.

I was stymied when potential employers asked why I’d make a good fit for their company? I mean, I didn’t know if I made a good fit for me.

As a result, I worked a string of back-breaking and paycheck-puny jobs. I tried counseling. I tried job fairs. I trudged from one ad to another, touted my pitiful skills, trotted out every reference, accomplishment, and award.

It didn’t help. I was free falling. My elderly and ailing mother was financially supporting me, while one sister with kids fed and housed me and the other fed my gas tank and car insurance. I was broke and broken.

Enter the good friend.

My best friend for almost fifteen years, the same man who’d introduced me to my husband (but I couldn’t hold that against him), mentioned his old job was open again. The pay was crap, the job bottom of the barrel, and the hours long with mandatory overtime. But he’d put in a good word for me.

I walked in, seven months out of work, with a pathetic resume of retail, food service, clerical, and a smidgen of advertising experience. The HR manager asked why I wanted the position.

“I’m broke. I need a job; you have one that needs to be filled. No matter that I feel like a feather in a hurricane, those two things are true,” is all I said. Desperation is rarely the best form of self-presentation, but I was beyond desperation, willing to consider jobs that weren’t exactly the most flattering or self-respecting.

He stuffed his hands in his pockets. “You’ll hate this job, probably quit in a month. Everyone does.” Pause. “You start Tuesday.”

For the first time in half a year, my stomach ceased churning. I put my hand in his and shook. “I won’t quit.”

My feather had snagged something solid and stopped spinning long enough for me to get my feet. I spent the next three years in that job, moving from the entry position to a middling position. Even when I was offered a better, full-time position elsewhere, I continued to work there. See, if everything I’d tried and done on my own hadn’t helped, I sure wasn’t going to give up the one good thing that had happened.

I learned an insanely good lesson. I’d been raised with a ‘do it yourself’ mentality. But that hadn’t worked. It was when I’d acknowledged that I needed others that life straightened out.

I could pick up the pieces, build a new me. But it took someone else, a good friend, to show me who I really was all along. Just me. And I could do this.

BC Brown featherBC Brown is the author of A Touch of Darkness and A Touch of Madness, both Abigail St. Michael novels. Her work has been included in three, multi-author anthologies – Fracas: A Collection of Short Friction, Quixotic: Not Everyday Love Stories, and A Chimerical World: Tales of the Seelie Court. She has published a dark fantasy novel, Sister Light, Book One: Of Shadows previously under the pen name B.B. Walter.

BC has upcoming work with the Abigail St. Michael novels entitled A Touch of Emptiness. More of her work will be released in a general fiction novella entitled Feather in a Hurricane and a dark fantasy novel, Of Shadows.

You can see more about BC and her books from the links below.

Amazon … Barnes & Noble … Facebook … Twitter … Goodreads


The discussion on the human condition will continue, with particular emphasis on the issues that complicate the life of Lindsey Chandler, the protagonist in A Fitting Place.  If you would be interested in contributing a guest blog to this series, please contact me here  or at