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


  1. Wow, Mary. Wish I could be in on your class. It would be too big a commute.

    I’ll be very interested to know what your students have to say about this.

    • Mary Gottschalk says

      Joan … I’d love to have you in the class … we’ve never met, so it wouldn’t be a familiar face, but definitely a familiar voice.

  2. Mary, what an interesting seque – publishing your novel A Fitting Place this summer and now teaching a course on the bio-ethics of aging. Both have required getting out of your comfort zone once again.

    Recently, Elaine Mansfield wrote a blog post on the topic of advance directives. In case you haven’t read it, here is the link:
    Her first-hand experience added a sense of urgency for her readers to consider their options in writing such a document.

    Like Joan, I would be interested in knowing your students’ perspective.

    • Mary Gottschalk says

      Marian … I read through Mansfield’s excellent piece. Our attorney urged to do very detailed advance directives a year or so ago …. covers every possible option, in a form accepted by Iowa. If you’re interested in this topic,you might check out “Exit – a Novel about Dying” by Cebuhar. It’s an often humorous romp through a hospice facility, that forces the reader to consider the human dimension of so many of the health care issues on which ideology seems to rule.

      I’ll let you know how the class goes.