Abstract
The Evening of Life: The Challenges of Aging and Dying Well, edited by Joseph E. Davis and Paul Scherz, is a collection of essays that aims to establish an ethics of aging which describes “an old age that is lived well and that goes well” (p. 2). In the book’s introduction, Davis posits that many of the social and cultural institutions that previously gave old age meaning have weakened, a modern deficiency which he suggests comes largely from the current age’s strict individualism. This is especially concerning given the changing demographics in the United States and beyond, with older adults comprising larger and larger portions of society. To address this issue, the book presents a series of diverse but connected essays from authors with backgrounds in sociology, anthropology, philosophy, theology, and medicine.
The book is divided into three parts: “Our Deficit Model of Aging,” “Living Old Age Well,” and “An Old Age that Goes Well.” Part One opens with a chapter titled “The Devalued Status of Old Age” (Davis). The author identifies and describes the factors that contribute to the deficit view of aging and the lack of significance with which our society views the evening of life. These factors include the familiar, such as the medicalization of aging, to the less familiar, such as movements that on the surface promote well-being in later life but actually commercialize anti-aging efforts and “intensify and perpetuate” the “devalued status” of older adults (p. 28). Chapter One sets the stage for Chapter Two in which the author uses the case of implantable cardioverter defibrillators (ICDs) to discuss the role that the medical-industrial complex plays in treatment decisions in later life (Kaufman). One of the more salient points made in is this chapter is the fact that the life-extending treatments that are offered to older adults often prevent them from experiencing the types of deaths that are most preferred (e.g., dying in the night) and push them into a “prolonged, unwanted kind of late life and dying” (p. 43). The author also points out that many of the evidence-based treatments that are offered to older adults are the result of the biomedical research engine that is driven by private, for-profit companies. With all of this evidence suggesting treatment rather than dying a natural death, “most deaths, regardless of a person’s age, have come to be considered premature” (p. 41). Part One of the book concludes with a deep discussion of the challenges that we face when trying to understand aging through the lens of contemporary ethics. The most intriguing sub-section of this chapter is a reflection on the concept of “dependency” and the centrality of “what it means to be human” (Scherz, p. 54). The author explores dependency using the ethics of Christianity to better understand the importance of fully experiencing and not necessarily controlling the dying process. The chapter concludes with this insightful statement: “The attempt to attain control over our dying through the exercise of autonomy clearly fails to properly recognize what we are as dependent, relational creatures” (p. 60).
Part Two begins with an essay on our society’s infatuation with youth and how the denial of the realities of our aging bodies can cause us to miss “little epiphanies that come to us with the advance of age” (McClay, p. 68). One such epiphany, the author argues, is that as we age, our past self continues to be a part of who we are in the present, and we are just as likely to be improved by age as we are to be reduced by it. McClay illustrates this point through an anecdote about his mother, who was left unable to speak, write, or read after a stroke. While many would look upon the disabilities she had with pity, McClay remembers the great joy and purpose his mother found in the last few decades of her life after the stroke. The essay concludes with the suggestion that we reconsider our definitions of “quality of life,” allowing ourselves to see the beauty in the aging process, and the epiphanies that come along with it.
Chapter Five builds on the previous chapter by suggesting that by focusing less on insignificant day-to-day matters and more on meaningful interpersonal relationships, older adults may experience more “authentic aging” (Aho). The author draws upon the work of Martin Heidegger to explain that when we are younger, the future is a horizon full of many possibilities. As we age, this horizon invariably shrinks. Rather than seeing this contraction as a source of distress, the author believes it can allow aging adults to really focus in on what is most important in their lives, no longer taking time for granted. Closely related, Chapter Six explores aging using insights from two works, Jean Améry’s On Aging: Revolt and Revolution and Martin Heidegger’s Being and Time (Guignon). Améry suggests that for much of our early and middle years, we are focused on the future, consistently making plans to achieve our goals. In old age, however, our emphasis shifts to the past, and on what we have already achieved. Améry goes on to explain that this understanding of time in old age is further complicated by “cultural time,” or the sense that the world around older adults is changing so rapidly and extremely as to no longer be recognizable. Taken as a whole, this particular temporality can lead to a sense of hopelessness among those over a certain age. This somewhat bleak perspective of aging is contextualized through Heidegger’s work in which he suggests that older adults must be able to balance holding resolute to what is most important in their lives with the ability to recognize and accept the realities of old age. In finding such a balance, older adults may find authenticity and happiness.
Part Two closes with an analysis of various definitions of happiness that have been used throughout human history to understand the experiences of aging (Turner). The author uses the work of Aristotle to argue that while contemporary research sees happiness as an individual state of contentment largely linked to privatized consumption, happiness and human flourishing are social and political issues. In Turner’s review of research on the connections between happiness and aging, he criticizes theorists who take a simplistic view of happiness, as well as those studies that ignore our embodied experiences as human beings. Instead, he proposes that considerations of happiness in old age must take body changes into account and be understood in the context of social belonging.
Part Three begins with a chapter titled “Friendship, Citizenship, and Abandonment: Older Adults with Dementia and Without Family Caregivers” (Taylor). While many see the memory deficits that accompany dementia as a loss of identity, the author proposes a relational understanding of personhood, in which a person with dementia’s “selfhood” is understood through their participation in social networks. In particular, the author explores the experiences and personhoods of adults with dementia who do not have family members to care for them, and who are consequently cared for by friends. This chapter is intriguing; however, the focus is rather narrow given the small population of specific caregivers. In Chapter Nine, the authors describe and provide a case study from the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program (Szanton & Taylor). This intervention for low-income individuals emphasizes the importance of viewing older adults in a holistic, person-centered manner that goes beyond their diagnoses and health conditions to consider the individual’s history and strengths, as well as those of the family, community, and society around them. CAPABLE is designed to work toward an older adult’s functional and activity goals by addressing personal and environmental causes of challenges in completing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). In the final essay of the book, the author uses a case story to illustrate the all-too-familiar scenario of older adults who are sent from medical practitioner to medical practitioner in search of a diagnosis, never receiving the holistic, person-centered care they need in any of these encounters (Mutter). The author argues that Medicare and, more broadly, health insurance’s emphasis on identifying a diagnosis prior to funding care is wholly at odds with the realities of aging with multiple complex chronic illnesses. After reviewing the history of Medicare’s “political economy of diagnosis,” the author suggests a shift to a “political economy of prognosis,” one which asks, “In view of the whole person—health, illness, vulnerabilities, and social supports—how is this person doing, what is her or his probable course, and how can we alter that course for the better?” (p. 175).
In the book’s conclusion, Paul Scherz argues that an ethics of aging must shift our understanding of human beings from being self-optimizing to dependent, with selves that are relational rather than individual. In addition, he asserts that human temporality in the evening of life must be seen as a closed, versus open, future. The essays of this book clearly support making these transitions in the way society views aging, some through provision of concrete suggestions for improving care for aging adults, and others through philosophical or ethical musings on the nature of aging and death. Those with a professional or personal interest in improving care for aging and dying adults will certainly find helpful insights within this book’s chapters. The diverse backgrounds of the book’s authors make this an optimal text for an interdisciplinary class on end-of-life, and it could also serve well as a supplemental text for graduate-level courses in gerontology.