The Evening of Life

The Challenges of Aging and Dying Well

Joseph E. Davis, Paul Scherz, Joseph E. Davis, Paul Scherz

• Publisher: University of Notre Dame Press
• Year: 2020
• Print ISBN: 9780268108021, 9780268108014
• eBook ISBN: 9780268108038
• Edition: 1
• Topic: Social Sciences
• Subtopic: Ethics in Medicine
• Index: Social Sciences

Although philosophy, religion, and civic cultures used to help people prepare for aging and dying well, this is no longer the case. Today, aging is frequently seen as a problem to be solved and death as a harsh reality to be masked. In part, our cultural confusion is rooted in an inadequate conception of the human person, which is based on a notion of absolute individual autonomy that cannot but fail in the face of the dependency that comes with aging and decline at the end of life. To help correct the ethical impoverishment at the root of our contemporary social confusion, The Evening of Life provides an interdisciplinary examination of the challenges of aging and dying well. It calls for a re-envisioning of cultural concepts, practices, and virtues that embraces decline, dependency, and finitude rather than stigmatizes them. Bringing together the work of sociologists, anthropologists, philosophers, theologians, and medical practitioners, this collection of essays develops an interrelated set of conceptual tools to discuss the current challenges posed to aging and dying well, such as flourishing, temporality, narrative, and friendship. Above all, it proposes a positive understanding of thriving in old age that is rooted in our shared vulnerability as human beings. It also suggests how some of these tools and concepts can be deployed to create a medical system that better responds to our contemporary needs. The Evening of Life will interest bioethicists, medical practitioners, clinicians, and others involved in the care of the aging and dying.

Contributors: Joseph E. Davis, Sharon R. Kaufman, Paul Scherz, Wilfred M. McClay, Kevin Aho, Charles Guignon, Bryan S. Turner, Janelle S. Taylor, Sarah L. Szanton, Janiece Taylor, and Justin Mutter

PART I

Our Deficit Model of Aging

CHAPTER ONE

The Devalued Status of Old Age

JOSEPH E. DAVIS

In our society, old age is understood and addressed in ways that lead inevitably to its devaluation. Its status is low and arguably is falling. On its face, such a claim might sound preposterous. Surely, the opposite is true. From the Social Security safety net to the Americans with Disabilities Act, from the positive portrayals of older people in popular media to near-record life expectancy, this is unquestionably the golden age of the golden years, a time of “No Limits. No Labels,” to quote a slogan of the American Association of Retired Persons (AARP). The scope of identification with the aged is wide, this time of life is treated with public respect, and extensive supports and accommodations for living well are provided. By what blinkered perspective or romanticization of the past can we fail to see this obvious progress?

There have been a great many improvements to the material welfare and health of the aged, no question of that. But there is another feature of our present situation, loudly touted as a breakthrough, that I want to argue is actually counterproductive and contributes to a devaluation rather than an enhancement of the evening of life. What I have in mind are the “new positive images of aging,” which, according to the sociologist Stephen Katz, “depict activity, autonomy, mobility, choice, and well-being in defiance of traditional gloomy stereotypes of decline, decrepitude, and dependency.”¹ These new images create their own expectations and obligations and deny the last stage of life its own meaning and character. And without those, old age can have no valued standing.

The evening of life is being redefined by imperatives that are not in themselves new, but are increasingly pressed onto the aged. One such force is the concern with the viability of public programs that provide income and health insurance for the elderly. Underlying much of this concern, and the resulting public discussion, are a growing sense of fiscal crisis and calls for cost-cutting reforms. The subsequent formulation of economic priorities and policies on aging is, in turn, amplifying another force that is engulfing old age: the growing medicalization of the lives of older adults. Efforts to fight rising costs are both informing and working in tandem with new and inflexible duties of health surveillance, prevention efforts, and lifestyle changes.

The trend toward medicalization dovetails with yet a third force, the commercialization of old age. Commercialization is inciting and informing imperatives to optimize self and body, realized through vast new industries of goods and services, including anti-aging interventions. Public policy, medicalization, and commercialization: All of these forces and more are generating new standards for and expectations of old age and contributing to its devaluation.

But a devalued old age cannot be explained solely by economic, medical, or commercial pressures. The challenge goes deeper. It involves basic cultural orientations — to time, kinship, social organization, the transcendent, and value premises about what it is good to do and good to be. We find ourselves today with a construction of old age built according to an irredeemable cultural logic.² That logic and its inevitable consequences become clear in various representations of old age and aging that I briefly consider. One is representations of aging in popular culture. In this sphere, vitality, fitness, and productivity, no matter the age, are the measures of aging well. The second case involves representations of aging in the gerontological discourse of “successful aging” and in anti-aging medicine. In these discourses, normal aging and death are implicitly or explicitly defined as a failure. And, finally, I want to consider representations of aging in the rhetoric of concern about a growing “epidemic of loneliness.” In an important sense, the aged disappear in this discourse as their life-worlds and vulnerabilities are reduced to individualized, medicalized problems.

Outside Time and Finitude

The last decade has seen the emergence of a plethora of health, fashion, and lifestyle blogs aimed at people over fifty or sixty years of age: Atypical Sixty, Fabulous over Sixty, Age Is Just a Number, Muddling through My Middle Age, Second Lives Club, and so on. Typically run by one or two individuals, the blogs and vlogs create an audience and interactive community around the discussion of aspects of living in one’s older years. Many also generate revenue by deftly acting as intermediaries between their audiences and commercial enterprises that support the sites.³

For a window on popular norms of aging, I chose Sixty and Me, a “community of 500,000 women over 60,” founded by Margaret Manning. Not only does the site claim to have a very large following, but it also covers a wider range of topics than most, including health, travel, money, life, mindset, dating, and beauty. Sixty and Me further recommends itself with its mainstream tone and advice. There are sites offering fanatical fitness regimes, calorie restriction diets, and “senior sex news,” but this is not one of them.

Sixty and Me brims with advertising. Manning is the central figure, but there are also many contributions by various experts, typically with something to sell. While there is some discussion of caregiving, self-care for caregivers, and the need to talk about death, there is little mention of suffering, decline, or death itself. These topics, it seems, don’t translate well into advertising opportunities. As gerontologist Harry Moody once observed about marketing to the older demographic: “The appeal is always to turn away from outdated images of maturity in favor of reinvented identity outside of time and finitude.”⁴

At Sixty and Me, an appeal to emancipation and reinvention informs the picture of good aging. That picture draws on familiar American norms of an independent, self-sufficient, and enterprising self. In one showcased post, for example, Manning quotes the actor Jamie Lee Curtis, then fifty-six: “If I can challenge old ideas about aging, I will feel more and more invigorated. I want to represent this new way. I want to be a new version of the 70-year-old woman. Vital, strong, very physical, very agile. I think that the older I get, the more yoga I’m going to do.”⁵

In commenting on Curtis and on this quote, Manning makes three points. She notes that Curtis “isn’t afraid of getting older. Instead of seeing life after 60 as a time to take it easy, she is looking forward to the opportunity to make the absolute most of her life.” Manning adds that she appreciates “the fact that Jamie Lee Curtis realizes that, as a celebrity, she has a role to play in challenging aging stereotypes.” And finally, Manning approvingly observes that Curtis “calls attention to the fact that life after 50 is a choice. At 56, Curtis is already planning for the decades ahead. As she correctly points out, the older she gets, the harder she will need to work to maintain her energy and physical strength.”

Make the most of life, live so as to challenge “old ideas about aging,” and treat life after fifty (or sixty or seventy) as a choice: These are the three norms that Manning takes Curtis to be living by and that Manning finds “right on the money,” as do many (though certainly not all) of the blog readers who commented on the article since its initial posting. In this view, later life should not be a time for less engagement or a reorientation away from a view of the world as a task zone, but rather a period of continual goal-seeking, work, or other contributive role-taking. The future is open, inviting, ready to reward new initiatives.

This liberal individualist picture of people as independent agents, masters of their lives through volition and choice, is familiar. As social institutions have declined in recent decades, however, there has been an even greater emphasis on self-optimization. The language for expressing this imperative has taken a number of forms since the 1960s, with terms like human potential, positive thinking, empowerment, “peak performance,” and self-esteem variously in use. A prominent rubric that began to spread in the 1980s framed autonomous persons as “enterprising” people energetically striving, with calculation and efficiency, to project a future and act to achieve their goals.⁶ The notion that life after fifty is a choice and is anything we want to make of it brings together the norm of self-optimization — Curtis will not be retiring or taking it easy, but making the absolute most of her life — with two related and widely accepted ideas: that health is an achievement and that body image is an integral component of personal identity.⁷ All of these ideas meet in the joint concept of “health and fitness,” which is presented by Curtis as the decisive blow to the old stereotypes of aging. What will make Curtis a “new version of the 70-year-old woman” is the fit and vital body that she will work ever harder to produce.

Aging well by such criteria, as the outcome of choices, requires continuous demonstrations of success through signs of initiative and energy. Appearance — looking healthy, fit, and “put together” — is also crucial: “To look old is to be old.”⁸ In the comments section of Sixty and Me, people sometimes report on how they look younger than they are. As one reader put it, “I am 70 (even though most folks tell me I look at least 10 years younger).” Such self-affirmation signals that they are aging well.

Another example illustrates this performative quality. In a discussion of “fashion for women over 60,” Manning stresses looking “fabulous without trying to look younger.” One of her fashion secrets is to “embrace your age.” Elaborating on that advice, she writes that “when people try to dress in styles that would be more appropriate for someone much younger, they paradoxically make themselves look much older. . . . If you “dress age appropriately,” it often has the effect of making you look younger because people are not distracted by age-inappropriate clothing, and instead can appreciate what great shape you’re in, or how healthy your skin is, or what a stylish haircut you have.”⁹

Again, the measure is the body. Health, fitness, a youthful appearance, entrepreneurial energy: These are not “add-ons,” like fashion or cosmetics; they are something you are. The point of the advice of Sixty and Me is not so much to deny the aging process as to postpone it to some indefinite future. The message is that good aging is living later life as if you were young, though with a necessarily even more exacting regimen of diet, exercise, and risk reduction practices — and, given that this good aging is a matter of choice and responsibility, with the unspoken implication that problems and failures are self-inflicted.

Personal efforts to stay fit or engage in work are certainly not to be derided. What is of concern is the language of individual choice, the incitement to a self-optimization understood in terms of “productivity” and an open future, and the use of the body as an instrument to register a superior position. There are no grounds here for coping with disability and decline, physical or mental, or for embracing old age as a valued and dignified final chapter in its own right. And in the individualism being promoted there is precious little rationale for interdependence: for the humility, for instance, to accept care or the commitment to provide it. Despite the effort to project a positive image, what is on offer is a construction of old age that can only intensify and perpetuate its devalued status.

The “New Gerontology”

The picture of aging that comes through on Sixty and Me has been a feature of consumer culture for decades. But in the late 1980s, it entered mainstream gerontology. The leading theorists of the “new gerontology,” John Rowe and Robert Kahn, distinguished their vision of positive aging from the “negative perspective” of the old gerontology and the “myths” and “denial” of society at large.¹⁰ Previously, gerontologists had treated age-related alterations in physical and cognitive functioning that were not due to disease or disability as normal and inevitable and unassociated with lifestyle and risk. Rowe and Kahn, by contrast, argued that many characteristics of and age-related disease risks were related to lifestyle and other environmental factors and that much of the decline in older age was therefore avoidable. With the right choices and the discipline to follow a careful regime of risk reduction, individuals could attain “successful aging,” generally characterized in the gerontological literature as sustained health and vitality in the later years.

Success, in those terms, means living with little disease or disability, maintaining high levels of cognitive and physical functioning, and remaining active and independent for as long as possible.¹¹ In an important sense, you satisfy the criterion of “successful” only to the degree that you are not “old.”¹² If you are frail, functionally disabled, disengaged, or have health risks, such as high blood pressure, your aging is “usual.” That doesn’t sound so bad, but, as many critics have pointed out, the opposite of success is not “usual.” It is “failure.”¹³

The normative appeal of the new gerontology to individual autonomy and responsibility makes it even clearer that “failure” is precisely what is at stake.¹⁴ Health is a matter of individual choice, and it becomes each person’s moral duty to muster all of his or her energies to be successful. Insufficient initiative, insufficient efforts to stay informed, incomplete compliance with expert advice, and the like are grounds for potential blame, stigmatized as fatalism and passivity and made the target of interventions by others. Calling, and getting called, to account for any slacking has become a pervasive phenomenon, so common that we offer anticipatory apologie...

Table of contents

• Title
• Copyrights
• Contents
• Acknowledgments
• Introduction: Toward an Ethics of Aging Joseph E. Davis
• Part I. Our Deficit Model of Aging
• Part II. Living Old Age Well
• Part III. An Old Age that Goes Well
• Conclusion Paul Scherz
• Contributors
• Index