Each time they talk, Jerald Winakur's brother asks him the same question: "What are we going to do with Dad?"
Their father, age 86, at times does not recognize his wife or children. He has suffered chronic heart problems for years, but they try and keep him out of the hospital as much as possible. The family spends a significant amount of money each month on home care aides and other necessary assistance.
Jerald secretly hopes his father will slip peacefully away before he grows more encumbered by health problems and dementia. But he feels guilty for those thoughts.
Jerald doesn't have an answer for his brother's persistent question -- even though he is one of the nation's relatively few experienced geriatric physicians, and one of even fewer -- only 1,900 -- certified in long term care.
His moving narrative of helplessness and desperation, published in Health Affairs this past August, sent a simple message: The process of aging, and the process of dying, present many challenges for which modern medicine simply has few easy answers. And with a growing cohort of elderly citizens, it will become increasingly important to address these challenges.
When we hit age 65 around 2050, the Census Bureau expects us to join a population of senior citizens 85 million strong, more than double today's population of 36 million seniors. We will likely make up more than 21 percent of the national population, compared to today's proportion of 12 percent.
However, it is our generation that will be largely responsible for leading this country through this demographic shift because it will happen long before we become senior citizens. It is expected that the elderly population will reach the 20 percent mark by 2030. And an increasing proportion of them will be the "old old," those 85 years and older, almost 10 million in 2030, more than double today's total.
What will this mean?
Medical advances over the past 50 years have allowed countless individuals to live longer, meaningful lives, but others are merely kept alive longer, despite remaining in poor health.
Drawing that boundary is an important, yet ethically difficult, endeavor.
It is also a deeply personal endeavor.
In a 1994 ballot initiative, residents of Oregon voted to allow individuals to decide that boundary for themselves. They approved the Death With Dignity Act, which allows physicians to prescribe lethal doses of medications to terminally ill adults of sound mind. The act survived a repeal vote four years later with an even greater majority.
Oregon is the only state with such a law. In its 11-year history, only about 200 Oregonians have opted to take their life, dispelling fears that many had concerning the potential for abuse of such a statute. The impact, however, has reached much farther. According to Oregon Sen. Ron Wyden, the Death With Dignity Act "has triggered a huge awareness of end-of-life options, including palliative care, hospice and living wills."
The Bush administration has been trying to squelch Oregon's Death With Dignity Act since its ascension to power in 2001. Officials claim that the law violates a federal statute, the Controlled Substances Act, which was originally written to combat the illicit use and distribution of prescription drugs.
The case, Oregon v. Gonzales, has already been decided twice in favor of Oregon by lower courts, and it went to the Supreme Court last week for oral arguments. Technically, it's a question of state's rights, but the ramifications clearly reach much further than federalism.
The explicit question of physician-assisted suicide has once before come in front of the Supreme Court. In 1997, the Court held in Washington v. Glucksberg that Washington state's ban on physician-assisted suicide was indeed constitutional. The court, however, was very much attuned to the evolving landscape of this issue. Chief Justice William Rehnquist concluded the majority opinion with deep respect for the ultimate judgment of the American public: "Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in a democratic society."
If Oregon's Death With Dignity Act is struck down, it would take away a valuable option that the majority of the state's voters have endorsed twice.
More importantly, however, it would stifle the ongoing debate and growing awareness about end-of-life options, a public discussion that is significantly strengthened by the natural laboratory of the states.
With this nation's growing elderly population, that public discussion is particularly salient. It is also important to ensure that we don't feel quite as lost and helpless when Jerald Winakur's story eventually becomes our own.Shannon Jensen is a senior real estate, business and public policy and urban studies major from Annapolis, Md. Above Board appears on Mondays.
