The Value of the Elderly

"I kept my faith even when I said, 'I am greatly afflicted' " (Ps 116:10): life in old age and at times of suffering from the Papal Encyclical Evangelium Vitae

46. With regard to the last moments of life too, it would be anachronistic to expect biblical revelation to make express reference to present-day issues concerning respect for elderly and sick persons, or to condemn explicitly attempts to hasten their end by force. The cultural and religious context of the Bible is in no way touched by such temptations; indeed, in that context the wisdom and experience of the elderly are recognized as a unique source of enrichment for the family and for society.

Old age is characterized by dignity and surrounded with reverence (cf. 2 Mac 6:23). The just man does not seek to be delivered from old age and its burden; on the contrary his prayer is this: "You, O Lord, are my hope, my trust, O Lord, from my youth ... so even to old age and grey hairs, O God, do not forsake me, till I proclaim your might to all the generations to come" (Ps 71:5, 18). The ideal of the Messianic age is presented as a time when "no more shall there be ... an old man who does not fill out his days" (Is 65:20).

In old age, how should one face the inevitable decline of life? How should one act in the face of death? The believer knows that his life is in the hands of God: "You, O Lord, hold my lot" (cf. Ps 16:5), and he accepts from God the need to die: "This is the decree from the Lord for all flesh, and how can you reject the good pleasure of the Most High?" (Sir 41:3-4). Man is not the master of life, nor is he the master of death. In life and in death, he has to entrust himself completely to the "good pleasure of the Most High", to his loving plan.

In moments of sickness too, man is called to have the same trust in the Lord and to renew his fundamental faith in the One who "heals all your diseases" (cf. Ps 103:3). When every hope of good health seems to fade before a person's eyes-so as to make him cry out: "My days are like an evening shadow; I wither away like grass" (Ps 102:11)- even then the believer is sustained by an unshakable faith in God's life-giving power. Illness does not drive such a person to despair and to seek death, but makes him cry out in hope: "I kept my faith, even when I said, ?I am greatly afflicted' " (Ps 116:10); "O Lord my God, I cried to you for help, and you have healed me. O Lord, you have brought up my soul from Sheol, restored me to life from among those gone down to the pit" (Ps 30:2-3).

Defending the Dignity of those with Dementia

I once heard a remarkable story from a woman named Cecilia sitting next to me on a long flight.

She told me how her mother had suffered from dementia for many years, eventually reaching the point that she could no longer recognize any of her children when they would visit at the nursing home. She then changed the tone of the conversation immediately when she added, "But there's always someone in there." When I asked what she meant, she continued:

"I love singing, and as an African-American, I've got a strong voice. I sometimes visit nursing homes near my house just to sing for the patients, to do something different and break up their routine a little. I still remember 12 years ago, I decided I would sing for my Mom. She didn't have a clue who I was, and didn't respond to much of anything, because the dementia was so advanced. She seemed almost catatonic. By chance I had come across one of her old hymnals with the Baptist songs we used to sing in church as kids. She used to know most of them by heart. Well, those old hymns stirred up something inside her, and after I started singing, she suddenly picked up and began to sing along with me! Yup, there's always someone in there."

Cecilia's story about her mother runs against a cultural tendency today, which is to dismiss those struggling with dementia as if they were no longer persons. These patients, however, clearly deserve much more from us than the kind of benign neglect (or worse) that they occasionally receive.

Many of us fear a diagnosis of dementia. We worry about "surrendering our core" or "losing our true self" to the disease. Many of us wonder how our loved ones would treat us under such circumstances.

Steven Sabat, writing in The Journal of Clinical Ethics, challenges the reduced expectations for quality care for those with dementia:

"Is his or her personhood recognized and supported, or neglected in favor of the assumption that it barely, if at all, exists…do we assume that the afflicted rarely if ever recognizes the need for company, for stimulation, for the same sort of treatment he or she would seek and be given as a matter of course in earlier, healthier, days?"

Sometimes we may view the situation more from our own vantage point, rather than the patient's. In a report on care for the elderly, physicians Bernard Lo and Laurie Dornbrand put it this way: "Family members and health professionals sometimes project their own feelings onto the patient. Life situations that would be intolerable to young healthy people may be [made] acceptable to older debilitated patients."

Sabat notes how this raises the prospect of reducing the patient to a kind of object:

"The dementia sufferer is not treated as a person; that is, as one who is an autonomous center of life. Instead, he or she is treated in some respects as a lump of dead matter, to be measured, pushed around, manipulated, drained, filled, dumped, etc."

Those suffering from dementia challenge us in a particular way towards the beautiful, and at times heroic, response of love, "perceiving in the face of every person a call to encounter, dialogue and solidarity."

The medical profession in particular faces a unique responsibility towards each individual with dementia, a duty to approach each life, especially in its most fragile (and uncooperative) moments, with compassion, patience and attention. When our ability to think rationally or choose freely becomes clouded or even eliminated by dementia, we still remain at root the kind of creature who is rational and free, and the bearer of inalienable human dignity. We never change from one kind of being into another. Parents who have children born with a serious birth defect or behavioral problem would never suggest that their defect or impediment transforms them into another kind of being, into an animal or a pet. It never renders them "subhuman," even though their behaviors, like those of advanced dementia patients, may at times be frustrating and very hard to bear. As Cecilia reminded me on the plane, "there's always someone in there."

Pope John Paul II in a beautiful passage from Evangelium Vitae (On the Gospel of Life) speaks of "the God of life, who has created every individual as a 'wonder.'" We are called to foster an outlook that "does not give in to discouragement when confronted by those who are sick, suffering, outcast or at death's door." Those suffering from dementia challenge us in a particular way towards the beautiful, and at times heroic, response of love, "perceiving in the face of every person a call to encounter, dialogue and solidarity."

Father Tadeusz Pacholczyk, Ph.D. "Defending the Dignity of those with Dementia." Making Sense Out of Bioethics (October, 2010).