Bioethics Discussion Blog: Is There a Duty for the Elderly to Die?





Wednesday, March 08, 2006

Is There a Duty for the Elderly to Die?

As a segue from my previous posting on sheparding of scarce resources by considering "social worth" of the patient, here is another topic from my now inactive "Bioethics Discussion Pages" which deals with an even more controversial issue: the suggested duty for the elderly to die. I should point out that since former governor of Colorado, Richard Lamm, allegedly made this comment years ago, there has been writings in the literature that he really didn't mean what has been publicly quoted. Nevertheless, this is an issue that is worthy of discussion since the concept might be extended from healthy elderly (Lamm's population of interest) to the sick elderly who seem to be the biggest consumers of healthcare dollars in our country. Certainly the visitors to my bioethics website took on the issue with some mighty interesting comments against the governor's view. Note: the oldest comments are at the bottom of this posting. And now, yours? Anyone think that there is any merit to the proposed concept? ..Maurice.

Is There a Duty for the Elderly to Die?

Former Governor of Colorado Richard Lamm had lit a firestorm of controversy when he suggested that old people have a duty to die. This concept has been elaborated by others. The reasoning is that our society, at least in the Western world, have no good financial plans for long-term care for the aged when they become incapacitated because of illness or mental debility. Often these persons become a financial and emotional burden for family members and may require family members to alter their own lives and goals simply to care for their aged relatives. It has been suggested that these burdens are not acceptable and that the aged should find a duty to terminate their lives before they have reached such a dependent state. This means that an elderly person while mentally competent and not terminally ill should arrange to die. The argument is that their life is almost over naturally and they should not interfere with the lives and careers of others who have yet many years of life ahead. Also implied is that society's monetary costs for caring for the elderly infirm could better be spent on children and younger people.

Here is the question:
Is There a Duty for the Elderly to Die?

Date: Tue, Mar 9, 2004 6:58 PM From: To:
"The" elderly is itself an unethical descriptor. I am not sure it has any meaning. Do people have a duty to die based upon their age? Silly. Proponents of the argument are not looking at people but at budgets, bottom lines. It is an academic discussion, mainly for entertainment. Harold

Date: Wed, Feb 11, 2004 3:56 PM From: To:
I was appalled by the suggestion that edlerly have a duty to die. I not sure how this man was ellected as a civil servant. I also wonder who will be taking care of him when he gets older, or if something was to happen to him now. I think his time would be better spent in trying to change social issues that impact the elderly.

Date: Wed, Jan 21, 2004 11:08 AM From: To:
I am amazed at the metaphor, "duty to die". I understand the "right to life" and living wills and advance directives which document an individual's choices, but a "Duty to Die" is a corporate metaphor, intent on a bottom line, and nothing else.

I also object to the employ of the term "burden", it is emotion-laden, and judgemental. Is it ethical for this site to reference a person as a "burden"?
Harold A. Maio, Consulting Editor Psychiatric Rehabilitation Journal Boston University

Date: Tue, Jun 17, 2003 6:56 AM From: To:
I was glad to read that most believe that the elderly do not have a duty to die. I think as in other cultures that our elders should be shown respect and have a place of honor in our society and not just tossed aside to die. I think that society is beginning to change in this respect. With more parents having to work grandparents are now taking on a role of assisting the caregiver. Many grandparents are now living near or with their families. I also think their worldview should be valued. This is not saying that wisdom comes with age but they have had different experiences in their life and maybe knowledge gained through those events would give different perspective that should be valued. I think the only time that anyone might have the duty to die is when care provided is futile care.

Date: Tue, Jun 3, 2003 4:41 PM From: To:
In my opinion, the elderly have the right to live as long as possible. If anything their children, family, and society have an ethical obligation to take care of them. We will all be elderly some day (hopefully!) and won't we wish to be respected, cared for and granted the dignitiy we deserve?

Date: Mon, Apr 7, 2003 1:19 PM From: To:

Yes the elderly has the right to die, but only at there discretion. If they feel the quality of life is over for them and a terminal illness or some other medical disorder that would require prolonging a life that would not have the quality to care for themselves. No it should not be up to anyone else to decide when the quality of life is over for these indiviuals, furthermore did the elderly put there children up for adoption when they interfered with there careers and when they finiancial burdens increased due to expenses to care for a child, some children grow up and become so high strung with there careers that they forget where they came from and who was responsible for giving them the foundation they have. I think these indiviuals should doom themselves dead if they have no regard for the elderly, last but not least the older the wiser and the Lord did not spare there lives this long for someone else to decide it is over.

Date: Wed, Nov 13, 2002 12:47 AM From: To:
Good evening Sir I see the debate is quite heated as the question posed speaks more to life as to death. Prior to my retirement from United States Air Force I would participate in medical exercises where we triaged our simulated war wounded. For instance their were those who given the combat situation were not the immediate priority due to the extent of their wounds but our attention would be the ones we could save on the battle field.

It seems the good governor has a combat battle field casuality ideology that he is applying to healthcare or his version death care. Only their wounds are from their age. That is at best misguided and at worst means we have a person in power with at least two potential characteristic of Psychopathy, lack of being able to empathize, and perhaps Axis II Narcissistic personality disorder. The god complex didn't work for the most beautiful angel and mankind doesn't wear it well either literally or figuratively.

I also taught value clarification exercises and it seems the author also see's us in a life boat situation. Let it be known that If I had to choose who stayed in the boat or didn't I don't think this politican would have a place in the boat. I would rather have men and women who through life experiences many through World War II knew about not just surviving but being a team and overcoming the impending tide of the enemy. Perhaps instead of wanting the elderly to "due their duty" he should realize many did and we are fortunate enough to have them. When is the last time he picked up a rifle and watched his fellow comrades die deaths dance prior to the victory at Normande. Where would he be without their sacrifice. Something to reflect on during Veterans Day.

[ Moderator's note: Governor Lamm or any other visitor may write a rebuttal to the above characterization.]

To take life is in direct conflict to every ethical code I've reviewed although I must admit I haven't read the aryian nations code. I have yet another lens perhaps that would be beneficial for the governor to look through. Lets say an age is set by someone else and adopted and it is the governors age or the age of his wife or perhaps he has a child that the criteria now includes. I think his ideology would be transformed to reality.

I'm usually not into throwing stones even intellectual ones because I'm painfully aware in us all is the capacity to be as deadly as Hannibal Lecter or as belevolent as Mother Thersa. I do not wish to attack this person but his ideology and the growing type of thought that puts not only the elderly but practically everyone that the list makers decide fits the criteria. Isn't that a scary thought.

My position at this point now tends to be more based on emotion and compassion. I've known so many older people that have been the tapestry of my lifes experience. They have imparted their hertitage, culture, values, and love. Without their mentoring I wouldn't have the compassion I have now for just about everybody other than those who would legalize hurting the ones I care about. I'm sure even for those who support death care must have some childhood memory that they hold like buried treasure. If not even they could not even begin to comprehend the loss of the elderly to this world. They are more precious than money because despite our age of efficency and cost effective measures you can not put a price on the human spirit.

Respectively, Bruce Linquist, MSW, CADC III, Retired USAF

Date: Tue, Nov 12, 2002 5:47 AM From: To:
I believe that the elderly should live as long as nature or god permits. However, I don't think that we should take steps toward furthering their lifespan beyond what they have naturally been alotted. If science were to increase the lifespan of every human on the planet we would undoubtedly exhaust our resources and famine and disease would be rampant and nearly unstoppable. Certainly the elderly are entitled to a long natural life, but not an unnatural one that would make them a burden on society.

Date: Tue, Sep 24, 2002 5:10 AM From: To:
Hi, My mother had so many different illnesses during her lifetime, but was nevertheless an amazingly strong woman! To my mind she died much too young - she was 79. Up until the Christmas before she died she enjoyed her life - in fact she was much younger in disposition than most of her juniors. Just five months were fatal to her and even much of that time, when under medication and nursed at home by her daughters, was spent laughing, planning, cuddling and generally enjoying what was left of her life. She underwent no treatment other than 'love' and painkillers. A cerebral carcinoma (brain tumour) ensured that her mind was taken before too much pain took over, and she died in peace, seeming to return to a childlike state. How can anybody be so selfish as to think that there should be an upper limit on a person's lifespan? Euthanasia is another subject, and one which needs to be addressed separately if a person is suffering unduly - however, a happy life should be allowed to continue. A person contributes a huge amount to the lives of others before they die - even, and sometimes especially in their twilight years when they often gain a special kind of maturity and tolerance which they can pass on to those around them. Families do owe a lot to their elderly relatives, and my sisters and I put our lives on temporary hold while we stayed with her 24 hours a day until she died. After all, she devoted a lot of her life to us, so it was pay back time wasn't it? Come on people (at least those who know that I mean them) - take responsibility and stop being so selfish - especially Richard Lamm!

Jackie Sherlock
Date: Mon, Apr 22, 2002 1:13 PM From: To:
My grandmother was 70 when I was born. She died at 96. She had high blood pressure, chronic heart disease and arthritis of the spine, hands and feet. The spinal arthritis bent her double by the time she was 80, and her hands were crippled and painful to use. She nevertheless enjoyed life to its fullest, laughed easily, nurtured as second nature.

She grew her own garden and orchard, canned from their abundance, baked her own bread, cleaned her own house, washed clothes in a big black washpot, cuddled children, made tea cakes, wiped tears from small faces, and cooked three meals a day until she was 91 and entered a nursing home. In the 26 years my life and hers coincided, I learned more from this small, crippled, aged woman than I could learn from any other in a 100 years. That "elderly" wisdom has been passed now to my children, and my grandchildren. If she had "done her duty" and died, four generations would have been deprived of knowledge, wisdom, the ability to be self-sufficient, and all the other of those small but crucial everyday lessons that make life infinitely greater in sum than the whole of its parts would indicate.

In the South, we have a word -- "grit." If plural ('grits"), one eats it. If singular ("grit"), one is eat up with it. My grandmother was plumb eat up with grit, to use the vernacular. Until there is a way to measure the aformentioned grit, leave well enough alone. People come into their dying in their own time and place, just as they do their birthing.

And there's not a one among we humans qualified to make that call. Sally Rogers
Date: Thu, Mar 28, 2002 2:35 PM From: To:
Even though I'm only a junior in high school I find it quite offensive for someone to tell me or anyone else for that matter that you have a duty to DIE when you are "old". What is old anyways? In some family's if you hit fifty you're old and likely to die soon, some family's the average is eighty. Although neither of these are the case in my family. In my family we have a tenancy to die later then most people we live our lives well into our 90's even our 100's therefore we are usually able to see our great-grandchildren grow. But we also have a tendency if we don't grow old we die a tragic death early in life. They tend to even out each other in the world as do the rest of the world and some families balance out other ones. You see that’s the way it works we go in our own time if that time is at age two so let it be if its at age one hundred and three you need to let that be too. Because people tend to have a way of evening out the ratio ourselves we don't need to go killing ourselves because "we're to old" and the society can't afford to pay for the medical costs or housing. No one knows when they're going to get sick or how it will affect the ones around them, but we deal with it every day, we have in the past as we should in the future. Because if we start telling people they need to die when they get into this age range what's next? Are we going to become like other countries and say only this many children are aloud to be born so we are able to deal with them when they're older? I hope not. Please think about it.JR Ostermeier

Date: Thu, Jan 10, 2002 6:57 PM From: To:
Hey, It is impossible for me to sit here and read some of the coments saying there is Thu, Jan 10, 2002 . I am in high school and feel that I should not begin to count down the number of years I know I have left. How can people urge a cap on life. If someone undertakes a lifelong humanitarian project that takes one day past the limit what happens? These people can not see the fruits of a life's work or it may never even be completed. We are the richest nation in the world and certainly have the resources to keep these people alive.Nick Zmijewski

Date: Wed, Nov 14, 2001 6:24 PM From: To:

God save us, what kind of Nazi is Lamm, anyway? I can imagine someone heinous enough to think such a thing, but it is hard to imagine a politician in the United States having the gall to say it publicly.

[ Moderator's note: Governor Lamm or any other visitor may write a rebuttal to the above characterization.]

No, there is no "duty to die", nor could there possibly be one. I will not elaborate on religious and ethical reasons to oppose such a duty, although I consider them binding. God would have us appeal to His providence, and not rely (to use the Biblical phrase) on the "arm of the flesh" (that is, taking such ultimate matters into our own hands). But, of course, those who do not acknowledge God's existance, or His authority, will not be impressed with such arguements.

However, even from a secular perspective, how can there be a "duty" to die? Who, after all, created the moral arguement that people have a "right" to publicly funded health care? And who wrote the rule that said that adult children have a "duty" to care for their parents? As a Christian, I am absolutely convinced that people have an obligation to help care for their elderly parents. It is a logical extension of the rule that says parents should care for their minor children, as well as an extension of the law of general benevolence ('do unto others as you would have them do unto you'). I can also see some reason to believe we ought to help the sick when they cannot help themselves.

But these dictates come out of a Judeo-Christian perspective, which I am sure the advocates of a "duty to die" are willing to toss out the window. Hence, what is their problem? Let Granny be. If she decides to go down swinging instead of just taking the 'easy way out', nobody is demanding that we give her a hand. So why are we insisting that she go out at a time and in a manner of our choosing? Because we may well find ourselves paying for it. The State is providing an ever-increasing amount of health care cost coverage. And what the State grants, it comes to believe it can withhold.

We must all beware of this line of reasoning. It may well not wait until we are 75 or 80 to catch up with us! We are constantly being warned that we need to be saved from war, pollution, crime, guns, bigotry, AIDS, ... the list of boogey men is long. But who will save us from our self-appointed saviors... i.e. the government and the activists? Let them learn their place, and stick to the needful tasks for which government is fit (which they all too often neglect to our great harm), and leave the question of who dies and when to the conscience of the people. Bill C.

Date: Sat, Feb 10, 2001 6:40 AM From: To:
Perhaps this is the wrong question. Daniel Callahan, co-founder of the Hastings Center for Society, Ethics, and the Life Sciences, has raised the question of whether there is a duty for the elderly (which he pegs at 80 or above) not to consume vast amounts of medical resources in attempting to prolong life. By that age, nearly everyone has achieved life's goals. Given that resources are limited, the cost of a heart transplant or other very expensive technology serves to deny resources to those who have not completed a full life. Therefore, medicine for the elderly should concentrate on improving the quality of their remaining life rather than extending the quantity.

It is a simple argument. Apart from the occasional example of a Grandma Moses whose life takes new directions in later years, what is the point of supporting full-bore allocation of medical technology to the elderly when it is to the detriment of those younger?
Richard T. Hull, Ph.D. Professor Emeritus, Department of Philosophy, SUNY University at Buffalo 4845 Spaulding Drive, Clarence, NY 14031-1563, 716-759-6692,

Date: Tue, Jul 25, 2000 3:03 AM From: To:
All I can say is that I lament the kind of world we live in if we even have to ask this question. The elderly have so much wisdom and history to share with us. These are the people who cared for us when WE were in nappies, incontinent, and unable to care for ourselves! It is part of the cycle of life for us to care for them when they can't do it for themselves. To speak of dying as an act we perform out of a sense of duty towards someone else is a sad reflection on society. Death is something we will all be forced to confront someday, whether we accept it or not. Would YOU like someone to tell you, when you are coming to the end of your life that it is your DUTY to die?! This issue comes down to basic respect and human decency, which must be sadly lacking for this to be seriously posed as a question.

Date: Thu, Jun 22, 2000 7:25 PM From: To:
As both a Registered Nurse who works with the "elderly" and as a granddaughter who helps care for a 91 year old grandma and her 96 year old sister I would like to respond to this question. Who decides what age constitutes "elderly"? Is it 75? 85? What about the 60 year old with chronic lung disease from 40 years of smoking? What about the "crack" baby born 12 weeks premature who will cost society thousands of dollars in his/her first years of life. Yes, I have days when I am tired of caring for my elderly relatives, but this is the cycle of life. We all need care at the beginning of our lives, and some of us need care at the end of our lives. Nurses affirm the sanctity of human life and we dedicate ourselves to providing care to those who are experiencing illness or seeking a higher degree of wellness (preventative care). We also provide care to those who are dying; our goal is to assist the dying person and their family to acheive a death with dignity.

Date: Sat, Jun 17, 2000 8:27 AM From: To:
In Jourard's classic 1957 article entitled "An invitation to die", he poses this question and makes numerous supportive observations. Be it conscious or unconscious, our general United States' society today, some 40+ years later, still "invites" many to die, including the elderly. Interesting that we still do not value individuals for who they are, what they were, who they will be, and how they can/will still contribute.

Date: Sat, Apr 22, 2000 5:59 AM From: To:
Hi DoctorMo
This is a rather stark way to ask a question and I think that is probably a valid way to draw attention to this difficult question.

I look at our nation spending a rather large and unprecedented amount of our GNP on health care and I think this is a very valid question. The fact is that to be born is to anticipate your death: death is inevitable. Can families (and nations) spend unlimited amount of financial and personal resources on individuals who will not tangibly contribute to the family over the long haul? I think the answer to that is "no" but I have several provisions. While I am willing to admit that the elderly and the disabled bring compassion, caring, wisdom (really good and valuable things) in to our lives, I don't think this real and compelling good outweighs everything else all of the time. Also, all persons, young and old, abled and disabled deserve CARE. To me, the crux issue is never the withdrawal of care. That should be an ongoing given. The crux issue is, more often, the withdrawal of life-preserving measures, procedures including the treatment of infections, feeding and hydration, surgical procedures.. My husband and I have had many, many discussions about the conditions under which we want our lives conserved and the conditions under which we want care but not curative measures. I feel like I know that for him (and our minor son) and he knows it for me and our son as well as possible. It is a beginning. we would have to apply it in the context of a real life situation.

I think some how we must help docs nurses and the general public to view life in the context of the family AND to help them understand the difference between care and aggressive life sustaining measures.janet, RN, KS

Date: Wed, Mar 1, 2000 2:15 PM From: To:
The whole human experience includes not only experiences of happiness and pleasure, but also those of suffering and pain. Being financially and emotionally strained by the aged population is part of living. And having the experience to care for elderly people makes us more well-rounded human beings.

Date: Wed, Apr 21, 1999 12:06 AM From: To:
I honestly do not understand the premise of the theory that elderly people have a duty to die. In my opinion, this duty to die theory completely contradicts the idea of self-determination that supporters of assisted suicide are always preaching. If someone has the right to choose to die, shouldn't they have the right to choose to live? I personally would never see another family member as a burden and would hope that in such a situation that I would rise to the occasion and do whatever it would take to make him/her comfortable and happy throughout the rest of his/her life. I think those in favor have forgotten the simple idea of getting joy out of life - you can still get it even when you're old - even when you're unable to care for yourself fully - even when you must depend on others. I think it's very selfish to say you are unwilling to care for an elderly family member because you don't want to change your lifestyle or sacrifice anything of monetary value. You should respect the people who cared for you when you weren't able to care for yourself.

Date: Wed, Feb 17, 1999 5:26 PM From: To:

No one should be allowed to die just because they are elderly. Each and everyone in society has every right to live in whatever quality of life he or she chooses. What is the definition of elderly? Is it age? Is it the graying of hair? Is it the disease? Or is the incapacities that make them a burden to society? Old age is only a number. What is important are the attitudes they carry themselves in order to live. If we allow them to die just because they are mentally incompetent, or too old and weak, then what about those in coma, or neurologically incompetent? Should they die as well? We in this society still need to value the wisdom and the many stories that have transformed us to where we are now. It is a respect issue. Respect for the elderly and respect for human lives!

Date: Tue, Oct 27, 1998 5:57 PM From: To:
I think that the elders do have a duty to die. If the family members have to altar their life style, then I think it is up to them. I believe that the doctors should look at the financial support availible before they are allowed to treat the patient. The elder also has an opinion in this matter. He has lived his life and if he wants to die, let him go. The family is probably trying to hang on to the person for as long as they can. The elders do have a duty to die. Death becomes everyone. If it is time for them to go, let it be done. Think as if it was back in the day without modern medicine. The person would be let there to die.
Connie Jones

Jeremy McSpadden Enka High School, Candler,NC
Date: Mon, Oct 12, 1998 5:11 PM From: To:
Hello, in my opinion I do not think that because someone is old they should have their life questioned. It does not matter if they are old and worthless to society, because that is the same as children. Children also have no relevant contribution to society, should we let them die too? This topic should not even be a question. Why would we want to let the elders die? They are really no different from me or you, except for their age. If anything we should respect our elders not kill our elders.

Date: Wed, Sep 30, 1998 9:46 PM From: To:
I believe that nurses are unaware that they hold true this belief that the elderly have an obligation to die. Daily I witness nurses caring for a patient in the final stages of their illness being treated as though their life was worthless & that the nurse begrudged the care required by this patient. I fail to understand why this trend is becoming more obvious or why. I would like to know if other nurses have witnessed this same impatience when elderly patients are TOO SLOW TO DIE.

Andrea Taylor,
Date: Thu, Mar 19, 1998 7:50 AM From: To:
Hello, In my opinion, I do not feel that there is any "duty" whatsoever for a human being to die once they reach a certain age. In fact, I laugh at the very thought of it. It is my belief that if God wanted elderly people to die at a certain age, I am sure that he would take care of it. In The Bible, (if you so believe) it tells us that we are to use our elderly as sources of wisdom and gain strength from the things that they have testimonies in. I am a firm believer that every person on the earth was put there to meet who they meet and to do what they do, whether it is to help them in their life or someone elses life. This couldn't very well happen if we were to exterminate all elderly people. I would also like to ask all of those in opposition to my opinion a few things. How would you choose who was to live and who was to die first, if it was up to you? I think that in our society, it is more often than not easier to stand behind something that might never effect you, but this would. If you think that all elderly people should be extinguished, say at the age of sixty five, what would happen to your opinion if you woke up tomorrow morning and you were sixty four? In my opinion, your opinion would be quite different. Mine would. How would you kill them too? That's right. If you choose to do away with people of a certain age, you are still killing them. Who would be responsible for the millions of senseless murders each year? Would it be on the head of the voter? I would also like to bring up the fact that we all are here because of our parents and our grandparents, do you think that you could look them in the eye and then kill them? I would like to think that most of us wouldn't. In conclusion, I would like to say that in my opinion, I don't think we would ever have to worry about this problem. I think that there are enough people in the world who would never vote this in, reguardless of their morals, values and/or beliefs.Piper

Date: Thu, Mar 19, 1998 7:48 AM From: To:
If one accepts the argument that it is the duty of the elderly to die, there would be arguments by others that other segments of the population must also die. For instance if it is established that the life of those who place a burden on society should be exterminated, many more besides the elderly would be affected. The poor, handicapped, children, criminals, and mentally incompetent may all be seen as burdensome. Thus should society decide that it is the duty of these groups to die too. The value of life is what is troublesome to me about this argument. Living in a society that prides itself in the advance of civilization, why are we resorting to Darwinian views that endorse the elimination of "our weak." Will sacrificing the weak segments of our population, really improve the quality of life for those remaining? Whether quality of life is improved or not, by reducing the diversity of our population do we not risk jeopardizing the resilience of our population to adapt to future ecological change. Although allocation of scarce medical resources is controversial and difficult problem, I believe simpler solutions exist then society deciding whose life still has value and whose does not. I do agree that medical costs associated with the end of life should be evaluated and some reform should take place. In my opinion, it is time society refocuses placing a bigger priority on a lifetime of activities to prevent disease, rather than a few months of expensive practices to prevent death.
Jeremiah Johnson, E&H Box 168, Emory and Henry College, P.O. Box 9001, Emory, VA 24327-9001, Voice:(540)944-4121 ext 6559,

Date: Fri, Feb 27, 1998 10:54 PM From: To:
I think that if we could mandate a law that the wealthy would have to totally give up control of their money, we could then begin thinking about the duty of old people to assume room temperature. I doubt the wealthy will surrender their money, but if they do, then I would consider thinking making the elderly give up their life. I think the elderly are safe with my plan. I really enjoyed visiting your page.
Larry McManus

Date: Thu, Jan 8, 1998 3:03 PM From: To:
The first thing that should be addressed in answering this question is the word "duty." This is a very strong word and it implies that once an elderly person reaches a certain age that it is their obligation to give up their life to benefit the rest of society. If an elderly person should choose to sacrafice their life because they feel that they are a burden, then this would be a different issue. However, it is not our position to tell a person that since they are a burden, that they are required to die. Personally, I feel that we should respect our elders. The elderly population is made up of our parents, grandparents, and friends. The elderly should be seen as wise and experienced. They are the best ones to teach us about our history and events that they have lived through. I think that we should respect them and love them and not treat them like useless objects. Also the idea that elderly people are a burden to us is a stereotype. We often use the elderly as scapegoats and we blame our problems on them. Not all elderly people are like this. Many are healthy and not burdens at all. Also, if we start to get rid of the elderly, what comes next? Will we begin to get rid of everyone who we don't like, or who inconviences our lives? We should respect the elderly and enjoy with them the time they have left in this earth. Afterall, they were hear before we were. We should love the elderly and care for them. Katie

Date: Wed, Jan 7, 1998 2:03AM From: To:
A duty by definition means a legal or moral/ethical obligation to commit suicide once a person reaches an age which is classified as 'elderly'. That 'age' is not beholden to wealth, sickness, infirmity, education, intelligence or anything else other than a numerical number based on the years one has lived. It is an artificial concept without regard to the rights of the individual and would mean that the power of the State becomes paramount as the 'age' would shift depending upon the perceived needs of the State. For example should the State wish to reduce health care costs then the 'age' of death would be lowered. A person has an autonomous right to make his/her own decisions as to life and death as long as those decisions do not impinge upon the rights of others. To say that 'life' or 'death' is a duty is an abhorrent concept that would lead to totalitarianism.

Date: Thu, Dec 18, 1997 10:08 PM From: To:
This is essentially a social worth issue and, as such, need not be restricted just to the elderly. The position seems to be that when, in someone's opinion, an individual is too much of a bother, i.e., in terms of social exchange theory that the costs outweigh the benefits, one should cut one's loses -in this case die. If that is someone's position (and it isn't mine), there will be a very long line of people who the Governor thinks have a duty to have their flame extinquished.

Date: Wed, Dec 17, 1997 8:14 PM From: To:
I think there is no duty for the aged to die. Needless to say, all human being,even if he or she is too old, has a right to live with autonomy! therefore I could say man should live a life basically for him,herself.The most important thing I want people to understand is that especially regarding to the elderly, they have good wisdom and know tradition more than young aged people, so we should not forget their values. We should be willing to respect their existance!!
Thank you for reading my opinion.(from a Japanese university student)

Date: Mon, Nov 24, 1997 4:24 PM From: To:
I think that even though people grow old, if God wished for them to die at a certain age, he would do so. Just because someone isn't as young as the rest of us, or can't be as capable of doing things as younger people can, it doesn't give anyone the right to tell them that they should arrange to die. There are a lot of people in the world who have older people in their lives such as grandparents, and even parents. Who are they to tell these older people that they should arrange to die? Are they God? I don't think so.Kelly

Date: Tue, Aug 5, 1997 8:30 AM From: (Vinay Mathey) To:
Dear Dr. Mo, We all have the duty to live. Death is not a duty- its an obligatory passage. If such a thing is possible, "a duty to die" is conflicting with the universal duty to live.

Taking care of the elderly has a price The lives of the elderly has no price.
Mirabelle Kelly,

Date: Sat, Jul 26, 1997 7:11 AM From: (William H. Reading, MD) To:

Please, read my whole comment before forming a reaction. This is an interestion question after the absurdity subsides. We expect young men to die or at least risk death for alturistic reasons in times of war and there is legal punishment for those who don't. As well, a soldier may be shot by commanding personnel for behavior which is endangering the lives of others during certain circumscribed situations. Certainly, there is no constitutional duty to die but what the law fails to demand would not necessarily be considered unethical. There apparently exists a duty for an unborn human child to die prior to a certain gestation for the convenience of the person (I intentionally do not use the term mother) who has that child within them. I would suppose along the same line of reasoning that the elderly should die for the benefit of conserving scarce resources. What about the handicapped? They use more resources and require more government funds for health care. They certainly have no more right to be alive than an unborn child or an elderly person. They (with the Americans with Disabilities Act) are more costly to American businesses and result in higher prices. Consider then the people who have genetic defects which result in higher utilization of healthcare. And what about the people who carry the high likelihood of genetic defects? Should they be allowed the opportunity to bear children? The testing for genetic defects in utero to decide whether to abort the genetically defective human fetus is costly. Then consider the poor. They are a drain on the economy and use more resources than they can afford on their incomes (that is if they have any income at all). Is there a duty for those who have HIV to die? What about the mentally retarded? Or the mentally ill? What about the whole concept of spending money in research to help diseases which few people have? What about the money spent on HIV research? What about criminals? What about the people who have a high degree of criminality in their families? What about the people with poor eyesight? What about the overweight? What about those individuals who have a higher than average number of physician visits or hospitalizations. What about people who drop out of school or fail a course? What about people who have lied or stolen anything in their lifetime? What about people who are using or have ever used drugs or substances which could harm their bodies? What about people who aren't physically fit? What about the people who have any illness at all? Have I left anyone out? No one has a more of a right to be alive than anyone else does! We are all exactly the same in this respect. To argue differently would be to suggest more of an intrinsic value in one human life as compared to another. To suggest this would also be unconstitutional based on equal treatment under the law so I doubt that legislation to this effect would ever pass. At least I hope that it wouldn't. There can certainly be no inherent duty for anyone to die.
Date: Mon, Jul 14, 1997 7:30 PM From: To:

The issue is NOT do the aged have a duty to die, it is do we have a DUTY to keep them alive. It is a mistake on both sides of the issue to think that a finite stance can be taken on an issue that involves so many factors. Two examples are: Religious beliefs are varied and full of emotional as well as philosophical traps and in some interpretations, if no effort is made to save a person it is construed as the equivalent of an act of suicide, or murder. Thus the patient is hesitant to make decisions before getting ill, and /or the family is reluctant to stop or withhold treatment after the patient is incapacitated and can't make decisions for themselves. Ethnic beliefs in which some minorities feel that they have been persecuted enough, and that to live as long as possible is a form of "pay back," and that any questions asked regarding DNR, or living will are viewed as efforts to "kill the brother." I don't understand this one, but I have had it stated in almost exactly these terms on more than one occasion. Add in the Guilt Factor, and you have a situation in which patients are left to the mercy of the healthcare system. Which after all has traditionally charged with the mission to maintain life as long as possible. Mix in the complication of the dissolution of the nuclear family, and the movement of death from the home to the hospital over the last 100 years or so, and you are left with a population that not only doesn't want to deal with these issues, but doesn't know HOW. NO the elderly do not have a duty to die. They are owed the dignity of appropriate care and consideration by their families, and the healthcare profession.

Date: Sun, Jul 6, 1997 3:24 AM From: (Robert Wesley) To:
Ever since Richard Lamm raised this issue, apparently by an inadvertent (Freudian?) slip of the tongue, the question of a moral duty has become conflated with a that of a social, political or economic duty. If I do have a moral duty to die so that I will not become a burden on my family, then should I fail to perform that duty, I no doubt ought to feel ashamed of myself, and perhaps others might express their disapproval, etc. However, the question of a "duty to die" in the context established by former Governor Lamm's remarks and by the recent resurrection of this issue involves public policy: if the elderly have a duty to die, then that duty entails a justification for a political decision to withhold medical care, not to fund medical care, not to allow the elderly to spend their own money on medical care, etc. What former Governor Lamm did was to transfer the emotional content of the former to the latter. When we look at the case of someone who refuses expensive medical treatment in order not to become a burden to his or her family, we may well admire the nobility of the sacrifice, but that approval does not carry over, except by a concealed illicit inference, to the case of a governmental body making the decision for that same person.Robert Wesley

Date: Wed, Jun 11, 1997 4:02 PM From: (hans g engel) To:
Maurice: Do the old have a duty to die? This question is as illogical as asking whether children have a duty to die. They also are unproductive and of no "use" to their society (of course, if such duty existed, that society would end rather abruptly!). And just what is "old"? a seventy year old today is probably in the same physical condition as a thirty year old was 150 years ago. If we are speaking of those with physical or mental disability only, then age is not pertinent either; also what degree of disability should demand the "duty" to die? "Duty to die" implies death due to outside demand or suasion rather than the aged person's own wishes and is therefore unacceptable. This is an issue totally separated from euthanasia; it is essential that the two concepts not be linked in our thinking.

Date: Mon, Jun 9, 1997 10:11 AM From: (craig cholson) To:
(Throughout the following first thoughts, I follow the example of most of our colleague-writers, using the term "duty" in its common form rather than the more specific philosophical usage.)

Some colleagues have recently answered the question in the affirmative: that there may, in fact, be a duty to die given certain circumstances. The most prevalent circumstance seems to be an illness with catastrophic results for the family of she who is ill. Surely, it is argued, it is better for one person to die rather than an entire family be put to great hardship economically (or otherwise).

Although arguments of this kind have a certain first blush appeal, it seems to me that these arguments cannot do the work asked of them. Firstly, to insist that any person has a duty to die is, I submit, in violation of the Kantian ethic. Further, such insistence cannot respond adequately to any model of either beneficence or nonmalificence. Secondly, the majority of such arguments beg the question, who shall decide who must die, and at what point? The inference is that the family decides, the person accedes, and a third party assists. Any scenario resembling this can best be described as coercive and, thus, could hardly be considered ethical. Finally, the only method advanced to date for determining whether/when a person has a duty to die has been that of a modified Quality Adjusted Life Year assessment. While I personally find QALYs repugnant and try to avoid their use, it seems to me that most institutions and people have accepted QALYs with regard to life-extending procedures such as organ transplantation and have rejected end-game scenarios rooted in a cost-benefit analysis of the QALY form.

I do not make a case for a person who wants to die being prevented from so doing, nor do I wish to advance an argument concerning restrictive covenants. My intent is to submit that, while there may be good reasons (social, economic, etc.) for a person suffering from an illness with catastrophic consequences to others to want to die, there is no duty to die.Agree/Disagree/Comment? Please feel free to respond to Craig Cholson

Date: Wed, Jun 4, 1997 6:42 PM From: To:
The elderly have no more duty to die than the newborn. I come from a family where a majority of us live well into out 100's. My aunt is 101 now and fully mentally and physically competent. I can't imagine Aunt Bertha having a duty to die no more than I can imagine me having a duty to die at age 45. She is a vital link to the 19th century and I hope she makes it into the 21st century. She remembers her grandmothers tales of slavery and her grandfather's experiences with the undergroud railroad. She has heard stories of her grandfather's experiences as an indentured servant in New York and how he came to Virginia to seek farmland and a living. Her grandmother was able to tell her of the Great Emancipation and Abraham Lincoln and the Civil War from both the Union and Confederate sides. Aunt Bertha is living history and the future because most of my generation can expect to see our tenth and eleventh decades. I just hope we can put our emphasis on quality of life and preventive medicine so that scarce heath care is available for those who need it.
Natalie Belle, Medical Student, Howard University

ADDENDUM: For an excellent and extensive discussion of the ethics of “duty to die” by John Hardwig, Department of Philosophy, University of Tennessee
which was published in: Hastings Center Report v27, no. 2 (1997): 34-42, go to this link. ..Maurice.


At Wednesday, March 08, 2006 2:38:00 PM, Anonymous Moof said...

Dr. Bernstein, I was trying to behave myself. Although I read yesterday's post in its entirety, I was able to keep my own counsel. But yesterday and today together ...

Most of your responders on the "duty to die" issue were horrified at the thought - and frankly, so am I. I particularly enjoyed reading the response of a certain William H. Reading, MD ... because he expresses my own thoughts almost exactly.

This entire issue is much less far fetched than it seems. One of your respondents asks about nurses who feel that some elderly patients die too slowly. I have a friend who works with the elderly, and who blanches when she whispers to me about the things she's seen. I've personally seen a few things which have left me shocked and angry, one of them being in a hospice care situation.

When I was small, my mother used to tell me that the first time was always the hardest. Whether it's telling a lie, or jumping from a plane, once you've done it, the subsequent times become much easier.

And so it is with our disrespect for life. A little here, and little there ... abortion before 12 weeks to save the mother's life... and then abortion for the sake of convenience ... and then late term abortion ... and then abortion for the sake of eugenics ... and then assisted suicide for the sake of preventing suffering .... and then euthanasia for the sake of preventing inconvenience and expense ... ad nauseam - ad infinitum.

It's only hard in the beginning ... each justification only serves as a dilator to prepare the way for the next larger issue.

In my opinion, our "duty" is not to die, but rather to respect life wherever we find it - in whatever condition it's in at the time. All religion aside - just good old humanity - to do to others as we would have others do for us.

At Wednesday, March 08, 2006 5:21:00 PM, Blogger Maurice Bernstein, M.D. said...

Moof,thanks for your comments. One of the comments to the issue which I really enjoyed reading was Sally's description of her grandmother. Her story emphasizes that there is more than a person's age or infimaties which predict the value to others of that person. ..Maurice.

"My grandmother was 70 when I was born. She died at 96. She had high blood pressure, chronic heart disease and arthritis of the spine, hands and feet. The spinal arthritis bent her double by the time she was 80, and her hands were crippled and painful to use. She nevertheless enjoyed life to its fullest, laughed easily, nurtured as second nature.

She grew her own garden and orchard, canned from their abundance, baked her own bread, cleaned her own house, washed clothes in a big black washpot, cuddled children, made tea cakes, wiped tears from small faces, and cooked three meals a day until she was 91 and entered a nursing home. In the 26 years my life and hers coincided, I learned more from this small, crippled, aged woman than I could learn from any other in a 100 years. That "elderly" wisdom has been passed now to my children, and my grandchildren. If she had "done her duty" and died, four generations would have been deprived of knowledge, wisdom, the ability to be self-sufficient, and all the other of those small but crucial everyday lessons that make life infinitely greater in sum than the whole of its parts would indicate.

In the South, we have a word -- "grit." If plural ('grits"), one eats it. If singular ("grit"), one is eat up with it. My grandmother was plumb eat up with grit, to use the vernacular. Until there is a way to measure the aformentioned grit, leave well enough alone. People come into their dying in their own time and place, just as they do their birthing.

And there's not a one among we humans qualified to make that call. Sally Rogers"

At Thursday, March 09, 2006 8:00:00 PM, Blogger Maurice Bernstein, M.D. said...

The following comment was posted by Bill yesterday but apparently erroneously on the wrong post. ..Maurice.

I dont believe anyone has a DUTY to die. No one shoudl have to feel as if there is an obligation to die. Its rude in a way to say someone has a duty to die. How is a person supposed to react to something like that?

At Thursday, March 09, 2006 8:53:00 PM, Anonymous kevin b said...

While reading this, i was honestly amazed at what i was reading. are they really suggesting killing off the elderly, because it can be their duty to die? what, just because they are old and more near to death then other humans, they should be the human test dumbies. no one should risk their lives for this cause.

At Wednesday, June 14, 2006 4:06:00 PM, Anonymous Daryoosh said...

I'm actually writing a paper on the topic of "duty to die". If you guys want more information on this subject you can refer to John's Hardwig's book called "Is there a duty to die?". I think it will be helpfull to get a good grasp on the topic.

At Monday, August 28, 2006 6:48:00 AM, Anonymous Anonymous said...

A lot of the poor elderly people should probably die. They are usually a result of laziness and poor planning during their powerful youth. Sure health issues could occur in younger age, but in younger age it is much easier to solve those issues and seek help.

Once health issues are resolved one should be able to earn back what they need to get ahead in life.

Sometimes these poor people have children which they can't possibly support properly. Their children wind up having to suffer lacking the early age support they deserve to get a jumpstart on life. And they wind up having to work menial undereducated jobs or busting their ass for their parents b/c they're sick and can't help themselves. It is internal destruction.

If old people haven't set up theirselves for success, their children definately won't. It is a horrible cycle. I do think some old people deserve to die. A lot of them spend their time or their lives only sucking off of society and not providing anything. They sit around, complain about their poverty, and watch TV.

What kind of meaning of life is that. There is no reason in living in that state. A peaceful less miserable death should be an option.

At Monday, August 28, 2006 7:23:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today, I hope you are not advocating these folks death because their quality of life doesn't meet your own criteria. Quality of life is a state to be judged only from the point of view of the one living it and no one else. However, if your advocacy is based on the burden to their family and also to society, that is another matter. Then the issue is whether one solves a problem by killing off the principal actor involved in the problem or working toward mitigating the problem in another way so that everyone involved can maintain a quality of life acceptable to themselves. ..Maurice.

At Tuesday, April 24, 2007 8:57:00 AM, Anonymous Anonymous said...

I had the pleasure to see Dick Lamm give a lecture about 17 years ago on this topic. At that time, I was working in a hospital (where he was giving this speech) and I was all too familiar with the amount of money spent in the last days of life. Mr Lamm's point and the subtitle for the lecture was "Biotechnology has surpassed society's ability and willingness to pay for it". This was at a time when expensive products to sustain the end of life were coming out a tune of $2000 per shot.

Just to take the "Elderly have a duty to die" statement out of this context is premature. In case you haven't looked at it lately we are going BROKE with Medicare. Medicare is more of a troublesome financial crisis than social security will ever be. People naively think that there are unlimited funds for healthcare and this is simply NOT the case. If you could chose between bypass surgery in a 80 plus year old and a life saving surgery on a 1 year old (with great potential for a good outcome), what would you do? We are in essence making that decision every day in healthcare as with the younger people (and the unborn) we aren't going to have the resources we have now as we are sinking deeper into debt every day and people haven't planned to live this long.

So people are basically outliving their money. Then I ask you who is going to pay for them? Are we as a society? We can't afford it. We possibly could if we went up to a 90% income tax rate. Is that what you want?

I believe we have a problem with death in general in the US and people really truly aren't prepared for grandma to die. There's a saying - Grandfather, father, son - that is the natural expected course of death - in any other order it is a tragedy. However, now Grandfather is outspending grandson's future in healthcare by living past life expectancy tables.

At Monday, July 20, 2009 1:40:00 PM, Blogger Maurice Bernstein, M.D. said...

A visitor wrote the following e-mail to me which I will publish here. ..Maurice.

This diatribe is absolutely disgraceful. In our case, at the ages of 73 and 82 respectively for my wife and me, we are caring for three minor (teenage) children. If you want us to die, who will take care of them?
Shame on you.

At Monday, July 27, 2009 10:02:00 AM, Blogger Maurice Bernstein, M.D. said...

Another visitor wrote the following e-mail to me today. ..Maurice.

This is an idea borne of convenience and will become a policy of necessity if our nation adopts a nationalized health care system. No product has an unlimited supply and that includes healthcare. If price isn’t used to ration availability as it is in other markets, then governments will ration it based on certain criteria. What more tempting a criterion is there then to withhold expensive healthcare from older Americans so we can use a limited amount of funds to fix some productive younger American’s broken arm? When most of a person’s healthcare expenses are racked up in their final year’s of life, then “duty to die” becomes a tempting option for big government in an increasingly Orwellian era.

At Monday, August 24, 2009 8:23:00 PM, Anonymous Anonymous said...

Dear God, is this what we are headed for? I pray for all of us. I have a narsistic incapicated parent I am dealing with. Do I have the right to end her life? No, this is not what our country is based on. We need to get back to what our country was founded on..God!!!!!USA must get back to basics with Jesus center of our lives or we are going to suffer as a nation. Look at where we are now. They have taken Bibles and prayer out of the classroom. Look where we are, now!!!



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