Archbishop - Elderly deserve protection
Tuesday 6th September 2005
The Archbishop of Canterbury, Dr Rowan Williams, has given a sombre warning that a more permissive approach to euthanasia and assisted suicide in Britain could undermine fundamental commitments to the needs of the elderly.In a keynote lecture at Church House, Westminster, on the challenges confronting an ageing society, Dr Williams said, "The current drift towards a more accepting attitude to assisted suicide and euthanasia in some quarters gives me a great deal of concern. What begins as a compassionate desire to enable those who long for death because of protracted pain, distress or humiliation to have their wish can, with the best will in the world, help to foster an attitude that assumes resources spent on the elderly are a luxury."
Dr Williams added: "Investment in palliative medicine, ensuring that access to the best palliative care is universally available, continuing research not only into the causes but into the behavioural varieties of dementia and so on - how secure would these be as priorities if there were any more general acceptance of the principle that it was legitimate to initiate a process designed to end someone's life?"
In his lecture, which marked the centenary of the charity, Friends of the Elderly, Dr Williams will made clear that he does not regard this potential erosion as the intention of proponents of change: "I am certainly not ascribing to the defenders of euthanasia or assisted dying any motive but the desire to spare people unnecessary suffering. But I think we have to ask the awkward question about how this might develop in a climate of anxiety about scarce resources."
Dr Williams, who is Patron of the society, also examined the impact of advertising and marketing cultures on attitudes towards older people, arguing that ageing has to be seen as a "a spiritual issue" in order to see more clearly and promote its positive role and dimensions:
"Work, sex, the struggle to secure our position or status, the world in which we constantly negotiate our demands and prove ourselves fit to take part in public life - what is there outside all this that might restore some sense of a value that is just given, a place that doesn't have to be earned? A healthy attitude to the elderly, I believe, is one of the things that can liberate us from the slavery of what we take for granted as the 'real' world... Contempt for older citizens, the unthinking pushing of them to the edges of our common life, is a sure sign of a shrivelled view of what it is to be human."
A transcript of the lecture follows:
'The gifts reserved for age: perceptions of the elderly'
A lecture to mark the Centenary of Friends of the Elderly, Church House, Westminster
We probably find this very strange. Although admirable organisations like Saga Tours have made the wandering life a real possibility for some beyond the first flush of middle-age I suspect this isn't quite what classical Hinduism has in mind. But what underlies the Indian idea? I think it is the belief that there comes a stage in people's lives when they no longer have to justify their existence; when it is right and proper for them to spend time reflecting on what they have been and what they have done and trying to make better sense of it. We used to talk, even in European culture, of having time to 'make your soul' as you move closer to death. It's a very telling phrase, suggesting that most of us in our working lives will have had little time to give substance and depth to who we really are.
In a spiritually sensitive culture, then, it might well be that age is something to be admired or envied. A person is released from the pressure to justify themselves, free to discover who they are – and perhaps to pass on to the rest of us something of what they discover. Looking around, my own sense is that there is a certain amount of double vision in our environment. There is a degree of jocular envy directed towards the retired; people will both express their wish that they had the leisure they imagine the retired have, and affect a cheerful scepticism about how 'retired' people actually are, a cheerful scepticism encouraged by the retired themselves ('I bet you find it hard to sit around all day'; ''I'm busier now than I've ever been').
But on the other hand, age in itself is not so positively seen. In sharp contrast to the idea that this stage of life is enviable, we hear high levels of anxiety about getting old, anxieties about health, mobility, access to facilities, simple routine care and attention. What's more, in a climate where media and marketing concentrate on the young to a staggering degree, the images of what age might be are seldom encouraging. What is there to aspire to in age? What does the good life look like for those who don't have the opportunities – for financial or social or health reasons – to live as the marketing industry seems to assume you ought to live? The point's been made often enough that a global advertising culture breeds both unreal aspiration and bitter resentment among the economically disadvantaged. But it's a point worth pondering in the context of our images of youth and age as well; what does this global culture say about – and say to – the elderly? It isn't surprising if the prospect of age is unattractive to many people. When Shakespeare's King Lear mocks the attitude of his business like daughters by offering to admit that 'age is unnecessary', he foreshadows with uncanny accuracy the fear that surrounds this area: being old is being dispensable. And it's worth noting that he also reminds us that prejudice or contempt for the elderly is not a purely modern matter, even if it has become culturally more prevalent. When T.S. Eliot used the evocative phrase I have borrowed for my title today, he was being ironic: he goes on to enumerate those experiences of remorse and helpless self-doubt or self-dislike that memory in old age can bring – a salutary reminder that 'making your soul' is never as straightforward as we might like it to be. What if age is largely about mourning, loss and bitterness?
Of course, ageing brings much that is bound to be threatening; of course it entails the likelihood of sickness and disability and that most frightening of all prospects, the loss of mental coherence. But if this is combined with an unspoken assumption that the elderly are socially insignificant because they are not prime consumers or producers, the public image of ageing is bound to be extra bleak; and that is the message that can so easily be given these days. In contrast to a setting where age means freedom from having to justify your existence, age in our context is often implicitly presented as a stage of life when you exist 'on sufferance'. You're not actually pulling your weight; you're not an important enough bit of the market to be targeted in most advertising, except of a rather specialised and often rather patronising kind. In an obsessively sexualised world of advertising and other images, age is often made to look pathetic and marginal. And in the minds of most people there will be the picture of the geriatric ward or certain kinds of residential institution.
To borrow the powerful expression used of our prisons by Baroness Kennedy, this is 'warehousing' – stacking people in containers because we can think of nothing else to do with them. From time to time, we face those deeply uncomfortable reports about abuse or even violence towards the vulnerable. Terrible as this is, we need to see it as an understandable consequence of a warehousing mentality.
As the Friends of the Elderly make plain in their literature, even if not precisely in these terms, the question of how we perceive age is essentially a spiritual one. If you have a picture of human life as a story that needs pondering, retelling, organising, a story that is open to the judgement and mercy of God, it will be natural to hope for time to do this work, the making of the soul. It will be natural to ask how the life of older people can be relieved of anxiety, and how the essentially creative work of reflection can be helped. It is not an exaggeration to say that, in such a perspective, growing old will make the greatest creative demands of your life. Furthermore, if we are all going to have the opportunity of undertaking reflection like this, it will be important that older people have the chance to share the task with the rest of us. The idea that age necessarily means isolation will be challenged. There is a sense that what matters for our own future thinking through of our life stories doesn't depend on the sort of things that go in and out of fashion. That is why, in most traditional societies, the term 'elder' is a title of honour – as it is, of course, in the Christian Church, where the English word 'priest' is an adaptation of the Greek for 'elder'. A person who has been released from the obligation to justify their existence is one who can give a perspective on life for those of us who are still in the middle of the struggle; their presence ought to be seen as a gift.
Incidentally, one of the most worrying problems in the impact of Western modernity on traditional culture is that it quite rapidly communicates its own indifference or anxiety or even hostility about age and ageing. Generation gaps open and it is no longer clear what there is to be learned. On our own doorsteps, we now have to confront a situation in, for example, the British Muslim community, where the status of older family members has been eroded by the prevailing culture around, creating a vacuum: of course it is natural and in many ways healthy for the young to examine and explore the received wisdom of their elders as they move towards maturity but when younger members of a community are left without signposts, they are more easily shifted towards extreme behaviour of one sort or another.
It is as if, in the crises of these communities and the challenge they pose to the rest of our society, we see an intensified image of the tensions and unfinished business in our whole attitude to age and ageing.
We must not be sentimental. Age doesn't automatically confer wisdom, and the authority of 'elders' of one sort or another can be oppressive, unrealistic and selfish. But when we completely lose sight of any idea that older people have a crucial role in pointing us to the way we might work to make better sense of our lives, we lose something vital. We lose the assumption that there is a perspective on our human experience that is bigger than the world of production and consumption. Work, sex, the struggle to secure our position or status, the world in which we constantly negotiate our demands and prove ourselves fit to take part in public life – what is there outside all this that might restore some sense of a value that is just given, a place that doesn't have to be earned? A healthy attitude to the elderly, I believe, is one of the things that can liberate us from the slavery of what we take for granted as the 'real' world. Giving dignity to the elderly – and dignity is a crucial word for the mission of Friends of the Elderly – is inseparable from recognising the dignity of human beings as such. Contempt for older citizens, the unthinking pushing of them to the edges of our common life, is a sure sign of a shrivelled view of what it is to be human.
That is why I've said that how we perceive age is a spiritual issue. And if it is the kind of spiritual issue I've tried to outline, we need, in response, to think hard about how we resource policies for the elderly that will not only secure the dignity we have been speaking of, reducing as far as possible the anxiety that ought to be lifted from the elderly, but will also help us see how relationship between older people and the rest of society can be best nourished, on the assumption that the rest of society actually needs its older citizens. Quite a few science fiction stories have played with the idea of a society where people's lives are terminated after a certain (not very advanced) age; but they all suggest that such societies are in one way or another mad. And their madness is the effect not simply the cause of their rejection of the process of ageing.
So the challenge we face in supporting the dignity and security of the elderly is far more than a practical one of raising enough resources; it is about identifying the underlying assumptions that keep elderly people marginal, challenging the shortage of positive pictures of ageing. And to do this effectively, we have to develop a view of human flourishing and human justice that is not content with the criteria of producing and consuming alone. Properly understood, a positive attitude to ageing is an act of faith in human freedom from the mechanical processes of work and the anxieties that go with this.
Developing viable and intelligent attitudes to ageing is not, of course, an academic issue, given the demographic facts. We are an ageing population. The percentage of young people in the total population is falling fast, and we have hardly begun to think through what this might mean as far as resource allocation is concerned. Can we envisage a situation in which this could be seen as a good thing? Can we envisage resisting the temptation to regard the demographic pattern of the future as primarily a threat to economic efficiency? Well, only if our current attitudes undergo a fair amount of reshaping. And every successful effort in giving the elderly choice, dignity and a respected place in the conversation of society is an essential element in that reshaping.
It is not easy to specify everything that needs doing as we work through all this. But, in the light of our society's history, we could venture a few obvious areas. Housing has become a focal concern; we are more and more conscious of the danger of assuming that there are only two real alternatives for the elderly – living alone (and therefore at risk) or living institutionally. One of the notable shifts in the pattern of life for older people in the last three decades has been the development of different levels of sheltered and partly communal housing. It would make quite a difference if the planning of new housing developments routinely incorporated questions about this element of the social mix. This is the case in some contexts, but not all; and the bringing of this issue more clearly and explicitly into the purview of planners and private developers would be a welcome sign of vision. What we do about planning and housing will speak volumes about whether we actually believe older people should be visible in society; so often we act and plan as if they shouldn't.
Training for professionals and volunteers is also going to be of importance. Volunteer home support is a crucial part of what Friends of the Elderly offers, but it needs constant encouragement and resourcing. If we are to see a society in which real friendship with older people matters, where they are actively encouraged to be part of the wider social network, we shall need more of the already developing co-operation and partnerships with social services and education and the NHS to equip younger people to carry this forward effectively. It is work that has begun very impressively in some areas, but it should be clear that it will make heavier demands as time goes on. If we genuinely want to give older people choices about where and how they live, and if it is best for some to continue with a degree of independence, we have to work to create the best conditions for this.
This instance brings into focus what ought to be obvious – in this as in other areas of social concern. Making sure that older people are part of networks and neighbourhoods is not a job that can be done exclusively or even primarily by statutory bodies. The demands are unpredictable, the goals often hard to quantify. But a thriving culture of voluntary help needs public affirmation. Should we be looking to government to sponsor something like a nationwide set of benchmarks for the care of the elderly; a full and comprehensive 'charter', if you like, for older citizens? Despite all the difficulties I have already mentioned, there is still widespread public sympathy for the challenges facing the elderly – most people, after all, have to deal with these in their own families. The sense that our government institutions were declaring some responsibility for standards here, and were actively encouraging and supporting training projects would be another welcome development in the eyes of most citizens.
To digress just for a moment, I want to mention one specific kind of enterprise which crosses several frontiers in addressing the needs of older people. I have seen at close quarters some of the positive effects of oral history projects. Such a project can involve very young people, schoolchildren especially; it affirms the value of older people's memories; it allows them a chance to do some of that work we have already been thinking about, of ordering and reflecting on a life history. Although it is not an activity that Friends of the Elderly can or should take responsibility for, it is one of those aspects of an integrated approach to the elderly which it should welcome and foster as best it can. I'd go so far as to say that any list of positive standards and expectations for the elderly should include the possibility of recording and talking through memories with younger people.
But mention of memory at once raises the dark shadow that is for most of us one of the most deeply threatening aspects of ageing. As your annual review points out, a generally ageing population means an increase in the number of people likely to be afflicted with dementia. A large percentage of the population (and I should say that I am among them) has experience of the dilemmas of care that arise here. So far, a lot of what I have said might presuppose a more sunny prospect for older people than is in fact the case for a significant proportion of them.
Our understanding of dementia conditions is growing all the time, and we have seen a number of promising theories developed about contributory causes or about aspects of lifestyle that might defer or prevent the onset of these distressing states. But much is still mysterious, and we are not remotely likely to have resolved the problems in the next few decades. Here perhaps we are most challenged; it is not a matter of respecting age because of the freedom of older people to reflect and share their reflection. The question is whether we can respect and love those who may seem to have no clear picture of themselves or others at all. These are the people who most of all have no obvious stake in society, no justifying role. Yet how we treat them is as clear an index of our social vision as is the issue of how we treat children – almost more so, since these are not people who will grow and change in obviously positive ways. Are we truly committed to giving place and respect to those who can return nothing (as it seems)?
Instinctively, we recognise that even the often deeply harrowed and disturbed consciousness of those who suffer from dementia is a human consciousness whose confusion and anguish do not make it any the less a proper subject for our compassion and service. Once again, increasingly sophisticated training is called for; and Friends of the Elderly can congratulate themselves on the pioneering work done in this field, with the imaginative developments in mapping behaviour, planning sympathetic physical environments and flexible timetables, and resourcing respite care. It is, I think, dangerous to imagine that in this area especially voluntary provision alone will meet the needs we re likely to confront in a couple of decades. It is all the more important to think ahead, to set standards for expectations, and to develop training programmes for both volunteers and professionals.
As I have said, this poses the toughest challenge to our willingness to take the elderly seriously. But if we begin from the spiritual priorities I have tried to outline, we should have to say that, even in a disturbed consciousness there is something going on that calls for our patience. One of my own most vivid and indeed painful recollections of my mother's condition in the last months of her life is of the feeling that she was still struggling to communicate, to make some sort of sense; I couldn't understand or help, but I knew that at the very least I owed her my presence and my efforts to listen.
Yet in the harsh world of limited funding and personnel, how do we go on defending the expenditure of money and skill on such situations? As we've seen, there is always the temptation to 'warehousing' in substandard geriatric care. But I have to say too in this context that the current drift towards a more accepting attitude to assisted suicide and euthanasia in some quarters gives me a great deal of concern. What begins as a compassionate desire to enable those who long for death because of protracted pain, distress or humiliation to have their wish can, with the best will in the world, help to foster an attitude that assumes resources spent on the elderly are a luxury. Investment in palliative medicine, ensuring that access to the best palliative care is universally available, continuing research not only into the causes but into the behavioural varieties of dementia and so on – how secure would these be as priorities if there were any more general acceptance of the principle that it was legitimate to initiate a process designed to end someone's life? I am certainly not ascribing to the defenders of euthanasia or assisted dying any motive but the desire to spare people unnecessary suffering. But I think we have to ask the awkward question about how this might develop in a climate of anxiety about scarce resources.
I do not have a quick solution to the undeniable problem of resources. Nor, frankly, does anyone, independently of a deepened motivation to guarantee just treatment and high quality care for all, a motivation that honestly faces the demands on public and private finance that this will make. The fundamental question is whether we see this as expenditure that honours a human dignity we care about, or whether it is thought of as at best an unwelcome and rather irrational obligation. What I have tried to do in these brief observations is to argue that age deserves honour in any society which is serious about two things – about the fact that we all have the task of making sense of our lives by telling our stories without pressure, and about the fact that the value of our lives is not ultimately linked with the level of how much we produce or how much we consume.
If we do not accept that we ought to be serious about these things, we shall not only fail the elderly and treat them more and more as marginal to the real business of human communities: we shall run the risk of building in to our society a far wider disregard for the disadvantaged, those who are not in the forefront of producing and consuming. The Friends of the Elderly first came into existence because of the recognition that people living lives of poverty needed literal friends and advocates; the current profile of the charity reflects the awareness that older citizens are still constantly among the most high risk groups where economic and social privation are concerned. Taking the poor seriously means taking the elderly seriously, even those older people who do not suffer the most obviously acute forms of material deprivation.
Friends of the Elderly has for the last century had the task of speaking and acting for the sake of what we now fashionably call 'social inclusion' – speaking for the poor, but more and more speaking for those whose lives are now lived outside the realm of 'getting and spending'. And this has meant speaking against certain things, against the over-functional narrowness that fails to see inherent dignity in everyone, against any idea that people don't deserve space and respect to become themselves more deeply and lastingly as they grow older. The task remains; it has not got easier and it is not likely to. But we should remember the millions of people who still have the instinctive feeling I described earlier, the feeling that something is owed to our older citizens and that something crucial can be learned from them. Our job is to affirm that instinct without reservation or apology and to keep it linked to a whole sense of what we properly are as men and women – people who live in time, who learn who they are as they pursue both inner and outer dialogues, who need to be released from the tyrannies of producing and performing which so dominate our lives. The respect we learn and practice with our seniors is not something slavish or immature; it is a mark of our own maturity, indeed, our respect for our own humanity. Showing that and sharing that will give us work for a good many more centuries.