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Longer Lives Reveal the Ties That Bind Us by David Brooks

New York Times columnist David Brooks writes about the vital messages one takes away from the landmark report by the President's Council on Bioethics, "Taking Care."

From The New York Times on the Web © The New York Times Company. Reprinted with permission.

Let me tell you how we're going to die. Twenty percent of us, according to a Rand Corporation study, are going to get cancer or another rapidly debilitating condition and we'll be dead within a year of getting the disease. Another twenty percent of us are going to suffer from some cardiac or respiratory failure. We'll suffer years of worsening symptoms, a few life-threatening episodes, and then eventually die.

But 40 percent of us will suffer from some form of dementia (most frequently Alzheimer's disease or a disabling stroke). Our gradual, unrelenting path toward death will take 8 or 10 or even 20 years, during which we will cease to become the person we were. We will linger on, in some new state, depending on the care of others.

As the population ages, more people will live in this final category. Between now and 2050, the percentage of the population above age 85 is expected to quadruple, and the number of people with Alzheimer's disease is expected to quadruple, too.

The President's Council on Bioethics, under Leon Kass, who stepped down yesterday as chairman, has been trying to grapple with what this means. The council considers the practical issues. We don't have enough people to take care of the millions on the glide path toward death. Fewer people go into nursing. Families are smaller and divided.

But the biggest issues the Kass report takes up are moral and cultural. We live in an individualistic society. We think of ourselves as autonomous creatures, making up our own minds and seeking self-fulfillment.

That was fine in an earlier age, when kids could go off at age 16 to make their way in the world, and when people died at age 65 after a short illness. But as the Kass report notes, ''The defining characteristic of our time seems to be that we are both younger longer and older longer.''

Parents have to spend a lot more time preparing their children for the new economy and children have to spend a lot more time caring for their parents when they are old.

In other words, technology, which was supposed to be liberating, actually creates more dependence. We spend more of our lives while young and old dependent upon others, and we spend more time in between caring for those who depend upon us.

Will our moral philosophy catch up to this reality?

When George Bush delivered a speech on the ownership society, Peter Augustine Lawler, who is a member of the bioethics council, wrote an essay in The New Atlantis called ''The Caregiving Society,'' chiding the president for offering an overly individualistic social vision. ''The ownership society only makes sense if it prepares us to be care-givers and care-receivers,'' he wrote, ''and if it does not encourage us to see ourselves as unencumbered individuals.''

Lawler argued that the ethic of ''mutual neediness should limit the idea of self-ownership.'' He cited the French philosopher Chantal Delsol, who observed that the ''amount of vigilance, care, friendship and patience that must be given any person, if he is not to be driven insane or to despair, is almost literally incredible.''

The council report is very much in this vein. It is a rebuke to the economic individualism of the right and to the moral individualism of the left. With its emphasis on mutual obligation, I sometimes thought I was reading a report from the old German Christian Democrats.

The report argues strongly against living wills and advanced directives, against individuals' attempts to control their own treatments and deaths. It is more ethical and more effective, the council believes, to give a loved one the power of attorney to make medical decisions for you, and so acknowledge your own dependence.

The report questions the foundation of individualism, that our worth is determined by what we say and do. No, the report says. Our worth is in our bodies, and our relationships. As Kass put it the other day, ''The much diminished mother I hugged on the day of her death was the same woman I'd been hugging all my life.''

The report also shows how far social thinking has moved in the past 30 years. A generation ago, all the emphasis was on rebelling against conformity, on liberating the individual. Now the emphasis is on nurturing bonds so sacred they are beyond the realm of choice. Now the individual is less likely to be regarded as the fundamental unit of society. Instead, it's the family.

In a mobile, high-tech age, the Kass report is a declaration of dependence.

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posted nov. 21, 2006

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