Book Review: Joseph Davis and Paul Scherz, eds., “The Evening of Life: The Challenges of Aging Well and Dying Well”

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The Evening of Life: The Challenges of Aging Well and Dying Well

Joseph E. Davis and Paul Scherz, eds., University of Notre Dame Press, 2022.
ISBN: 978-0-268-10802-1, 205 pages, Paperback, $35.00

As a geriatrics specialist for over 20 years, I found The Evening of Life an engaging exposition of the ethical challenges of aging and death in a modern culture uncomfortable with these realities. The editors are Joseph Davis, a research sociologist, and Paul Scherz, a Catholic moral philosopher, who have assembled a socio-ethical treatment of the journey of aging and dying. They note that ancient shared traditions that encouraged and honored the elderly have diminished in today’s world: “The task of preparing people for their later years, once a central cultural and philosophical task, has correspondingly waned” (p.2).

With the cresting silver tsunami, the dwindling of geriatrics specialists, and the rise of medically assisted dying, this book comes at a critical time. It contains a collection of essays from the conference “Cultural Challenges for Aging and Dying Well,” sponsored by the Institute for Advanced Studies in Culture (March 2018). The editors have crafted a cohesive work that challenges modern assumptions about aging, identifies socio-cultural factors that influence the concept of aging well, and reflects on directions for change. The book was recognized by the Catholic Media Association and Forward Magazine. Contributors include theologians, historians, ethicists, physicians, nurses, philosophers, and sociologists.

The Evening of Life begins by defining the problem. The overwhelming message in modern culture is that aging is a problem to be solved. Yet aging and dying are universal experiences. Those unaware of the resources available through a Christian worldview may give in to the cultural tides of individualism and ability. Such ideas are dangerous, for our life decisions are rarely made in a vacuum, and every person is part of a larger community. Several of the book’s contributors argue that community resources are vital in helping the elderly and infirm live their remaining years with dignity.

The book’s next section addresses the factors shaping the concept of aging as a problem to be solved. These forces include the language used in healthcare and the framing of incentives built into the healthcare system. While the “medicalization” of aging might be a bit strong, the current system does not readily address frailty and multi-morbidity. Attempts to serve these needs continue to fall short due to approaches focusing on efficiency (out of economic necessity) over person-centered care. To be sure, the needs are many, but the workers are few.

Modern bioethics has elevated autonomy as its highest value. Individual choice is good, but it can be deadly when paired with the limitations still present in modern medicine. Navigating aging becomes more complicated when the elderly are preoccupied with medical decisions. This section addresses the socio-cultural factors that have led our society to forsake traditional patterns of handling aging and dying.

The final section suggests ways some systems have attempted to shift the focus from seeing aging as a deficit to decreasing mortality and increasing choice. One novel idea is that non-medical services could be a routine part of elder care. For example, one study looked at a program where a nurse, an occupational therapist, and a handyman teamed up to improve outcomes in older adults. The lesson is that comprehensive plans for aging and dying well should include non-medical interventions.

In this book, the authors have begun the hard work of restoring dignity to the evening of life. Though the focus remains strictly on sociological and philosophical domains, many ideas presented can be affirmed as biblical. The various authors bring perspective and clarity to aging by allowing the elderly to accept dependence and vulnerability as normal.

Did this volume achieve its goal to “work, in sum, towards illuminating our current predicament and charting a better way forward” (p. 16)? Many of their insights are consistent with what I have observed as a geriatric clinician. For example, many family members and friends lament the loss of someone with a dementia diagnosis long before their cognitive abilities diminish. This may create great fear over the future burdens of dependency as cognitive abilities decline. Yet we are all dependent on one another as a community.

In the third section, various authors critique the political and economic constraints leading to the devaluation and dehumanization of older adults. I would have liked to have seen more concrete solutions to these daunting problems. Yet the perspective here is sociological and ethical rather than medical or legal.

Nonetheless, this text offers valuable new perspectives, since “recognizing the failures of contemporary experiences of time opens up an avenue of hope by allowing a new relationship to time” (p. 186). As such, I believe this collection of bioethical essays on aging and dying would serve anyone currently caring for older adults or who may be developing policies that affect the care of older adults. Indeed, Davis and Scherz have provided a thought-provoking and profoundly philosophical text with real-world implications for all who will inevitably engage the evening of life.

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