The President’s Council on Bioethics
1801 Pennsylvania Avenue, N.W., Suite 700
Washington, D.C. 20006
September 28, 2005
The White House
Dear Mr. President:
I am pleased to present to you Taking Care: Ethical Caregiving
in Our Aging Society, a report of the President’s Council
on Bioethics. It seeks to gain attention for a burgeoning
social problem and to offer ethical guidance regarding the
care of our elders who can no longer care for themselves.
American society is aging—dramatically, rapidly, and
largely well. More and more people are living healthily into
their seventies and eighties, many well into their nineties.
With birth rates down, with the baby boomers approaching retirement,
we are on the threshold of the first-ever “mass geriatric
society.” The fastest growing segment of our population
is already the group over 85. Historically speaking, it is
the best of times to be old.
Yet the blessings of greater longevity are bringing new social
challenges. Although people are living healthier longer, many
are also living long enough to suffer serious age-related
chronic illnesses, including dementia. Alzheimer’s disease
now afflicts more than four million Americans, and the number
is expected to triple before mid-century. Already by far the
most common trajectory toward death is a lengthy period of
debility, frailty, and dementia lasting not months but years.
Already millions of American families are struggling nobly
to provide steady and demanding long-term care for their incapacitated
loved ones, often with little respite or communal support,
usually for many years. Yet precisely as the need for caregiving
rises greatly, the number of available caregivers—both
professional and volunteer—is dwindling. We appear to
be on the threshold of a crisis in long-term care.
As a society, we have not yet faced up to this difficulty,
especially in its human dimensions. And the popular legal
instruments that we are being encouraged to employ to avoid
the problem will fall short of what we need as individuals.
As this report points out in great detail, living wills, drafted
years in advance, are not the answer. They simply cannot substitute
for reliable and responsible caregivers on the spot, devoted
to the welfare of the incapacitated person here and now. Even
worse is the deadly “solution” of legalizing assisted
suicide and euthanasia, advocates for which are again active
in several state legislatures. Caring wholeheartedly for a
frail patient or a disabled loved one is incompatible with
thinking that engineering their death is an acceptable “therapeutic
option.” Betrayal and abandonment of the elderly can
never be part of a decent and compassionate society, one devoted
to the equal worth and dignity of every human life, from start
to finish, regardless of personal strengths, weaknesses, or
In addition to calling attention to the larger social issues
of long-term care, this report therefore also tries to articulate
the goals and principles of ethical caregiving for persons
no longer able to care for themselves. We emphasize both the
singular importance of seeking to serve the life the patient
still has and the moral necessity of never seeking a person’s
death as a means of relieving his suffering. At the same time,
we emphasize also that serving the life the patient still
has does not oblige us always to elect life-sustaining treatments,
when those interventions impose undue additional burdens on
that life or interfere with the comfortable death of a person
irretrievably dying. Even when the doctor’s black bag
of remedies is empty, comfort and care remain inviolable duties.
If our elderly are to be well cared for and if family caregivers
are to be able to care well, caregiving needs to be supported
by our civic and faith-based communities but also with the
help and encouragement of government. Yet as we bend our efforts
in support of the elderly, we can ill afford to neglect the
needs of the young, who, unlike the old, have no organized
voice to speak up for their needs. We must at all costs avoid
a conflict between the generations over scarce resources.
To help us think through these very complex issues, we need
sustained research, hard thinking, and a creative search for
modest reforms that could make a big difference. And we need
leadership at the highest level. Therefore, among our recommendations,
we call for a Presidential Commission on Aging, Dementia,
and Long-Term Care, to focus the nation’s attention
and to carry forward this work. Any approach our society takes
must attend to the ethical and humanistic dimensions of our
situation, not only the economic and institutional ones. For
we will be judged as a people by our willingness to stand
by one another, even as the flame of life flickers and fades
in those who have brought us here and to whom we owe so much.
Mr. President, allow me once again to thank you, on behalf
of my Council colleagues and our fine staff, for this opportunity
to offer you and the American people our assistance in promoting
a future in which human well-being will be served by science
and medicine, human beings will be respected at every stage
of life, and human dignity will always be upheld and preserved.
Leon R. Kass, M.D.