Living well or comfortably waiting to die?

It can be argued that life isn’t something we have, it’s something we do.  

It is a set of activities that we can fuse with meaning. There doesn’t seem much value to living if all we do with it is exist. More is demanded of us.  

One of my favourite quotes about living comes from French Philosopher, Jean Jacques Rousseau.

“To live is not to breathe but to act. It is to make use of our organs, our senses, our faculties, of all the parts of ourselves which give us the sentiment of our existence. The man who has lived the most is not he who has counted the most years but he who has most felt life. Men have been buried at one hundred who have died at their birth.” 

Rousseau’s quote isn’t just sage; it’s inspiring. It makes us want to live better – more fully. It captures an idea that moral philosophers have been exploring for thousands of years: what it means to ‘live well’ – to have a life worth living. 

Unfortunately, it also illustrates a bigger problem. Because we tend to interpret Rousseau’s guide to ‘Really Good Living’ in a particularly narrow way – that it’s all about vitality, seizing the day and YOLO. 

This is a reality that professionals working in the aged care sector should know all too well. They work directly with people who don’t have full use of their organs, their faculties or their senses. 

Months ago, before the pandemic, I presented Rousseau’s thoughts to a room full of aged care professionals. They felt the same inspiration and agreement that I felt. 

That’s a problem. 

If the good life looks like a robust, activity-filled life, what does that tell us about the possibility for the elderly to live well? And if we don’t believe that the elderly can live well, what does that mean for aged care?

The findings from the recent Aged Care Royal Commission reveal galling evidence of misconduct, negligence and at times outright abuse. The most vulnerable members of our communities, and our families, have been subject to mistreatment due in part to a commercial drive to increase the profitability of aged care facilities at the expense of person-centred care. 

More recently, we have seen aged care at the centre of the Covid-19 pandemic. Over 250 deaths have been recorded in facilities across Australia from the virus and our State and Federal governments are fighting out responsibility. 

Elderly residents have been prevented from being treated in hospitals, their facilities have been drastically understaffed and public commentators have wondered whether we ought simply to allow more of them to die.  

Absent from the discussion thus far has been the question of ‘the good life’. That’s understandable given the range of much more immediate and serious concerns facing the aged care sector, but it is one that cannot be ignored, despite the urgent matters before us.

Whilst leaders and decision-makers must be held accountable, there is a deeper sense of shared responsibility we should all carry when it comes to our attitudes toward ageing and aged care.

In 2015, celebrity chef and aged care advocate Maggie Beer told The Ethics Centre that she wanted “to create a sense of outrage about [elderly people] who are merely existing”. Since then she has gone on to provide evidence to the Royal Commission because she believes that food is about so much more than nutrition. It’s about memory, community, pleasure and taking care and pride in your work. 

Consider the evidence given around food standards in aged care. There have been suggestions that uneaten food is being collected and reused in the kitchens for the next meal; that there is a “race to the bottom” to cut costs of meals at the expense of quality, and that the retailers selling to aged care facilities wildly inflate their prices. The result? Bad food for premium prices. 

We should be disturbed by this. This food doesn’t even  permit people to exist, let alone flourish. It leaves them wasting away, undernourished. It’s abhorrent. But what should be the appropriate standard for food within aged care? How should we determine what’s acceptable? Do we need food that is merely nutritious and of an acceptable standard, or does it need to do more than that? 

Answering that question requires us to confront an underlying question: Do we believe aged care is simply about providing people’s basic needs until they eventually die?

Or is it much more than that? Is it about ensuring that every remaining moment of life provides the “sentiment of existence” that Rousseau was concerned with? 

When you look at the testimony provided to the Aged Care Royal Commission, a clear answer begins to emerge. Alongside terms like ‘rights’, ‘harms’ and ‘fairness’ –which capture the bare minimum of ethical treatment for other people – appear words such as ‘empathy’, ‘love’ and ‘connection’.

These words capture more than basic respect for persons, they capture a higher standard of how we should relate to other people. They’re compassionate words. People are expressing a demand not just for the elderly to be cared for but to be cared about. 

Counsel assisting the Royal Commission, Peter Gray QC, recently told the commission that “a philosophical shift is required, placing the people receiving care at the centre of quality and safety regulation. This means a new system, empowering them and respecting their rights.” 

It’s clear that a philosophical shift is necessary. However, I would argue that what’s not clear is if ‘person-centred care’ is enough. There is an ageist belief embedded within our society that all of the things that make life worth living are unavailable to the elderly.

As long as we accept that to be true, we’ll be satisfied providing a level of care that simply avoids harm, rather than one that provides for a rich, meaningful and satisfying life. 

Unless we are able to confront the underlying social belief that at a certain age, all that remains for you in life is to die, we won’t be able to provide the kind of empowerment you felt reading Rousseau at the start of this article. 

What it will do is provide a better version of what we already believe – that once you are at a certain age and stage of life, ‘living’ is no longer a real option? You must settle for existing.

At this stage, we can pump you full of our care, love, empathy and respect – and most people accept that we should do that – but you are no longer living for yourself. You are waiting, as humanely as possible, to die. 

Unless we confront this deeper belief, any positive movement in aged care will struggle to provide residents with what we all hope for – a life worth living. 

*This is an edited version of an article first published on 10th September 2019