It’s a sober new year, with 13 miners trapped underground in carbon monoxide-saturated air in West Virginia. Those men and their families need our prayers. And Stanley Kurtz of National Review Online links us to this important article in the January issue of Commentary about something we’d all rather not think about: the burdens of caring for our increasing numbers of frail old people in a society where the family itself, the traditional mechanism of caring for the elderly, is rapidly disintegrating. The authors, Eric Cohen and Leon Kass, are two of our country’s most thoughtful and eloquent medical ethicists, and this article is something that we who who strongly defend the traditional role of women as caregivers ought to ponder:

“Although most Americans can expect to live healthily well past sixty-five, many will also live long enough to endure a prolonged period of frailty. According to a recent Rand study, roughly 40 percent of deaths in the United States are now preceded by a period of enfeeblement, debility, and (often) dementia lasting up to a decade. Prominent are those suffering from Alzheimer’s disease, a condition that steadily destroys the mind and body, strips individuals of self-awareness and self-control, and often requires that they spend their final years in an institution, incapable of feeding or bathing themselves or of using a toilet. Today, over 4 million Americans suffer from Alzheimer’s; by mid-century, that number is expected to rise to over 13 million-all of them requiring many years of extensive, expensive, and exhausting full-time care.

“Yet precisely as the need is rising, the pool of available family caregivers is dwindling. Families are smaller, less stable, and more geographically spread out. Most women are now employed outside the home. The well-to-do can afford to hire professionals, but there are already shortages of geriatricians and nurses. Those jobs requiring great humanity but offering little paid reward-like feeding Alzheimer’s patients or changing bedpans-are greatly undersubscribed.

“All this creates a perfect social storm. As the number of retired baby-boomers expands, they will seek to augment existing social programs for the elderly, creating novel fiscal challenges for Medicare and Medicaid. Politically, long-term-care benefits might become the sequel to prescription-drug benefits-and far costlier. At the same time, the burdens of caring for needy elders will test the strength of already fragile modern families. Those in middle age may wonder about the wisdom (or duty) of sacrificing so much, for so long, on behalf of lives that seem so diminished. And they may come to believe that the death of the elderly is preferable to life in what seems like such a miserable condition…..

“In the end, there is no ‘solution’ to the problems of old age, at least no solution that any civilized society could tolerate. But there are better and worse ways to see our aging condition. The better way begins in thinking of ourselves less as wholly autonomous individuals than as members of families; in relinquishing our mistaken belief that medicine can miraculously liberate our loved ones or ourselves from debility and decline, and instead taking up our role as caregivers; and in abjuring the fantasy that we can control the manner and the hour of our dying, learning instead to accept death in its proper season as mortal beings replaced and renewed by the generations that follow.”