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Tuesday, 28 November, 2000, 11:19 GMT
Ageing population fuels debate
Britain's ageing population could force the question of euthanasia and other end of life issues into the spotlight.
With people living longer and longer because of medical and other advances, health experts believe the number of people suffering from debilitating conditions such as cancer and heart disease will grow and could affect their quality of life.
In the UK, there were 300 people aged 100 and over in 1951. By the year 2031, it is estimated that this figure will boom to 36,000.
In 1995 there were less than 9 million people over 65 in the UK - by 2030 there will be almost 50% more.
The picture is replicated elsewhere in the West, while the developing world is in for an elderly explosion.
In China, it is estimated that the elderly population could double between 2000 and 2027.
The World Health Organisation (WHO) warns that the health impact could be enormous.
It predicts a big rise in cancers, coronary heart disease, diabetes, dementia and other illnesses related to ageing.
In the UK, heart expert Professor Michael Marmot has warned that there could be "a huge increase in the number of people suffering from coronary heart disease" in the next century.
The WHO has launched a campaign to promote good health in old age.
Doctors in the UK say people have an over-gloomy picture of old age and that there is no reason why they should have a lower quality of life than other people if they keep healthy.
Dr Stephen Webster, a geriatric health expert at Addenbrooke's Hospital in Cambridge, said: "People do have anxiety that there will be a period of disability at the end of their lives.
"But there is no evidence that that is the case if they are encouraged to live a healthy life and this generation of elderly people are in better nick than the previous generation."
Beating the ageing process
He said most of the trouble was due to degenerative problems.
"If they do gentle, regular exercise and keep at a reasonable weight, these can be kept at bay," he said.
"To other people, the elderly may appear to have a fairly restrictive life, but they may have a different view.
"They may develop pleasures in different ways."
Elderly organisations say people should be given a range of choices about end of life issues.
The Millennium Debate of the Age, organised by Bupa, Age Concern and Legal & General, argues that the choices should include both voluntary and non-voluntary euthanasia.
Its interim report says "good reasons can be supplied to support making both voluntary euthanasia and physician-assisted suicide, under appropriate circumstances, one option amongst others that a patient might pursue."
"Controlling the way in which one dies is no more a logically distinct part of life than are other activities.
"Arguably, therefore, the same principles that govern autonomy of action in other spheres of life ought to obtain with respect to the manner and time of death."
It says there is also a good argument for what it called non-voluntary euthanasia, such as advance directives or living wills.
These are documents which allow people to outline their wishes about treatment before they become so ill that they are incapable of expressing them coherently.
The Debate of the Age says: "Enabling individuals to have control over the manner of their death is a desirable element of according individuals the basic right to self-determination."
Living wills have been promoted by organisations caring for the terminally ill and people with degenerative conditions.
The Terrence Higgins Trust (THT) says there is a big difference between euthanasia and living wills.
"Euthanasia is about a positive intervention to bring about death while a living will concerns refusal to have treatment in certain circumstances," said a spokesman.
"Everyone has the right to refuse treatment when they are mentally competent so this is just giving them that right in advance."
Living wills have not been formally incorporated in legislation, but supporters argue that they are legally binding in common law.
A slightly more controversial aspect of living wills concerns health care proxies, whereby a person appoints someone to make decisions about medication on their behalf when they become mentally incapable.
The Debate of the Age says it does not support any particular end of life option.
"We seek to stress that giving patients a choice between options is justified in terms of respect for people's differing deep-seated convictions about what gives life value and meaning."
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