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Moderator: Ladies and Gentlemen! I would like to welcome you all to this symposium on the theme of ‘The last phase of a human life’. The symposium was organized by DELLEM. DELLEM is the project group in the Social Ministry dealing with particular questions regarding the last phase of human life.

When we sent out our invitations and information we also named some ground rules to be observed in such conferences involving issues which public opinion treats as sensitive. I hope you will not take it amiss if I briefly remind you. Above all, this is a closed conference: the media have no access to it, and what is dealt with here may only be communicated to them – now and also later – with my approval. Second: everyone is requested not to leave the conference without a serious reason. Experience has shown that continued presence of [all members] is of great importance for maintaining contact in the discussion and thus for the outcome of the whole symposium. That was the unpleasant part. We hope that the enjoyment of one another’s company will compensate for it.

The last phase of human life: this covers an extraordinarily broad spectrum of questions, from theology and philosophy to sociology, biology, and ←1 | 2→chemistry. And so I am especially happy to welcome our invited participants, who have agreed to expound for us their points of view. We are grateful to them for thus giving us a means of testing our ideas.

I welcome Ministerial Director, Mr Bert Persson; Dr Storm from the Institute for Medical Ethics; the historian of Intellectual Sciences, and writer, Mr Axel Rönning; and the theologian, Dr Carnemo.

In his introductory paper Mr Persson will give an overview of the problems and a political orientation which reflects the Social Ministry’s point of view. Then we will have two lectures. Dr Storm will speak about social and nursing ethics, and Mr Rönning will give what he calls a review of the history of human dignity. But first, Mr Persson.

Ministerial Director Persson: Ladies and Gentlemen! In this early stage of our new plans we are happy to put out feelers in different directions to gather criticism and knowledge through informal discussion, for the questions about the last phase of human life are no longer the privileged domain of the doctors. Instead, shared economic concerns are to pave the way for necessary reforms. I don’t need to describe the situation in much detail. A quick sketch should suffice. The population pyramid looks like a cigar, and if everything goes on as at present it will assume the form of a mushroom. The children we have been deprived of through abortions will reappear threefold at the top when we are old and unproductive. One person in four is on a pension by reason of age, and one person in eight has taken early retirement. 75% of care costs are for long-term care and for hopeless cases. Here the summit is reached and in the last ten to fifteen years has been passed. Amongst the 25% ←2 | 3→of those who are productive and carry everything there are varying degrees of discontent, but this discontent has been gagged in two ways. The first is called the right to vote, and silences the politicians. Old people still have the right to vote, even if they live to be a hundred, and no party can afford to lose two million votes. The other is an old taboo and is called reverence for human life, and this silences everybody. And so all is quiet, although the pressure of taxes becomes increasingly unbearable, unemployment is on the increase, and a seemingly endless depression is consuming all but the bones of our society.

Perhaps one or other of you will feel uneasy.

Where is Persson heading? Don’t worry. I haven’t forgotten Hitler. We are not planning a mass murder of the old, the physically impaired, and other useless mouths to be fed. If Hitler achieved anything, it was that he made such thoughts impossible in Europe for the foreseeable future. The question is whether the very name of Hitler should, along with all that is associated with it, also block cautious and human selection, which is necessary to save a nation from decline. If that were the case he would have finally conquered us.

For decades we have been reckoning damage caused by alcohol, traffic accidents, and suicide, in terms of social costs for care and reduced production. Even those who are still angling for pensioners’ votes by talking about more funds for long-term care, and about non-erosion of pensions and such-like things, finally fall back on an economic argument, namely, that the old have the right to a comfortable old age, because, it is said, they have built up this society. But what if their old age costs so much that they tear down again what they have built up? And now, when the economic situation is really bad, we have an explosion in the numbers of old people. Dying is seen ←3 | 4→as unnatural. More than ever. An important reason for this, of course, is that there has been great progress in the easing of pain. But we also have what is called the new fear of death, and we have to deal with this. We need a new attitude towards death and towards aging. It must again become natural to die when the active phase is over. We have to solve the problems with the old people, not against them.

One politician wanted to take away from pensioners their right to vote, along with their driver’s license. But as long as they have the vote their numbers will be sufficient to out-vote such a suggestion. For the same reason it is not possible to lower their standard of living in any significant way. The politicians can get nowhere. As planners we have to help them to make a start.

So the situation is as follows: if we want security we have to be selective. And if we want to retain the system, compulsion is excluded. So what is left?

First I want, in a non-committal way, to sketch a feasible solution. My starting point is the following question – and again, I repeat, I have not forgotten Hitler – : How can society increase the readiness to die, the willingness of our target group to leave this life? For some that may perhaps sound utopian, as we in DELLEM thought before we started into it. But it is not utopian. It is only a question of avoiding a particular kind of political terminology. We took an opinion poll, naturally in a veiled form, involving a chosen group of pensioners. Especially in the groups which the politicians usually refer to as the weak members of society or as the little people, there is a latent readiness for reform in this area beyond all expectation. A community spirit that is admirable, if one considers the hard life experiences of these people. They are plagued by the thought of being in some way a burden ←4 | 5→to the community, not being able to provide long-term care for themselves and so on. Even by the age of seventy, when their energies decrease and the debilities that come with age set in, they begin to feel the pressure of the younger people; the burden of the crisis and of unemployment which is placed, so to speak, on the shoulders of the consuming group [the aged]. And the voice of the community, if we are careful to strengthen it, becomes so much stronger than that of their own will to live that they will, perhaps precisely as a final act of independence, ask to be allowed to end it.

Of course, this is only the beginning of a development which has to be steered with the help of patiently sifted information and enlightenment before a final solution can take shape. We at DELLEM want to apply to this final solution the well-known formula voluntary obligation. Naturally, by ‘voluntary’ I mean a centrally taken decision which is reached in a proper democratic process.What we want is a social solution: a right, established by law, to protection against prolonged old age and its hardship. Everyone should have the guarantee that, when they have reached a certain hopeless stage in sickness, helplessness, or weakness associated with age – or still better: earlier, when they have reached a fixed age limit – society should step in and administer a liberating and painless death. People should not have to beg for it. Before we are ready for a general age limit of seventy, or perhaps seventy-five, society can delegate individual decisions to composite parliamentary committees with a doctor as chairperson, following the model of our courts. Discussion about the modalities can continue, but in the meantime there is a long journey ahead of us, and, on the way, many stumbling blocks will doubtless have to be removed. But more have already been removed than most people think, ←5 | 6→very quietly. I can offer the example that for a long time now in our hospitals an unspoken instruction has been followed which allows for incomplete treatment of pensioners who have heart attacks. The same applies, quite officially, to the treatment of certain children who have severe impediments. This brings about savings we cannot ignore. In addition we have an area of privileged treatment in intensive care, about which Dr Storm will give us more detailed information.

Finally, I would like to point out a few stumbling blocks which doubtless still exist. As is well known, since the 1960s society has carried out intensive health campaigns on a broad scale. Health checks, calls for fitness, better working conditions, enlightenment of people about alcohol and tobacco, propaganda for certain kinds of nourishment and so on. All with the aim of increasing productivity and reducing the burden on the health-care system. But in a time of economic crisis like ours, with its increasing unemployment, all this leads to a painful contradiction. We have produced people who not only live longer but also retain their productive capacity much longer. And now we are sitting here with a crowd of well-trained pensioners who could very easily keep on working and would also do so if they were given the chance. But you can’t have that. There are not enough jobs and there is pressure from the unemployed young people. But the old people live on even without working. They are physically fit and mobile, and they are storing up enough health and energy to last for decades. And for all this outdated and completely useless life-energy society is paying ever higher storage costs: 60 billion a year at present. And that has to be paid by taxing the active population. And if we now get to see a generation of hundred-year-olds it will finally be the task of long-term care to look after them, if ←6 | 7→only because no abstinence in the world can help them to remain clear-headed. And so we have, alongside the political problem, a vicious circle.

But for the moment I would like to leave it there.

Moderator: I would like to thank Mr Persson for his introductory thoughts which, as he told me beforehand, he intentionally delivered in an unsystematic way to avoid setting tracks which might impede a fresh and lively exchange of ideas. The discussion needs to have the openness and daring which the situation demands. We need a new impulse. And now: Doctor Storm of the Institute of Medical Ethics.

Dr Storm: Thank you. I will take up immediately what for me was the central point of Mr Persson’s remarks: the question of economics and ethics, social values and human values. I will begin with three choice situations, three constructs, which I also use as examples in my teaching. Imagine an intensive care unit in the country which only has facilities to deal with one patient. In the first example, a serious case of brain haemorrhage is delivered in with a 10% chance of survival. While he is on the machine a traffic accident case comes in with a 50% chance of survival. The case is clear: the brain haemorrhage has to give way. We have made a choice based on the doctor’s judgement of the chances of survival. There was no evaluation of human worth. In the next example there is the choice between two people with the same chances of survival. One of them is mentally deficient and the other is a Nobel prize winner. The choice in this case is equally obvious. Here, too, I have never encountered a doctor who, idealistically, would hesitate to ←7 | 8→save the Nobel prize winner. Here we have an evaluation both of human worth and of what I call social value. I will come back to the subject of the human worth of the mentally deficient. It would be interesting to hear what Mr Rönning has to say. And also Doctor Carnemo, who is a theologian.