INTRODUCTION: The Graying of America: Challenges and Controversies

journal of law, medicine & ethics Growth of the world’s population is accelerating. It reached one billion people in 1800, and added the next billion by 1930 — 130 years later. The population reached three billion by 1960 — in only 30 years — and ever since then, a billion more people have been added every 12-13 years. The world’s population now stands at nearly seven billion, and epidemiologists project that it will rise to 9.3 billion by 2050. The majority of that population, 61%, lives in Asia, mostly China and India, and only 4.5% live in the United States — those proportions will change little by 2050 (see Figure 1). In developing countries, the population’s frequency distribution by age is heavily weighted toward youth, while in developed countries such as the U.S., the bulk of the population is in the 30-60 year age group.1 In the U.S., the expanding population is reaching old age more rapidly than in most of the rest of the world, largely because the baby boom of 1946-1964 produced a large bump in population, and the first of the baby boomers reached age 65 in 2010. Between 1900 and 2010, the proportion of the population age 65 and older increased at an average rate of 0.74% per decade, but over the next two decades, the rate of increase in the elderly population will be over 3% per year (see Figure 2). By 2030, the rate of population growth related to the baby boom will level off, and by then, about 20% of the U.S. population, 72 million people, will be over the age of 65 years (see Figure 3). This aging of the U.S. population has brought to the fore a number of ethical issues that will grow in importance as the elderly population expands. The 16th Annual Thomas A. Pitts Memorial Lectureship in Medical Ethics addressed several of these issues, including the idea of rationing health care based on age; disparities in health care of the elderly; caring for the growing number of persons with advanced dementia; and physician-assisted death for terminally ill individuals with unremitting suffering. Some of the nation’s leading authorities in these areas were brought together for this conference. Daniel Callahan has been one of the foremost proponents of rationing health care for the elderly since the publication of his 1987 book, Setting Limits: Medical introduction