ABSTRACT

The year is 2020. The AIDS pandemic is over, leaving a legacy that has changed the demographics of the world. Large numbers of baby boomers are just beginning to die of heart disease and an array of cancers, which are apparently on the rise due to decades of ozone depletion and other assaults on our environment. Medical science is now so advanced that doctors can keep our bodies alive for months, even years, beyond what used to be considered a “natural” death, in part because of the knowledge gained during the AIDS epidemic. However, they have not been able to restore health to the degree that these patients can leave their beds and return to normal lives. Patients are too often a mass of tubes and catheters, hooked to ventilators and dialysis machines. For decades, the right-to-life movement has successfully blocked physician-assisted suicide in the political arena, after the Supreme Court’s ruling in the summer of 1997 that it was a matter for the state legislatures to decide. Despite concerns about terminal patients being coerced to end their lives, physician-assisted suicide has finally become legal in most states, facilitated by the collision between medical advances and the population’s increase in disease due to the aging baby boomer population. Managed health care has begun to ration medical interventions, viewing the indefinite prolongation of bedridden patients’ lives as pointless. Despite a loud right-to-life outcry, the general population is in agreement with these changes. At the forefront of the right-to-die movement is AARP, now run by the post-World War II babies, who are concerned with not ending their lives as helpless invalids with no quality of life left. Mental health practitioners have taken on the role of assessing competence, helping to differentiate between those patients with terminal, irreversible conditions wanting a “hastened death” and those who are suicidal due to depression or some other psychiatric disorder. Social workers have developed a specialization as mortal midwives. In the history books, there is a footnote about the PWAs, infectious disease doctors, and mental health clinicians in the era of AIDS, pioneering standards for what, in the year 2020, is called “final transition interventions.”