Dr Mahendra Gonsalkorale delivered the 14th S.R. Kottegoda Memorial Oration at the Auditorium of the SLAAS on the 24th of November, 2011. He was introduced by Dr Lalini Rajapaksa, Chairman of the Ethics Committee of the SLAAS. The title of the Oration was “Ethical Challenges in an Ageing Society”.
He commenced by reminding the audience of the unique talents of the late Prof Kottegoda who he described as a witty polymath with a love of life and passion for photography, a medical doctor, a physiologist, a researcher, a distinguished academic and an able administrator. He spoke of his contribution to developing Medical Ethics in Sri Lanka. Dr Gonsalkorale amused the audience by his first recollection of Prof Kottegoda as a third year medical student at the Physiology lecture theatre when he stood up from his stool to lecture and virtually disappeared from sight behind the desk. He said “It is then that I realised that he was not the tallest man I have come across. However what he lacked in physical stature, he made up with immense intellectual stature and charisma”. He went on to speak about Medical ethics in general but focused on the special problems and dilemmas doctors and Society as a whole face in dealing specifically with the elderly. In particular, he stressed the importance of recognising patient autonomy and justice. He spoke of the rapid growth in the world elderly population, especially that of the over 85s, in the next 30 years. Sri Lanka has one of the fastest ageing societies in the World, second only to the OECD countries, and the proportion of people over the age of 60 will increase from the current 10% to 25% of the population in 2030, to just over 4.5 million older people. He made special mention of the increase in people with dementia in the world. The numbers in 2001 was 25 million and this is projected to increase to a staggering 50 million in 2020. He spoke of the challenges arising from these changes in ensuring that elders get a fair deal in the face of rising health care costs and the temptation for aged based rationing, which in his view was both unethical and unjust as it assumes that the lives of younger people have more value than that of older people. He said, “The right to health care does not diminish with age. Older people have as much a right as younger people to have aspirations and goals and indeed, their best years may still be ahead, witness Nelson Mandela”. He touched on some myths pertaining to the elderly which has led to ageism and devaluation of older people and attempted to dispel them. He provided some evidence from the West that disability rates in the elderly have fallen in the last 10 - 15 years and is continuing to fall. He suggested that a positive approach to ageing with emphasis on health promotion starting at a young age designed to maintain health, a change in attitude towards retirement making older people more productive by finding roles for them in Society and making use of their wisdom and experience, investment in health education awareness and in recreational facilities for older people, would contribute to mitigating the considerable rise in projected health and social care expenditure. He concluded, “I hope I have been able to demonstrate that ethical principles which apply to people in general should be equally applied to older people. Ageism and age based rationing have no place in a civilised society. People should gain comfort from knowing that as they get older, they would not face the indignity of being discriminated against and being treated as second class citizens”.
