A number of forces are bringing ethical issues to the fore. We clearly live in an era-one that will continue at least until the next half century-characterized by the aging of its population. Low birth rates and increasing life expectancy are leading to dramatic shifts in the age structure. By the year 2030, after most of the baby boomers have reached old age, it's projected that one out of every five Americans will be 65 years of age or older. And steady increases are expected in the numbers of persons at the more advanced ages-the "oldest-old" or those 85 years and older-who are most likely to encounter the frailties and infirmities associated with old age. At the same time, a host of other changes are taking place, accompanied by profound ethical challenges: advances in biomedical technology and alterations in the financing of health care and in the delivery of health and human services, to name just a few.

In this course, we'll examine a variety of ethical issues, with particular attention to how they apply to aging and to the older population. For roughly the first half of the semester, we'll consider why ethical dilemmas seem to be emerging with increasing frequency, and discuss what it is about aging and the older population that make these ethical issues particularly relevant and problematic. And we'll devote significant time to examining the principles and concepts that are useful in analyzing these ethical dilemmas. For example, how can autonomy be preserved and maintained as individuals undergo the changes that often occur with aging? Is it possible for an older person to exercise self-determination in the presence of decisional incapacity? How and by whom should end-of-life decisions be made? When, if ever, is it permissible to override a person's autonomous wishes and preferences and act paternalistically to promote her or his best interests? We'll also consider issues related to distribution of limited resources, for example, whether age should ever be used as a criterion for allocating scarce economic and health care resources? Finally, we'll examine the place of older persons as subjects of biomedical and social and behavioral research. Do elders need special protection in human subjects research? Are there characteristics of the aging process or of older persons that threaten the process of informed consent?

We'll consider these and other issues from several perspectives. The three books I've asked you to purchase (along with other readings in the Student Guide) will give you the necessary background. Wicclair's Ethics and the Elderly is written by a philosopher who applies the basic principles of biomedical ethics to older persons. Quill's A Midwife through the Dying Process: Stories of Healing and Hard Choices at the End of Life presents a series of detailed case studies about end-of-life decision making. And Callahan's Setting Limits: Medical Goals in an Aging Society is a controversial and provocative examination of how age might be used as a criterion in the allocation of scarce health care resources. To further concretize (and humanize) these matters, we'll look at a number of other case studies (written and on video), trying our hand at sorting through and resolving the underlying ethical issues in specific contexts.

The first half of the course, then, is designed to acquaint you with some of the major concepts and principles of potential relevance in deciding upon appropriate courses of action in the face of moral and ethical dilemmas. However, it's one thing to discuss these issues in the classroom and quite another to confront them on a daily basis in the course of one's work-in the trenches, so to speak. To give you a glimpse of how ethical issues are dealt with and resolved in "real life," much of the second half of the course will be given over to presentations by and discussions with visitors whose work brings them face to face with the types of problems we will have considered. How do physicians, lawyers, and human service personnel handle these issues when they are serving an affected population?

You will be expected to be actively involved in a variety of ways. Certainly by asking questions and by participating in the many discussions we'll have. I'll ask you not only to read and think about Callahan's book but also to prepare a critical review of its strengths and weaknesses. There will be a mid-term exam (in-class, but based on questions you've seen ahead of time) that will give you an opportunity to review, synthesize, and apply the information presented during the first part of the course. And there'll be a written assignment, due toward the end of the course, that will allow you to sink your teeth into a particular topic of your choosing. (If you are planning to enroll in the course as an auditor, please speak with me no later than the end of the first week of classes to discuss my requirements for receiving audit credit.)

I think you'll find, as I always have, that the issues considered are interesting and stimulating, challenging and vexing, and often moving and poignant. While we'll focus on the application of ethics to the older population, the underlying principles and concepts more often than not cut across age groups. No matter what your age, these issues are of relevance to you-if not right now, then they will be at some point in the future. They are also issues, as we'll see, about which reasonable people disagree. Thus, I hope our discussions will be characterized by openness and candor, as well as a healthy respect for the thoughtful positions of others.

Finally, although I've taught this course many times over the past 17 years, this is only my fourth foray into the world of distance learning. I suspect some of you will already have had considerable experience with this medium, having taken a few or perhaps several gerontology courses offered via UVM's Distance Learning Network. For many of you, though, it will be a new experience-exciting in that it is an opportunity to bring together learners from across the state, but at the same time a bit different and perhaps challenging. So, let's bear with each other as we (continue to) familiarize ourselves with the technology and with this new approach to learning.

I look forward to meeting you and to having you in the course. If you have any questions or if there's anything you'd like to discuss before the course begins, please feel free to call me at 656-2217 (or my assistant, Megan Johnson, at 656-3238) or e-mail us at scutler@zoo.uvm.edu or mmjohnso@zoo.uvm.edu.