Ethnological studies show that the care which societies are able to provide for their old people depends largely on available resources. However, the concept of resource depends on contemporary requirements and expectations. Modern families still try to look after their old people, but increasing longevity is making this more difficult. There is a finite ability of populations, however wealthy, to support dependent members. Resources provided to look after old people must necessarily be subtracted from those available for the other, still more important dependent group, the children, with potentially disastrous results in underfunding of social support and education. The sociobiological theory of inclusive fitness emphasizes the importance of the ways in which family members interact to help each other and try to ensure their genetic survival, even if this involves sacrificing their own interests and occasionally, their lives. Many old people do not wish for further longevity after they have become too disabled to be of service to their families, and would prefer to see limited resources being used for the young. In the USA, loss of autonomy of patients and their families owing to the practice of defensive medicine has resulted in the development of the 'living will', a legal document in which people can specify in advance what treatment they wish to accept in the event of life threatening illness. It is to be hoped that improved understanding of family relationships will make this generally unnecessary in the future and that, unless specified to the contrary, families will be allowed to decide about treatment for members who are unable to decide for themselves.(ABSTRACT TRUNCATED AT 250 WORDS)
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