In this moving and controversial Quarterly Essay, doctor and writer Karen Hitchcock investigates the treatment of the elderly and dying through some unforgettable cases. With honesty and deep experience, she looks at end-of-life decisions, frailty and dementia, over-treatment and escalating costs.

Ours is a society in which ageism, often disguised, threatens to turn the elderly into a “burden” – difficult, hopeless, expensive and homogenous. While we rightly seek to curb treatment when it is futile, harmful or against a patient’s wishes, this can sometimes lead to limits on care that suit the system rather than the person. Doctors may declare a situation hopeless when it may not be so.

We must plan for a future when more of us will be old, Hitchcock argues, with the aim of making that time better, not shorter. And we must change our institutions and society to meet the needs of an ageing population. Dear Life is a landmark essay by one of Australia’s most powerful writers.