As growing old gracefully becomes more attainable than ever, so we increasingly fear old age. There are predictions that in 30 years’ time there will be twice as many over-75s as there are now. The implication is that these people will be a burden on society, but does the evidence underpin the gloom?

We live in a control culture — we want to control everything around us and get angry when we cannot. But this fails to recognise that the things that really matter are vastly beyond our control. We cannot control when disease strikes, when the accident happens, when tragedy strips us of those we love or everything we value.

We increasingly deny that uncertainly is part of life, but when that life is over the finality of death is absolute. There is no going back. The knowledge, skills, wisdom and experience of that person are gone for ever.

So why are we increasingly fearful of growing old? People can consider longer working lives to contribute actively to society, precisely because health is better than ever. They can share their wisdom, accrued over years, with others. The trick in being an inspirational older person is perhaps in attitude rather than in physical performance. Of course, none of us wants to be a burden or to feel lonely. However, the future for our connectedness with others, maintaining our role in life and independent living, has never been greater.

After spending much of my life treating people who are very seriously ill and dying, I have come to be in awe of death and to realise the amazing uncertainties of life. I have been privileged to be part of a revolution — it’s nothing short of that — in the way that people are treated. When I was a young doctor, people regularly died exhausted by unrelieved pain and other distressing symptoms, often consigned to a side room on the ward as staff flitted past, paralysed by ignorance of what could be done to help. Thank goodness those days are gone. Attitudes have changed and patients and their relatives rightly expect to be treated with respect, in a way that enhances their sense of dignity and considers their preferences in care.

I have often been struck by the way that children see past the façade to the real person; how they love their grandparent as much when frail as when able-bodied. I will never forget the patient with a facial tumour whose children lovingly and gently helped her with dressings each day. The person they loved was inside that shell and of no less value.

And yet now modern medicine can do so much more that it did even a few years ago. It can help to provide effective and lasting relief for much of the distress of serious illness; indeed it must respond to distress, not walk away and abandon people to hopelessness and despair. Today’s specialist palliative care is concerned with all aspects of the person — the psychological, social and physical.

It is paradoxical that, at the same time as we have seen ground- breaking advances in the treatment of serious illness, we see increasingly strident demands for euthanasia. The pressure seems to come from fear of tomorrow rather than from the reality of today. Those who commend euthanasia usually frame their proposals around terminal or chronic illness. But in reality they base their case on personal wish alone and see assisted suicide as another “end of life choice”.

Their demands assume that everyone who is seriously ill can say without difficulty whether they want to be cared for or to end their lives and that no one ever comes under pressure to “do the decent thing”. The real world isn’t like that. Among the thousands of seriously ill patients I have treated, the vast majority are vulnerable to influence. Most people getting old are aware that death is approaching; they want to talk about dying. They often seek reassurance that they are still of value and worth, that they can contribute to society. Very few wanting to talk about dying actually want to die.

However, often people do control death — they let go of life at the time of their choosing. They stay alive for weeks to see a long-lost relative or for a family occasion. One day I was in the room with a young man and his partner; in a moment’s distraction we looked out of the window and laughed, only to turn back to see he had just died. It was as if he waited to know his partner was safe before departing.

The Government is showing commendable commitment to dealing with the plight of the elderly. Last year it launched an ambitious End of Life Care strategy, with more resources for spreading good palliative care to all areas of the country and all parts of the medical profession. And now it is considering the establishment of a national care service and examining ways in which elderly people who need care can get it without having to sell their homes.

In truth, we have much less to fear from growing old and becoming ill than did our parents or grandparents. We should remember that what we read in the papers and see on TV, whether it is a death from swine flu or a suicide in Switzerland, is the exception rather than the norm — it wouldn’t be news otherwise. And, when we feel inclined to pessimism about the future, we should reflect on what earlier generations had to cope with and ask ourselves how much of our gloom stems from our own changing expectations.

It is great to able to grow old. So perhaps we should enjoy the glory of the setting sun.

Baroness Finlay of Llandaff is an independent crossbench peer and Professor of Palliative Medicine at the University of Cardiff

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