Aging and death are some of the harshest realities of human existence that we all have to experience. Advancements in science and technology are likely to change the human experience of death and aging altogether. Scientists, futurists and philosophers have theorized that the human body could be made immortal several decades from now. This involves technologies such as cryogenics, cloning, cybernetic brains and bodies, the immortal gene implant, nano-robotics for rapid cell repair, extropy and many more currently under research. If this happens, humans are looking at extended lives stretching even millennia. Few films portray the harshness of aging and death as Rob Reiner’s The Bucket list (2007). The purpose of this paper is to examine the theories of aging as they apply to Carter Chambers, a geriatric starring character in the reviewed film – The Bucket List (2007).
Film Plot
The film is based on the lives of two older men in their 70s. One is a blue-collar motor vehicle mechanic named Carter Chambers who is played by Morgan Freeman and the other is a multi-billionaire named Edward Cole who is played by Jack Nicholson. The two are roommates in a hospital’s long term care program having been diagnosed with terminal lung cancer. The prognosis according to the oncologists is that they both have a maximum of one year of life. In his younger years, Carter’s philosophy professor had given them an assignment to prepare a bucket list or, instead, the most exciting thing one wishes to do before they “kick the bucket.” Having been a mechanic for 45 years and now dying of terminal stage 4 metastatic lung cancer, Carter had neither done nor sees the point of doing anything listed on the bucket list. He folds it up and tosses the list away. The next morning his roommate, billionaire Cole, also dying from terminal lung cancer, takes the list and encourages Carter to go ahead and execute the bucket list, taking up all the expenses.
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The two set off on the epic adventure despite the protest from Carter’s wife, Virginia Chambers (played by Beverly Todd). They go skydiving, race in Shelby mustangs, visit Egypt's pyramids, the Great Wall of China, go to the African plains, the North Pole, travel to Paris on a private jet, get tattoos, and so many other things. Their relationship starts to fail when Cole hires a prostitute for Carter, who insists on not continuing the list. Cole is also angry at Carter when he tries to reunite him with his estranged only daughter, who drove off years ago. During the reunion with his wife and family, Carter collapses. The tests reveal that his cancer had spread to the brain. He dies on the operating table soon after. At his funeral, Cole, who was in miraculous remission, eulogizes Carter and reminisces the last three months of his life as the best he had ever lived. His cancer however returned a few years later, but not before had completed the bucket list. He is buried at Mount Everest in the Himalayas, next to Carter.
Biological, Psychosocial, and Developmental Theories of Aging
Scientist, psychologists, theologizes, philosophers, and other scholars have tried to understand the mystery of senescence and death and have over the years, developed various theories to explain these phenomena. According to Touhy and Jett (2013), theories of aging can be classified into three broad categories, that is, biological theories, psychosocial theories, and developmental theories. There are seven biological theories outlined in the Touhy and Jett (2013) text. First, there is the programmed aging theory which suggests that aging occurs as a result of predictable cell death, whereby each cell has a multiplicity limit called the Hayflick limit. In other words, there is a biological clock for organ and cell death. Next is the neuroendocrine control theory, which suggests that aging occurs as a result of a programmed decline in the function of the endocrine, nervous, and immune systems, where cells lose their ability to replicate in a process referred to as cellular replicative senescence.
The third is the immunity theory which implicates aging due to a declined function of the immune system in the immunosenescence process. Next, the error theory suggests that aging occurs as a result of errors in cellular DNA and RNA synthesis, leading to loss of cell function. The “wear and tear” theory explains aging to occur as a result of “wearing out” of organs due to extensive use and the effect of internal and external stressors. The cross-linkage theory suggests that glycation of cross-linkage proteins affects wound healing processes resulting in declined body functioning over time. The final theory is the oxidative stress theory, where oxidative damage of mitochondrial cells results in diminished body strength. Psychosocial theories of aging include disengagement theory, continuity theory, gereotranscendence, exchange theory, and role theory. The developmental theories include Carl Jung's Theory, Abraham Maslow's theory, Lars Tornstam's theory, Robert Peck's theory and Erik Erikson's theory.
Aging Theories As They Apply to the Film the Bucket List (2007)
In the film the Bucket List (2007), Carter's process of aging can best be explained by three essential theories of aging. These are the “wear and tear” theory, the error theory, and Erik Erikson's developmental theory (ego integrity vs. despair stage) of aging. The “wear and tear” theory is one way to explain Carter’s aging process. This theory suggests that aging is a gradual process that involves progressive damage to cells, tissues and organs, caused mainly by dietary and environmental agents leading to their eventual death. Having worked 45 years in a blue-collar job at a garage to support his family, internal and external stressors might have enormously contributed to the damage of his cells over time.
The next theory is the error theory, more specifically, the somatic mutation theory of aging. These somatic mutations could have affected the EGFR or KRAS genes resulting in tumor formation in the lungs. The lung cancer was mainly attributable to Carter’s smoking habits and exposure to automotive toxic chemicals. The development of terminal lung cancer brings him closer to death when he is told he only has a year left. The final theory that explains Carter’s aging process is Erick Erikson’s psychosocial theory of development, particularly the final stage that starts between 65 years until end of life. Erickson claimed that this is a reflective stage, where one looks back at their accomplishments in life. According to Erickson (1986), evaluation of one’s life enables them to come to terms with the life they have lived thus far. This is extensively depicted by Carter as he lies on the bed and reflects back on his life. He has a list of the things he did not achieve. He wanted to be a history teacher but ended up as a simple mechanic. He is in despair until Cole convinces him that it is not yet too late to achieve some of his dreams. He gives him a chance to achieve ego-integrity by financing his bucket list. In his final letter, he thanks Cole for everything acknowledging that “ There's no way I can repay you for all you've done for me ...” (The Bucket list).
Comparing the three theories
| Error theory (somatic mutation theory) | The “Wear and Tear” theory | Erik Erikson’s psychosocial theory | |
| Theory proposer and year of publishing | Leslie Orgel (1963) | August Weismann (1882) | Erick Erickson (1986) |
| Assumptions |
There is a constant and linear increase of genetic mutations over time. Cells function optimally until cellular redundancy is exhausted (Milholland et al., 2017). Normal somatic cells have a finite maximum life. |
Animal cells, tissues and organs like machines wear out after extensive use over time. | Personality develops in a number of stages that are believed to be in conflict |
| Key concepts | This theory proposes that the aging phenotype results from an accumulation of random errors in the synthesis of cellular DNA & RNA. Each replication produces more errors until the cells no longer function. Accumulation of mutated genes in the genetic composition of somatic cells eventually leads to their decline | The theory posits that cellular errors are the result of "wearing out" over time due to continuous use. Internal & external environmental stressors such as pollutants cause progressive decline in cell function. | The stage of late life is ego integrity as opposed to despair. This theory suggests a sense of completeness and self-coghesion. Erikson & his wife wrote in 1986, "The process of bringing into balance feelings of integrity & despair involves a review of & a coming to terms with the life one has lived thus far." (Erickson, 1986) |
| Defining feature | Functional decline (cognitively and functionally) | Functional decline (cognitively and fictionally) | Personality changes over time mainly define reflection of past life and. |
| Link with disease development | Manifested by diseases | Increases vulnerability to diseases progression in time. | Unspecified |
| Caused by reactive oxygen species (ROS). | Mostly | Mostly | ROS does not cause aging. |
| Associated Struggles | Increased burden of disease and decline in physical and mental functioning | Increased burden of illness and decline in physical and psychological functioning | Letting go, accepting care, detachment and some measure of cognitive and mental decline |
Strengths and Weaknesses of the Theories in Explaining Carter’s Character in the Film
The somatic theory of aging best explains Carter's aging process when his DNA replications continue to mutate over time and eventually become cancerous. This significantly decreases his physical functioning despite life-prolonging therapy. The mutation spreads to the brain, which causes his death. On the other hand, this theory does not explain aging before cancer developed. The “wear and tear theory” is one of the most accepted theories of aging. Accordingly, this theory can best explain the aging process, not justified by the somatic mutation theory. For 45 years, Carter toiled and overworked himself to support his family. Environmental stressors, both external and internal, could have contributed to faster wearing and tearing of cells leading to declined function. Like machines, the body reaches a point when it cannot do certain things and becomes vulnerable to diseases, as Carter was. This theory, however, does not explain how Carter was able to accomplish his bucket list in his 70s with terminal lung cancer, given that most tasks were physically demanding. This is where Erick Erickson’s personality theory comes in. This theory explains that lack of satisfaction with the life he had lived prompted him to go after self-fulfillment even in the later stages of life. However, this theory does not explain why his physical health had deteriorated so much over his lifetime, as well as the other two theories explain. Of the three theories, I hold for the somatic mutations theory since it explains his death and the decline in physical functioning, including the cause of these mutations.
Implications for Nursing Care
Given that Carter is a terminally ill patient with metastatic lung cancer, conversations about slowing or reducing cellular damage and current treatments to improve their quality of life are out of the question. His health, comfort and wellbeing can only be enhanced by making him as comfortable as possible through empathetic, patient centered care. This includes providing them with a listening ear, administering pain reduction medication, and providing them with the sensitive and emotional support (Reljic et al., 2017), that distracts them from their pain, anger, loneliness, and bitterness for not accomplishing all he could have wanted to accomplish in his lifetime.
Ethical Issues
Touhy and Jett (2013) describe two main ethical and legal issues in the care of older adults. These are decisional incapacity which renders them unable to decide on the best course of treatment for their health. The authors also describe elder mistreatment and abuse, especially for those with extensive physical and cognitive decline. Decisional incapacity is the ethical issue mostly apparent to Carter as evidenced by the decision to stop treatment and go out for a wild adventure. This is detrimental as it causes the cancer to spread to his brain. He does not have a standing DNR or living will, which means he is taken to the operating room, where he dies. As his nurse, I would advise him to write a living will or sign a DNR to prevent any measures to unnecessarily prolong his life (Cui et al., 2021). Carter’s religious beliefs would encourage him to welcome death as a sign of God’s grace and mercy. Being God-like creatures, Christians believe that it is not their portion to live with infirmity, degenerative diseases, pain, suffering, deranged mind or eternal suffering. By appealing to these beliefs, carter would sigh the DNR would allow him to die when the time comes. This paper evaluated the theories of aging with reference to the life of Carter. The error theory was found to best explain the aging process leading up to death for this character.
References
Cui, P., et al. (2021). Timing of do-not-resuscitate orders and health care utilization near the end of life in cancer patients: a retrospective cohort study. Supportive Care in Cancer , 29 (4), 1893-1902.
Milholland, B., et al. (2017). Mutation and catastrophe in the aging genome. Experimental gerontology , 94 , 34-40.
Mocieclips. (2011, 16 th June). The Bucket List . [Video]. YouTube. https://www.youtube.com/watch?v=vc3mkG21ob4&list=PLtOcBWvs7XfnaPWtioYR7h6cK5PxKg5e3
Reljic, T., et al. (2017). Treatment targeted at underlying disease versus palliative care in terminally ill patients: a systematic review. BMJ Open , 7 (1), e014661.
Touhy, T. A., & Jett, K. F. (2013). Ebersole & Hess' Toward Healthy Aging-E-Book: Human Needs and Nursing Response . Elsevier Health Sciences.
