Ezekiel Emanuel wrote an article for the Atlantic on “Why I Hope to Die at 75: An argument that society and families — and you — will be better off if nature takes its course swiftly and promptly.” As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest — and that it may be best to avoid the consequences of aging and declining health (which probably really begins around age 25).
Recently, I gave a talk called “Your Life Your Choices” to a couple of life-care communities where the average age was near 80 and most were still in independent living. Many had lost their spouses and most, by definition, had some degree of declining health. Sounds depressing doesn’t it? Yet these folks were active — in their faith groups, with their grandchildren, swimming, singing, playing and performing in bands or quartets, line dancing, playing tennis (a few), golf, and enjoying each others company. There was keen recognition and understanding about end-of-life issues. Many had POLST forms saying they would never want CPR, but they would accept removing an appendix, taking an antibiotic, and even a new knee or hip.
I showed these groups a video of CPR, and talked for about 90 minutes about having “the conversation” with loved ones, designating a durable power of attorney for health care, etc. It seems that Emanuel wants to shock us to to accepting that we need to face up to the declining years and make plans. We discussed Emanuel’s proposal in these groups. None of them felt they should have died 5 years ago!
Emanuel states that his family disagrees with his wishes. I hope he can find out someone to follow them and respect his autonomy. But what if he comes in with an infected hangnail with an ascending infection threatening his life with septicemia. At age 74 take an antibiotic, but decline at 75?
So I think I get his over-exaggerated point that we need to think carefully about prolonging the dying process when we are at an end. But, with due respect, I think his ethics are flawed. He is discounting the delight of being old and still functional. Yes, we won’t win a Nobel Prize. But how about the joy of attending a grandchild’s concert, going up to the lake cabin once more with the family, traveling together to Alaska, singing old favorites, volunteering at the food bank or library, going to the opera, Ezekiel, there is no age cutoff for enjoying family, friends, and the pleasures of life. Even though you say you don’t support death with dignity, you are basically proposing that for yourself when you would even decling taking an antibiotic after age 75.
As we die, we leave a legacy for those we leave behind. Ethical wills, sharing our values, showing love, and supporting our loved ones — yes, even as our spouses age. There’s nothing wrong with a cane, a walker, or a wheelchair — enjoyable life can still be there for many of us. There can be growth in our spiritual life and new-found loves even as we experience loss. The old saying “getting old isn’t for sissies” rings true so aging has its trials. Personally I think rekindling an old forgotten friendship is more important, and perhaps as satisfying, as your climb of Mt. Kilimanjaro.
At age 76, as I write this, I think your ethical view of aging is at best cloudy and seems based on fear of loss rather than autonomy. Yes, there are problems of cost, resources, and “getting out of the way” for the next generation. But with my new corneas, I can drive safely again. I love playing tennis doubles with my 80 year old friends twice a week. Should I have resigned to go blind at 75? At your healthy age of 58 Ezekiel, you seem to have a peculiar disconnect with those aging and declining in health. So please re-write your article at age 74!
Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.