Ezekiel Emanuel has written a somewhat controversial piece in The Atlantic on his hopes to die at the age of seventy-five. He doesn’t hope to be able to live to that age. He hopes he won’t live much past it.
That’s how long I want to live: 75 years.
This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can’t mean what I say; that I haven’t thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90.
I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.
But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.
He does not intent to commit suicide on his seventy-fifth birthday, to be sure.
Let me be clear about my wish. I’m neither asking for more time than is likely nor foreshortening my life. Today I am, as far as my physician and I know, very healthy, with no chronic illness. I just climbed Kilimanjaro with two of my nephews. So I am not talking about bargaining with God to live to 75 because I have a terminal illness. Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority.
I am talking about how long I want to live and the kind and amount of health care I will consent to after 75. Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal.
He will not take any active means to extend his life any further.
Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either. Today, when the doctor recommends a test or treatment, especially one that will extend our lives, it becomes incumbent upon us to give a good reason why we don’t want it. The momentum of medicine and family means we will almost invariably get it.
I must say that I am at least somewhat sympathetic to this point of view. Anyone who has ever watched a loved one growing older into senescence and decay must wonder if longevity is really something to be desired. What good is it to live to be ninety if the last decade is spent chronically ill and miserable? There is also something unseemly and even futile about this quest we have to live ever longer. We cannot be immortal. No matter how healthy our lives, we will die eventually.
If I eat the right sorts of foods and get the right amount of exercise, perhaps I will live to be eighty rather than seventy. So what? Compared to eternity, ten or twenty years is an infinitesimal amount of time. If I ate a diet of bean curd, perhaps I might live to be one hundred. What good is that if I am miserable every day because I am eating food I hate? Of course, I am being a fool. Living in a healthy body is more pleasant than living in an unhealthy body. But, then this is a matter of quality of live as opposed to quantity of life.
For a Christian, it is especially unseemly to cling to this life. We believe, in theory, that this life is only a prelude to a greater life to come. Why cling to the shadow when we can have the substance? Perhaps our attitude should be that of Pope Pius IX on his deathbed. When told that people around the world were praying for his recovery, he jokingly rebuked his advisors saying, “Why do you want to stop me from going to Heaven?”. Why are we determined to stay out of Heaven? Many other religions have similar views.
I don’t quite agree with Ezekiel Emanuel’s position, all the same. For one thing, I do not have the authority to choose the time of my death any more than I had to choose the time of my birth. It is common to say that this is “my body” or “my life”, but it really isn’t. None of us created ourselves. It would take a PhD in several fields to even begin to understand the processes that keep us alive. If any of us were given conscious control of every biological and chemical reaction in our bodies, we would die within seconds. Properly speaking, my body and my life belongs to the One who made them.
Perhaps Mr. Emanuel might agree with me, although I have no idea what his religious views are. As I noted, he does not plan to actively seek death.
This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.) After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.
Surely there is something to be said for this attitude. Yet again, I do not quite agree with him. I do not and cannot know what my ultimate fate will be and it seems presumptuous to decide that after a certain age I am finished. For all I know the plan might be for me to live to ninety-five in reasonably good health. It would be foolish not to take reasonable steps to keep myself well. If one must accept Mr. Emanuel’s reasoning, surely a consideration of overall health and quality of life is a better basis for deciding when to stop getting checkups, etc, than an arbitrarily chosen age. In any case, I will simply take what comes.
Ezekiel Emanuel states that he is opposed to euthanasia or physician assisted suicide, and I see no reason to doubt his word. He does not even recommend that every one agree to his ideas.
Again, let me be clear: I am not saying that those who want to live as long as possible are unethical or wrong. I am certainly not scorning or dismissing people who want to live on despite their physical and mental limitations. I’m not even trying to convince anyone I’m right. Indeed, I often advise people in this age group on how to get the best medical care available in the United States for their ailments. That is their choice, and I want to support them.
And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy. What I am trying to do is delineate my views for a good life and make my friends and others think about how they want to live as they grow older. I want them to think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging. Are we to embrace the “American immortal” or my “75 and no more” view?
He wants medical research to focus on better treatments for the diseases of old age rather than simply prolonging life or extending the process of dying. But, does he not see that he is actually making some very good arguments for euthanasia? He spends the middle part of his article noting that creativity tends to decline with age, even when there is no dementia. The minds of the elderly no longer work as well, just as their bodies no longer function as well.
Even if we aren’t demented, our mental functioning deteriorates as we grow older. Age-associated declines in mental-processing speed, working and long-term memory, and problem-solving are well established. Conversely, distractibility increases. We cannot focus and stay with a project as well as we could when we were young. As we move slower with age, we also think slower.
It is not just mental slowing. We literally lose our creativity. About a decade ago, I began working with a prominent health economist who was about to turn 80. Our collaboration was incredibly productive. We published numerous papers that influenced the evolving debates around health-care reform. My colleague is brilliant and continues to be a major contributor, and he celebrated his 90th birthday this year. But he is an outlier—a very rare individual.
American immortals operate on the assumption that they will be precisely such outliers. But the fact is that by 75, creativity, originality, and productivity are pretty much gone for the vast, vast majority of us. Einstein famously said, “A person who has not made his great contribution to science before the age of 30 will never do so.” He was extreme in his assessment. And wrong. Dean Keith Simonton, at the University of California at Davis, a luminary among researchers on age and creativity, synthesized numerous studies to demonstrate a typical age-creativity curve: creativity rises rapidly as a career commences, peaks about 20 years into the career, at about age 40 or 45, and then enters a slow, age-related decline. There are some, but not huge, variations among disciplines. Currently, the average age at which Nobel Prize–winning physicists make their discovery—not get the prize—is 48. Theoretical chemists and physicists make their major contribution slightly earlier than empirical researchers do. Similarly, poets tend to peak earlier than novelists do. Simonton’s own study of classical composers shows that the typical composer writes his first major work at age 26, peaks at about age 40 with both his best work and maximum output, and then declines, writing his last significant musical composition at 52. (All the composers studied were male.)
Perhaps he does not intend it, but this is dangerously close to valuing individuals not as human beings created in the image of God but on a utilitarian basis according to what they can be expected to contribute to society. If we are going in that direction, we might as well open up the death panels right now. We had also better be honest enough to admit that most of us are not going to contribute very much to the arts and sciences and might be fair game for such a panel at any age.
As for me, I will take whatever comes
I wonder if a lot of the conservatives who written about his article have actually read it.