Tuesday, October 7, 2014

Are You Supposed to Die at 75?


     The Atlantic recently published an article called "Why I Hope to Die at 75" by Dr. Ezekiel Emanuel. He is a Harvard-educated doctor who's the brother of Chicago mayor Rahm Emanuel. He also heads the Department of Medical Ethics & Health Policy at the University of Pennsylvania, and served as an adviser to the Obama Administration in developing the Affordable Health Act.

     Dr. Emanuel says that he wants to die at age 75. Why? First of all, he argues, most people have made whatever contribution they will make to society by the time they are 75 -- or even long before that. In fact, most people see their most productive years in their 40s, and after that they slowly decline and fade away. By age 75 any man or woman will have lived a full life -- they will have finished their career, raised their family, seen their grandchildren begin to grow up. By age 75, there's nothing left to do but hang on and suffer the degradations of old age.

     He then points out that modern medicine has lengthened our life expectancy -- and for a long time it also improved our quality of life. But in recent years, he says, increases in longevity have instead been accompanied by increases in disability.

     He cites a study by Eileen Crimmins, a researcher at the University of Southern California, who found that between 1998 and 2006, the loss of functional mobility in the elderly actually increased. In 1998, about 28 percent of American men 80 and older had a functional limitation; by 2006, that figure was nearly 42 percent. And for women the result was even worse: more than half of women 80 and older had a functional limitation. Crimmins’s conclusion: There was an “increase in the life expectancy with disease and a decrease in the years without disease.”

     Dr. Emanuel's conclusion:  "Over the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process. The contemporary dying process has been elongated ... So modern Americans may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me."

     Dr. Emanuel does not want to live with inevitably decreasing mental and physical abilities. He also doesn't want his grandchildren to remember him as a dottering old man, but as the man he was when he was in command of his abilities. And he doesn't want to subject his children and grandchildren to the "very real and oppressive financial and caregiving burdens" that fall to people who are responsible for the aged and infirm.

     Dr. Emanuel is not in favor of euthanasia. He has no plans to commit suicide at age 75. What he plans to do is refuse any preventive care after age 75. He will instead let nature take its course. He will have no more colonoscopies, prostate exams or flu shots. He will not undergo heart surgery or chemotherapy. He will accept palliative care, if need be, to lessen his suffering; but he sees no point in going to extreme measures to extend his debilitated and useless life after age 75.

     So ... do you buy his argument? I might. Except I'd put the age at 85 instead of 75. But then, I'm a few years older than Dr. Emanuel. So we'll see. Dr. Emanuel is 57 years old. Let's check in on him, and see if he still holds the same view, in 18 years.

     Meanwhile, as a postscript, another doctor, Atul Gawande, a professor at Harvard Medical School, has written a book called Being Mortal, which addresses end-of-life issues from a similar but slightly different perspective. He points out that modern medicine has focused on fixing and managing both injury and disease -- and continues to try to fix problems right up to the bitter end, beyond the time when it can really be of much help, and in the process often causes a great deal of physical and emotional suffering.

     Dr. Gawande argues that there comes a point when medicine should focus on a person's well-being more than their life expectancy. That instead of trying to prolong a person's life by an extra week, or an extra month, doctors should instead offer them as much comfort as possible, and let them go with some degree of autonomy and dignity.

     And I'd agree with Dr. Gawande. Let me go with some degree of autonomy and dignity ... you know, in 20 years or so.

31 comments:

Olga Hebert said...

I agree with the notion that there is too much emphasis on treating disease no matter what the cost in terms of quality of life. I have my advance directive in place. On the other hand, I find Emanuel's arguments offensive and spurious. They are his own opinion, subject to change by his own admission. There are much better discussions to have around end of life care.

Florence said...

Olga said exactly what i was thinking.

Anonymous said...

Now this is a doctor speaking and his own opinion, I disagree with his opinion..No one wants to suffer and be tossed aside, in the USA nursing homes to me in my opinion are expensive places to sit and die or suffer and die alone..Advanced directives are absolutely necessary and the after care of one's own life is important too, why let the funeral business the biggest business in the billions take care of your body after you leave the living? No I think one has to make sure that they get what they want how they want it and to protect their family from the greedy funeral directors a will and end of life directive, but I don't agree in suicide and that is that! I am only 66 I doubt I will be alive to my 100's and have my wishes done legally no pain for my hubs of over 40 years and heartache too for our only child either..!!!!!!!!!!!!

Meryl Baer said...

I hope I am around to see if he still feels this way when he is 75. I know too many healthy 75-year-olds who would not want to forego some medical care - flu shots a good example.

DJan said...

I read Dr. Emanuel's article with interest, and I agreed with some things he said, but not all, by any means. The book by Atul Gawande I knew nothing about, but I immediately went to the library to place a hold on it (and I'm #15 in line for ONE copy). I've read everything the man has written and I'm glad to know he's written on this subject.

I've got a DNR directive and know that my partner will not allow me to hang around if I don't want to, and I also live in a state that allows one to choose suicide if things get really bad. I voted for it and would use it if I needed to. I believe people should have a choice. I know some people don't agree, but I've seen people who begged to die, who were sick beyond belief and the doctors STILL kept them alive. Just my two cents.

Pam said...

This article might be controversial, but I hope that all who read it will complete an advanced directive ASAP. Make sure it's legal. Give copies to your partners, children and medical providers. It's one of the most loving gifts we can give to those who mean the most to us.

Douglas said...

I'm with Meryl, we should ask the good doctor if he feels the same at, say, age 74. My father always figured he'd die in his mid-60's, as all his male forebears did. But he lived to age 81 and complained about his health for the last three. Me? I want to die after I hit 78, at least, but I am not in a hurry.

Kirk said...

His brother Rahm is 54; 21 years from now he'll probably be campaigning for re-election for a 7th term.

Tabor said...

I want to live as long as I can as long as my mind is complete. I am a bit of an artist and do not need all my faculties to study and work on types of art...painting, writing, drawing, thinking...etc.

Stephen Hayes said...

My 89 year old mother keeps saying, "When you're my age..." I keep telling her I don't expect or want to reach her age and she doesn't get it. She's in remarkable health and living in the golden age for senior citizens. I don't expect to be that lucky.

Tom Sightings said...

Well, I wonder (picking up on what Pam said) if Dr. Emanuel wrote this not so much because he believes it, but because he wanted to stimulate the discussion -- a discussion well worth having. As for my own experience ... my mother got breast cancer when she was 60, and lived for another 28 years. She suffered the last couple, but I'm sure it was worth it to her for the other 20+. My dad died at 91, and was only debilitated for the last six months. So as for myself ... I'll take what medicine has to offer -- with the Gawande caveat about the last few months or weeks, which is also why, as several pointed out, the advance directive is important.

Linda Myers said...

I think the doctor has a good point, that we shouldn't have to live at the point where our quality of life is less than we can handle. I think everyone should have a choice as to when their lives end. I live in Washington State, too, and have an advance directive. My mother lived to be 86 but her last three years were pretty miserable.

schmidleysscribblins.com said...

I had to turn off the TV when Judy Woodruff interviewed EE two nights ago. Too depressing! David is 85. For a different perspective, check out Ginnie at Goldendaze. Link on my blog. She posted a moving post on her 80+ mother a day or two ago.
This week, ' Next Avenue'.a PBS e-letter had a response to EE about the joy of life for an older person. Even if they are incapacitated.

I believe EE is arrogant. Her is now trying to qualify his remarks by saying the end of life depends on the individual...but the damage has been done. After these comments, people can look at an older person and think...why aren't they dead.

I worked on aging data at the Census Bureau for several years. My boss thought you hit a wall at age 80. Does not matter, of course. When my Aunt Rita was 75, she biked 75 miles. She is 97 today and enjoying life. My daughters MIL just turned 100. I posted a photo of her last week. She is happy and loves reading a good mystery.

Life is not about how productive one is, it is about the journey. The last part of life should be about spiritual connection. We don't have time before then. Enjoy it as long as you can..I say.

Janette said...

My husband wants to live to be 100. I told him long ago that I will not accept any huge treatments after the age of 70. I agree with Dr Emmanuel. I have already had a great life. I don't want tons of money spent on me in the end.

When my nephew was in the hospital for congenital heart failure, there where ten rooms of people undergoing major surgery for the same thing. Two received heart transplants. He was the only one under 70. It seemed so unfair that he was on the same list, at 20, as they were.

Anonymous said...

The Irish have some quotes which could apply here:

May you die in bed at 95, shot by a jealous spouse.

We drink to your coffin. May it be built from the wood of a hundred year old oak tree that I shall plant tomorrow.

And finally:
May you live to be 100 years, with one extra year to repent.

rosaria williams said...

It's an adult conversation we should be having, not about the perfect age to die, but how and when to let go when our capacities and energy level are beyond repair.

gigihawaii said...

I am 68 and will be 69 in January. I would not mind living to 100, but I don't want to do so with dementia. With dementia, you can't even fry an egg.

schmidleysscribblins.com said...

Got the book you recommended and am half-way through. So far so good. Thanks.

Karen D. Austin said...

Whoa. I just put Gawande's book on hold yesterday. And here you are talking about it. *Twilight Zone theme playing*

Douglas said...

Gigi, sure you can fry an egg if you have dementia but you are equally liable to set fire to the house.

Terry said...

As a 57 yo social worker working in a hospital devoted to Geriatric patients I can certainly agree with some of his points. Some of the patients I work with are barely hanging on by a thread, they can't perform most of their regular activities and depend on others for their personal care, usually provided by a friend or family member. Many can't walk, are a fall risk, have gait imbalances. I saw several individuals today who were dressed in stained clothing, smelling strongly because they have difficulties bathing or performing hygiene and don't have anyone to assist them with these tasks. I certainly would not like to live like this and these are the ones that are living at home, not in an nursing home. Many have chosen procedure after procedure with the end result being that they need more care than ever but as time goes by they have limited supports. We are currently facing a similar situation with my husbands 87 yo father who underwent 2 knee replacements with no visible changes in his mobility and is now undergoing chemotherapy for cancer. It is very sad to see but I believe that we sometimes think we will live forever and refuse the inevitable. After working in health care for so many years, I do agree with the doctor to a certain extent. I do know many individuals in my clinic who have done remarkably well until their late 80's or 90's all things considered but find themselves frustrated because mobility problems do not permit them to be as independent as they would like. Others very sadly lose their cognitive abilities rendering them completely dependent on others. While I personally would not refuse a flu shot (that is just silly) I do think other types of medical intervention is oftentimes pointless. Our bodies degrade and things do start to fall apart. After almost 30 years working with the elderly, I do not believe I will pursue life prolonging treatments and have written and Advanced Directive indicating the same.

Pam said...

Tom, you and your readers might be interested in reading the article written by Dr. Ken Murray entitled, "How Doctors Die" (Sat Evening Post, Mar/Apr 2013). Talk about thought provoking...well worth the read!

schmidleysscribblins.com said...

I'm back, Read Gwande's book, got depressed sent it back. I think I like being ignorant and taking life as it comes. I do have a medical directive, however for my loved ones. I had the will, directive and power of attorney drawn while I was working and in my 40s Updated before I retired.. Now I'm off to walk the dogs.

Sunshine said...

I disagree completely. My father is going to be 76 soon and contributes so much to the joy of our family. Just three years ago, he learned how to drive a boat. Now he travels with my mother. They are vibrant, healthy and we are all glad they are alive. They have many good years left and I hope to live as long as healthy as they are.

Dick Klade said...

History tells us the human community would lose a lot if packing it in at 75 became a general rule.

Winston Churchill, in his 80s, finished a great work, "A History of the Englist-Speaking Peoples." Dr. Michael DeBakey, America's greatest heart surgeon, practiced medicine, lectured, and wrote, well into his 90s. Barbara McClintock won the Nobel Prize in medicine when she was in her 80s for groundbreaking work in genetics. At 78, Supreme Court Justice Oliiver Wendell Holmes issued a landmark opinion defining the limits of free speech.

Outstanding authors George Bernard Shaw and Johann Wolfgang von Goethe produced some of their best work in their 80s.

And many, many more.

I believe much of what Emanuel says, but think the value of longevity really is a very individual matter.

Friko said...

It’s the quality, not the quantity, that counts. That’s what we say until we reach 75 and plus ourselves.

All the old people I know hang on for dear life, whether their life is worth living (from a younger person’s viewpoint) or not. They take everything modern medicine can give them to keep life going.

I would wish to be different when my time comes, but who knows. Perhaps I’ll be one of these drooling, immobile, incontinent women who ask for nothing more than to be allowed to live.

DDD said...

I saw it from Djan's link first. Thanks for your explanation, I enjoy you made the important points across!!

June said...

Not so very long ago I would have thought, "Yeah. 75 sounds like the right time." It's the age my grandparents all were when they passed away. But I'm 63, and 75 isn't that far away anymore. Only twelve more years?
I guess I agree with you, and with Friko. I don't want to go any sooner than I must, but when the law of diminishing returns kicks in, I hope to recognize it.

Amy Blitchok said...

I think it is misleading to say that Dr. Emanuel says that he wants to die at age 75. He simply says that he will not go to extreme lengths to prolong his life in the face of chronic and debilitating illnesses after that age. If his health continues to prosper, then great, but he is't willing to sacrifice quality of life for a couple extra years of diminished health after once he is edging towards his 80s. The title of his article is meant to be attention grabbing, but doesn't not do justice to the subtitles of his actual argument.

Laura Lee Carter said...

I wise elder told me: "Old is always ten years older than you are."
I agree and I also totally support the idea of ending your life on your own terms...

Dick Klade said...

I think Amy B. has it right. Reading the whole article is recommended. It contains lots of interesting views about old age and dying.