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.