In a recent article in The Atlantic, entitled “Why I Hope to Die at 75,” Ezekiel Emmanuel makes the following provocative argument: I am not interested in living beyond age 75 since I am likely to suffer from functional limitations and will no longer be able to contribute much to society. I will not accept curative medical treatment, only comfort care. Put me on the ice floe and push me out to sea.
Like much of what Emanuel has written over the years, the piece is challenging and (not accidently) incendiary. It is about half right, but in some important ways, very wrong.
Emanuel’s long article is based in part on disputed data and some curious ideas about what it means to be productive. And, for reasons he does not effectively explain, he fixes his optimum age of death at 75. But behind the flaws, he makes an important point: None of us will live forever and at some point we should stop trying.
Many of us will in fact reach an age where we will be better served by comfort care rather than aggressive medical treatment. On that point, Emanuel is exactly right.
Emanuel, who, by the way, is now 57, is not some random guy. He is an oncologist, director of the Clinical Bioethics Department at the U.S. National Institutes of Health, and head of the Department of Medical Ethics & Health Policy at the University of Pennsylvania. He also played a key advisory role in the design of the 2010 Affordable Care Act.
In fairness, let’s be clear about what Emanuel did not say. He opposes euthanasia and suicide. And he says he is not suggesting that government or insurance companies ration medical treatment for those over 75. No death panels, in case you were wondering.
Nonetheless, he says he has drawn a bright line for himself at age 75. Before, treatment (maybe). After, forget it.
Why 75? Why not the Biblical lifespan of 70? Or 80? On this point, Emanuel is remarkably unpersuasive.
He argues, for instance, that “creativity, originality, and productivity are pretty much gone for the vast, vast majority of us” at 75. He cites research that productivity peaks in our 40s, and that on average Nobel Prize winners made their discoveries at 48. So why not pack it in at 60? Why wait?
Besides, this seems an absurdly false argument. Let’s assume that on average people are indeed less productive at 75 than at 45. That hardly means they are unproductive. They may still have plenty to contribute to their families, their communities, and (increasingly) their work.
But Emanuel takes an oddly absolutist view of this. If you’re not out there competing for a Nobel Prize, he suggests, “life comes to center around sitting in the den reading or listening to books on tape.…”
Seriously? Do I really need to say that many older people are living much more interesting—and useful—lives than that? Even if they won’t get an international award for what they do.
His argument is also based on an important question about aging: Have we seen what researchers call a “compression of morbidity” as life expectancy has increased? Or, as Emanuel asks, “As life has gotten longer, has it gotten healthier? Is 70 the new 50?”
He firmly concludes the answer is no and cites an academic study that finds functional limitations among the elderly increased from 1998 to 2006.
Emanuel does not tell his readers that this issue is hotly debated among serious researchers. The truth is we do not understand this phenomenon well at all, but there is at least some evidence that we have been able to push back the period when we live with functional limitations.
That leaves one more question: Why does Emanuel fix a date at all? He says it “removes the fuzziness of trying to live as long as possible.” But life is fuzzy. Trying to squeeze individual circumstances into some arbitrary rule seems foolish at best, especially for a physician and ethicist. While comfort care only may be the best course for some 75 year olds, it may be entirely inappropriate for others. Will 75 work for him? I submit he won’t know for 18 years.
For all of my criticism, I agree with what appears to be Emanuel’s overall conclusion: We should stop trying to be immortal and recognize that, at some point, efforts to cure what ails us are at best worthless and at worst torture.
Years ago, the great British journalist Alistair Cook said, tongue firmly in cheek, “In America, death is optional.” For all its flaws, Emanuel’s article is really saying the same thing. It just took a lot more words.