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.
Whoa, this article really flies in the face of the theories of “successful aging!” I think iit is a pessimistic view, and I’ve known plenty of 80 and 85 year olds who are fully engaged with their community, volunteering, creating art, staying physically fit, living in their own homes, etc.
I for one would like to live to 85 or so – but don’t really want to be in my 90s, to be honest. Yes, we are mortal, and it is up to us to make the best and the most of whatever years we are fated to be on this Earth.
I have not read the full article by Mr. Emmanuel but l this seems to be a fairly self-centered assertion. What about generativity? He seems to be lacking a sense of responsibility to pass along knowledge and skills gained through long life experience. I agree that you should be prepared to die by age 75 by having your affairs in order but not that you should hope for death at 75. I work in geriatric medicine and learn from people well over 75 every day (despite being at my “peak”). This gentleman should take a moment to recognize that his experience in oncology colors his feelings on this topic. Not everyone has a miserable, painful, and/or difficulty illness course. Some of the most optimistic upbeat people I know are looking forward to their 100th Birthday. As far as productivity goes, some people are far more productive at 80 than others have been at any age during their lives. If this is really an age related issue, then there would need to be a comparison of productivity levels for the research to, what? Determine who should receive medical tx and who shouldn’t. I’m not a believer in the slippery slope argument but, this sure looks like one.
I too agree that the attempt to eke out more years when a person’s quality of life is poor is not a goal to be pursued. There is a time to say enough is enough. But Emanuel says, “But the fact is that by 75, creativity, originality, and productivity are pretty much gone for the vast, vast majority of us.” It seems Emanuel is setting the bar as major contributions to society. I agree with Jenna’s comments that we know many people who live vibrant contributory lives well past 75, many minor creatives, good thinkers and producers. Yet, even more than that, I see that a life whose later years are spent reading books, interacting with family and friends, and yes, even watching the History channel can still be part of a life well lived and still well living.