58-year-old Ezekiel Emanuel has declared that he hopes to die by age 75. Why should we care? Because he said so in the pages of the The Atlantic, and he’s a man of some influence: a health policy adviser to President Obama, director of the Clinical Bioethics Department of the U. S. National Institutes of Health, and head of the Department of Medical Ethics & Health Policy at the University of Pennsylvania. (He’s also the brother of Rahm Emanuel, current Mayor of Chicago and former Obama Chief of Staff.)
Emanuel begins by opposing the trend to wanting to live longer and to taking steps to ensure a higher quality of life:
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. I reject this aspiration. I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop.
Emanuel plans to take the opposite tack:
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. 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.
What about simple stuff? Flu shots are out. Certainly if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs. A big challenge is antibiotics for pneumonia or skin and urinary infections. Antibiotics are cheap and largely effective in curing infections. It is really hard for us to say no. Indeed, even people who are sure they don’t want life-extending treatments find it hard to refuse antibiotics. But, as Osler reminds us, unlike the decays associated with chronic conditions, death from these infections is quick and relatively painless. So, no to antibiotics.
Obviously, a do-not-resuscitate order and a complete advance directive indicating no ventilators, dialysis, surgery, antibiotics, or any other medication—nothing except palliative care even if I am conscious but not mentally competent—have been written and recorded. In short, no life-sustaining interventions. I will die when whatever comes first takes me.
It’s clear that on purely personal grounds, Emanuel has every right to adopt such a program and to tell the whole world about it. What makes the article chilling, however, is his rationale — and the extent to which that rationale may eventually be imposed on society as a whole. It comes down to this: after age 75, you’re just not terribly useful anymore.
But as life has gotten longer, has it gotten healthier? Is 70 the new 50? Not quite. It is true that compared with their counterparts 50 years ago, seniors today are less disabled and more mobile. But over recent decades, increases in longevity seem to have been accompanied by increases in disability – not decreases.
Americans may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me.
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. (The) fact is that by 75, creativity, originality, and productivity are pretty much gone for the vast, vast majority of us. We accommodate our physical and mental limitations. Our expectations shrink. Aware of our diminishing capacities, we choose ever more restricted activities and projects, to ensure we can fulfill them. Indeed, this constriction happens almost imperceptibly. Over time, and without our conscious choice, we transform our lives. We don’t notice that we are aspiring to and doing less and less. And so we remain content, but the canvas is now tiny.Yikes. Should we all abandon hope? Is the “reinvention of aging” an illusion? Is the canvas really all that tiny? What about the explosive growth of experiential traveling, and “back to school” learning for learning’s sake, and bucket lists and all that? What about the “softer” experiences — like more years to enjoy family and grandchildren? Emanuel anticipates this counter-argument…sort of.
Maybe this is too dismissive. There is more to life than youthful passions focused on career and creating. There is posterity: children and grandchildren and great-grandchildren. But having nodded in that direction, he is quick to be dismissive again:
But here, too, living as long as possible has drawbacks we often won’t admit to ourselves. I will leave aside the very real and oppressive financial and caregiving burdens that many, if not most, adults in the so-called sandwich generation are now experiencing, caught between the care of children and parents. Our living too long places real emotional weights on our progeny. We’re getting really close to putting the old folks on the ice floes. And let’s face it, if we really loved our kids and grandkids, we’d actively want to get the hell out of the way:
...parents also cast a big shadow for most children. Whether estranged, disengaged, or deeply loving, they set expectations, render judgments, impose their opinions, interfere, and are generally a looming presence for even adult children. This can be wonderful. It can be annoying. It can be destructive. But it is inescapable as long as the parent is alive. Examples abound in life and literature: Lear, the quintessential Jewish mother, the Tiger Mom. And while children can never fully escape this weight even after a parent dies, there is much less pressure to conform to parental expectations and demands after they are gone. Living parents also occupy the role of head of the family. They make it hard for grown children to become the patriarch or matriarch. When parents routinely live to 95, children must caretake into their own retirement. That doesn’t leave them much time on their own—and it is all old age. When parents live to 75, children have had the joys of a rich relationship with their parents, but also have enough time for their own lives, out of their parents’ shadows.
Emanuel anticipates the firestorm this article will cause — and in particular, the fear that he is trying to lead to some pubic policy conclusions (recall the “death panel” hysteria about Obamacare). He tries to address it by pointing out that he is not calling for radical change — he does want more research into infant mortality and better health for the younger generations, but also calls for more research into Alzheimer’s. And to be fair, too, Emanuel has always been an outspoken opponent of euthanasia. But in the end, he can’t quite hide from the “greater social good” implications of his 75-and-out viewpoint:
The deadline also forces each of us to ask whether our consumption is worth our contribution.
Alzheimer’s is the second-most feared disease after cancer and many people say they would seek testing for themselves or a loved one even if they did not have symptoms, U.S. and European researchers say in a report presented to the recent Alzheimer’s Association International Conference in Paris.
Alzheimer’s now affects more than 35 million people worldwide, and research indicates the disease starts developing at least 10 years before the symptoms appear. This makes early testing extremely important.
Researchers at the Harvard School of Public Health and Alzheimer Europe conducted a telephone survey of 2,678 adults aged 18 and older in the USA, Germany, France, Spain and Poland. The study was funded by Bayer AG, which is working on an imaging test for early signs of Alzheimer’s.
When asked to identify the most feared disease (from a list of seven including cancer, stroke and heart disease), almost 25% said they fear Alzheimer’s the most. 85% said they’d see a doctor if they were experiencing confusion and memory loss, and 94% said they’d want early testing of family members.
The study also revealed considerable ignorance about the disease. Many thought there were already effective treatments that can slow it down, and almost 50% said they believed there was a reliable medical test to confirm whether people suffering from confusion or memory loss were in the early stages of Alzheimer’s. (Wrong on both counts – current drugs treat symptoms, but no drug has yet been shown to delay the advance of the disease. And so far, there are no reliable medical tests at the early stages.)
Signficantly, even healthy people with no symptoms are very interested in being tested. About 66% said they’d get tested to see if they were at risk for developing the disease.
“The children now love luxury; they have bad manners, contempt for
authority; they show disrespect for elders and love chatter in place
of exercise. Children are now tyrants, not the servants of their
households. They no longer rise when elders enter the room. They
contradict their parents, chatter before company, gobble up dainties
at the table, cross their legs, and tyrannize their teachers.”
Yup. 2,500 years later, and now it’s my generation that’s doing the bitching (me included). But do you remember what they said about us?
Blackboard jungle. Juvenile delinquents. Rock ‘n roll was the work of the devil.
You don’t give me no dirty looks,
Your father’s hip, he knows what cooks,
Tell all your hoodlum friends outside,
You ain’t got time to take a ride.
Yakkety-yak — Don’t talk back…
And when he was growing up – the father who was dishing it out – his parents generation was complaining about bobbysoxers and zoot suits.
The lesson in all this? We may be reinventing aging, but we’re not making a dent in the intergenerational yakkety-yak. Which I find kind of comforting, in a way…
In the Middle East and Africa, 17% of people think being “old” starts at age 40. By contrast, only 1% of Latin Americans agree, and only 5% of North Americans agree.
On the other hand, 43% of North Americans think you can’t be classfied as “old” until you hit age 80! In Asia, only 7% of people share this view.
These are just a couple of the interesting findings in a new study published by Nielsen, “The Global Impact of an Aging World.” (You can get the full report here.) Nielsen asked people in 53 countries at what age they would consider someone to be “old.”
In the 14 oldest countries (median age 42), not surprisingly, “old” is older. 70% think “old” doesn’t kick in until age 70, and almost a third say you’re not “old” until you’re 80.
In the 14 youngest countries (median age 27) – equally unsurprisingly – “old” starts younger. 27% say you’re “old” once you hit 60, and about the same say “old” starts at 70. Less than 1% are willing to let you wait until age 80 before you’re labeled “old.”
The age of the respondent also matters. The older you are, logically, the older you think “old” is. Globally, about a half of those over 60 think “old” means 80. Talk about defining your way into youth! Those under 60 can’t agree, though – the votes for 60, 70 and 80 are all pretty even.
How old you do think “old” is? Take our my poll – I’ll be writing about this and posting results and comments not only here but on www.50plus.com.