How long do you want to live?


The death and dying news from America begins with an incredibly powerful piece that ran in The Atlantic on September 17th by prominent medical ethicist, Ezekiel J. Emmanuel. Emmanuel states in the article that once he reaches the age of 75 (18 years from now), he will no longer accept any medical treatment, including routine checkups, cancer screenings, heart stress tests, or even antibiotics. What’s more, after the age of 65, he will no longer receive colonoscopies. He currently refuses to receive any prostate cancer screening and hung up the phone on his urologist when he called with his PSA test results. Read the article here.

Emmanuel is being deliberately provocative. He wants to start a conversation about aging and sets up a straw man he calls “the American immortal.” This person, he writes, is “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.” Admitting that 75 is a somewhat arbitrary number, Emmanuel cites all sorts of statistics that indicate, on average, declines in health from the effects of ageing take hold at about that age.

A few things stand out for me in the article. First, I’m intrigued by the idea of picking a number. One of the most difficult things about our mortality is not knowing when our time is going to be up. Another compelling point that Emmanuel makes is the notion that modern medicine has prolonged life without prolonging the quality of life. “Is 70 the new 50?” he asks.

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. For instance, using data from the National Health Interview Survey, Eileen Crimmins, a researcher at the University of Southern California, and a colleague assessed physical functioning in adults, analyzing whether people could walk a quarter of a mile; climb 10 stairs; stand or sit for two hours; and stand up, bend, or kneel without using special equipment. The results show that as people age, there is a progressive erosion of physical functioning. More important, Crimmins found that between 1998 and 2006, the loss of functional mobility in the elderly 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.

Emmanuel’s piece has garnered thousands of comments on The Atlantic’s site and Mary Schmich from The Chicago Tribune fired off a response: I want to live to be 85. Well, 92, if my legs are still working. Definitely not 105. At least that’s what I say now. Whatever age I’d choose for my swan song, I’m aiming farther than Zeke Emanuel.

The Washington Post responded with survey statistics on what Americans outside of the Washington Beltway think about dying (not much, it turns out). Clearly, Emmanuel’s goal of sparking reflection and debate around this important topic is working. Read more

In related news, the Institute of Medicine (IOM) issued a 500 page report on the state of dying in America. According to reports, the IOM is calling for dialog about death and dying to begin in teenage years. It also recommends new rules for simplifying how older adults can make their end-of-life wishes known. In addition, there are suggestions for impelling wider acceptance of and access to of the types of services currently provided by Hospice. Read more...

In the New York Times, health reporter Nina Bernstein penned a long and moving account of the difficulties families in New York and across America are having in fulfilling their aging relatives wish to die peacefully at home. The medical and healthcare systems are stacked squarely against what used to be the norm here and across Europe too. Articles like this put a human face on a wrenching problem that millions of people are faced with each year.

Finally, The New York Times ran an obituary of Gerald A. Laurie, an early advocate of the right to die. An ex-minister of religion who went on to become the first President of the Hemlock Society, Laurie was 98 when he died. Read more…

By John Tintera, New York City, October 2014


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