Should we all want to die at 75?
Nursing homes would be put out of business if scientists discover how to stop the aging process, McKnight's Editorial Director John O'Connor wrote in his blog yesterday. But the reverse is also true: Nursing homes would find their beds empty if many seniors were to die earlier in life — because, say, they start refusing antibiotics for common infections, as Ezekiel Emanuel, M.D., Ph.D., plans to do once he turns 75.
Emanuel probably needs no introduction; I imagine some long-term care administrators have him dead-center on their mental (or actual) dartboards. As a prominent sculptor of the Affordable Care Act and a prophet of managed care, he's someone to blame when the huge changes that are afoot cause headaches or worse. The controversial piece he wrote in the current issue of The Atlantic is not likely to make him any more endearing to the long-term care community.
He says that he wants to die at age 75 (he's currently 57). He is not saying that he would kill himself at 75, but he does not want to burden his family and the healthcare system by trying to prolong his life at that point. Therefore, he plans to refuse any treatment for cancer and other conditions, he is going to stop getting routine tests to monitor his health, and he will even cut out antibiotics. Dying from a skin or urinary infection is not a terrible way to go, he believes.
I think it's great that Emanuel has gotten people thinking and talking about end-of-life decisions, but like many others, I was appalled by some of his positions. For example, he seems to believe that it's time his own father shuffled off his mortal coil, simply because he's slowed down following a heart attack. (The elder Emanuel is still healthy enough to swim and says he's “happy.”)
I also have a gripe with the way Emanuel positions himself against a group he terms “American immortals.” These are people, he writes, “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.”
The American immortals desperately want to believe that scientific progress will enable us both to live longer and to be healthy and high-functioning until very close to death. This is a “quintessentially American” fantasy, Emanuel states.
I'm annoyed by American immortals myself. But I think Emanuel is being equally annoying because he's the other extreme; at the same time that he's lamenting the “American” mindset of the immortals, his own argument strikes me as blinkered in a particularly American way. We're a country obsessed with productivity and achievement (compare our vacation days and work hours to Europe's). The immortals want to extend their productive years as long as possible. Emanuel thinks this is a fantasy, yet he seems so obsessed with remaining vital and creative, he says he'd rather be dead than to lose his significant mental and physical powers (he just climbed Kilimanjaro).
I'd also say that competitiveness is a typically “American” trait — our practical fetish for the virtues of capitalism being one major symptom or cause. And competitiveness is a huge aspect of Emanuel's thinking. Children constantly compete with their parents and can never truly vanquish them and become the head of the family unit, so the parents should do their kids a solid and die relatively early, he writes.
He points out that the United States ranks No. 42 globally for life expectancy. Japan's 84.4 years leaves our 79.5 years in the dust. But, “we should not care about catching up with — or measuring ourselves against — Japan,” he writes. At least on this metric. We should focus instead on infant mortality and pediatric healthcare, trying to maximize the quality of a person's good years rather than prolonging their terrible last ones.
Again, competitiveness shines through. Why is it all about “catching up with” Japan and “measuring ourselves against” that country? I thought back to last year's LeadingAge conference in Dallas, where National Geographic Fellow Dan Buettner gave a keynote presentation on Blue Zones — areas, including in Japan, where people tend to live extraordinarily long lives.
Buettner did not argue that life expectancy is a competition or that merely living a long time should be the goal. Instead, he focused on what we can learn by looking holistically at the lifestyles in these Blue Zones. I believe many of his findings add needed nuance to Emanuel's arguments. For example, Buettner proposed that there are lifestyle habits and cultural points of view around aging that correspond to long and fruitful lives. People in Blue Zones aren't just living longer because they are overdoing it on antibiotics and foolishly undertaking chemotherapy, or because they're doing crossword puzzles and juice cleanses. And Buettner has written a book about what it means to be happy and how happiness is linked to longevity — he unpacks that word, “happy,” that Emanuel seemed to consider a paltry consideration when it was uttered by his father.
I'd love to hear Buettner in conversation with Emanuel on this topic. I think he would press Emanuel to get away from the “American immortal” fixation and speak about other types of immortals; and I'm sure Emanuel would bring up some uncomfortable but important questions about the tradeoffs of long life expectancy, both for an individual and society — Japan has huge issues in caring for its sizable geriatric population, for instance.
It would be great if LeadingAge facilitated this dialogue, but the association better move fast. Time flies, and Emanuel's not getting any younger.
Tim Mullaney is McKnight's Senior Staff Writer. Follow him @TimMullaneyLTC.