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Bioethicist At National Institutes of Health: "Why I Hope To Die At 75"

Posted by samzenpus on from the end-of-the-line dept.

HughPickens.com writes Ezekiel J. Emanuel, director of the Clinical Bioethics Department at the US National Institutes of Health, writes at The Atlantic that there is a simple truth that many of us seem to resist: living too long renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. "It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic." Emanuel says that he is isn't asking for more time than is likely nor foreshortening his life but is talking about the kind and amount of health care he will consent to after 75. "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." Emanuel says that 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. "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."

27 of 478 comments (clear)

  1. The WHO by gbjbaanb · · Score: 5, Insightful

    "hope I die before I get old".... until I get old, that is, and then I expect to scrap life along as much as humanly possible.

    1. Re:The WHO by Mr+D+from+63 · · Score: 5, Insightful

      We'll see how he feels when he's 75.

    2. Re:The WHO by amiga3D · · Score: 5, Insightful

      I can't say how I will feel at 75 but already at 55 I'm thinking that I'm not all that desperate to live forever. What's the point of living when their is no real enjoyment? When it hurts to get out of bed and you can't go and do what you want when you want? When you aren't living but just existing and waiting to die? I can see his point easily enough. I'm pretty sure that if I get cancer after 70 I'm just going to start the bucket list. I don't want to be 90 laying in bed waiting for someone to come change my diaper.

    3. Re:The WHO by Jhon · · Score: 3, Insightful

      "What's the point of living when their is no real enjoyment?"

      This is not some "universal" state -- there will be less things to enjoy, but most likely there will still be enjoyment.

      "When it hurts to get out of bed and you can't go and do what you want when you want?"

      Then you change your expectation of yourself. You DON'T go and do what you want WHEN you want. You rely more on others and your world will grow "smaller". So long as long as the pain can be managed...

      "When you aren't living but just existing and waiting to die?"

      That's something else. If you are stuck on a machine completely unable to interact with the world around you, then yes. But that needs to be two-way -- there must be someone on the OTHER end of that (family or friends) who want to interact with you.

      "I can see his point easily enough."

      I can UNDERSTAND his point. I don't AGREE with it. I'm not saying "forced life" under any condition, of course.

      "I'm pretty sure that if I get cancer after 70 I'm just going to start the bucket list."

      My mother-in-law has cancer. She's 80. Aside from age related dementia (and the limitations that come along with that) she's doing great and enjoying her home, garden, family and life in general.

      "I don't want to be 90 laying in bed waiting for someone to come change my diaper."

      Ever read "Tuesday's with Morrie"? I like his outlook on life when HE came to having someone else wipe his arse.

    4. Re:The WHO by CrimsonAvenger · · Score: 5, Interesting

      My parents are both 75+.

      And still doing fine.

      Yeah, they've slowed down a bit, and have some aches and pains they didn't have 20 years ago. But they still walk the dog a mile or so each day. And Dad still mows five acres (give or take, the treeline could have moved some over the last decade) of his yard weekly.

      I think this bioethicist bozo is forgetting that "75" is life expectancy at birth. If you make it to 75 today, odds are good you've got another decade or two in you*. And if you're born today, by the time you're 75, you should have four or five decades left*.

      * barring unpredictable things like terminal cancer, of course.

      Note that my wife's parents were both born in the early 1920's, and both lasted into this decade. Arguably, they'd have both been better off to have died a year earlier than they did (in both cases, their last year was pretty bad), but that still meant 85+ good years starting from before the Great Depression....

      --

      "I do not agree with what you say, but I will defend to the death your right to say it"
    5. Re:The WHO by ShanghaiBill · · Score: 5, Insightful

      My thoughts exactly. He'll change his mind.

      Quite likely, especially since his basic premise is wrong. Many people get dementia as they age, but many others don't. It is not inevitable. I know bright, active people in their 90s. We are making a lot of progress at understanding the causes of Alzheimer's and other debilitating diseases of old age. His future may not be as bleak as he imagines. On the other hand, he may already be losing his grip on reality, since he believes that American are "obsessed" with exercising, and doing mental puzzles. A quick glance at obesity rates, and reality TV popularity, should disabuse him of that belief.

    6. Re:The WHO by Opportunist · · Score: 4, Funny

      Hey, dementia is a great disease.

      At first, only you notice it.
      Then everyone else notices it, too.
      Then, only everyone around you notices it and you don't.
      And then life's great again.

      --
      We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
    7. Re:The WHO by nucrash · · Score: 5, Insightful

      I was thinking about Larry Ellison being 70 and still wanting to work and in fact, actually wanting to take a position where he can continue to be creative instead of one handling the day to day business.

      At the same time, my Grandfather passed away last year at age ninety-one. He was weeks away from being ninety-two. When asked about how old he wanted to live, he responded, "My dad lived to be ninety-two, and I think that's a good age, so I want to be ninety-two."

      Towards the end, he was being despondent and spent most of his days sleeping. There were times where he would be lucid and say some fantastic things, but for the most part, I could tell he was ready to go. He had lived a good life. Many of us in the family felt that he was due as he lived his last year in a nursing home and didn't really want to even do that.

      I do think that quality of life should be included in decisions to prolong life. Terry Schaivo was a case where there was nearly zero potential to improve her life. Other times, I sense that some of these hospital administrations are doing what they can to bilk insurance companies in order to extend a person's life regardless of the eventuality of their passing. Not to sound completely inhumane, but if a person is going to continue their existence by suffering, are we being humane by prolonging their existence.

      There are some cases, like with Stephen Hawking, where an individual wants so much to contribute to the world that they want to exist. Because of this, there should not be any hard limit put in as far as a person's life to which we should consider ending health care.

      --
      Place something witty here
    8. Re:The WHO by alvinrod · · Score: 3, Interesting

      I think the problem comes from medical professionals only or almost always dealing with the people who are having terrible health problems. If the only time you see older people is when they're in pain or suffering from horrible illness, you wouldn't want to be old either. I suspect that as many of them actually age they find that they still enjoy life and that when they retire they're able to spend time with their families and grandkids and that being old isn't a constant state of suffering or misery. However, medical professionals are only exposed to the worst of old age, so it's hardly surprising that they have such a negative outlook.

      It's easy to sit back from my position and say that, but I would imagine that my opinions would change if the vast majority of my day were spent being confronted with what happens to people who don't take care of their bodies or experiencing other illnesses that aren't currently preventable. If nothing else, one would think that this would motivate medical professionals to take good care of their health, so they can avoid finding themselves in that position.

    9. Re:The WHO by avgjoe62 · · Score: 5, Interesting
      My Dad suffered from Lewy Body Dementia at the end of his life. Early on with the disease he had days he was OK, other days he would see and talk to people that weren't there.

      On one of the days when he was doing OK I told him that he was suffering from dementia and that he was talking to people that weren't really there. He was surprised and asked me to repeat that. When I confirmed that on his bad days he was talking to people that weren't really there his response was, "Well, at least I'll never have no one to talk to."

      --

      How come Slashdot never gets Slashdotted?

    10. Re:The WHO by Ol+Olsoc · · Score: 3, Interesting

      My thoughts exactly. He'll change his mind.

      Quite likely, especially since his basic premise is wrong. Many people get dementia as they age, but many others don't. It is not inevitable. I know bright, active people in their 90s.

      You see stories about people at 100 years old. It's news because it isn't that common. I know people who are active into their 90's. I know a lot more in their late 70's who are living on maintenance drugs and opiates, riddled with pain pretty well fuzzed out. A little older, and they are starting the dementia trip, with nursing homes at the ready to take their estates.

      I think the problem is that people see the outliers, and assume that's how they will age. I don't want people determining the quality of my life by looking at the lucky ones wh oage gracefully. If I do - fine. But I watched enough family members die over a many year period. Not goiing to happen to me unless I catch a stroke that keeps me from exiting with some dignity.

      --
      The shepherds did so well protecting the flock that the sheep no longer believed that wolves existed.
    11. Re:The WHO by Ol+Olsoc · · Score: 3, Insightful

      My parents are both 75+.

      And still doing fine.

      Mine are dead. Doing okay for charcoal, I suppose.

      As humans, I think that we tend to not see far past our noses. Your's being healthy hale and hearty parents doesn't really mean much, because as I note, for every human living a wonderful happy and healthy existence well beyond normal, there are those who don't.

      And if this gentleman doesn't see much utility to living past 75, well, that's his business. If you want to fight kicking and screaming too the last breath, well, that's yours.

      --
      The shepherds did so well protecting the flock that the sheep no longer believed that wolves existed.
    12. Re:The WHO by Anonymous Coward · · Score: 5, Informative

      Holy fuck is this WRONG and it's not funny at all.

      I worked in a dementia ward and I would not wish that on my worst enemy. It is a truly, staggeringly horrible way to go out. You don't know about the confusion, the pain, the mental trauma this disease causes, do you/ You dont just slip into a blissful state of forgetfulness, you are in a world of torment as your mind fucks you over.

      Dementia is a very distressing, traumatic disease and the reason I support assisted suicide. There are things worse than death and dementia is one of them - the piss poor jokes about dementia serve to cover up the horror that patients truly experience. And it is horror, why do you think dementia patients are drugged to the gills?

    13. Re:The WHO by Fjandr · · Score: 4, Insightful

      I doubt the GP is drawing those conclusions from the distress of relatives, but rather from direct interaction with dementia patients.

      You've never lived with someone who has advanced dementia, have you? I suppose you could be on the autism spectrum and be unable to understand body language that is obvious to everyone else. When you learn how mental trauma translates into actions, you can come to pretty obvious conclusions about the mental state of someone by those same actions, even if they are unable to articulate what's going on in their head.

      When someone regularly descends into fits of sobbing when certain things happen, it's pretty easy to come to the conclusion that, hey, there's something disturbing this person. You don't need to be in their head to figure out things with other obvious signs.

    14. Re:The WHO by Fjandr · · Score: 4, Insightful

      This is a personal decision, not one he's trying to push on others. Just as those who so choose have the option of living as long as their body holds out, so too should people have the option of not prolonging their life as long as possible.

      I have inoperable cancer, and its effects on me are such that at some point I will no longer be able to manage the symptoms to the point that life will not be worth living. I don't want to spend months or years in a narcotic fog to dull the pain enough so I can just keep breathing. Short of spontaneous remission, I will at some point choose to end my own life rather than suffer needlessly. My family is aware of this decision, and I will inform them at the point it is necessary so there are no surprises. I would do the same were my mind degrading to the point it would be clear my existence contributed nothing more than consuming oxygen and taking up space. I've talked to many others who feel exactly the same way. I'm not trying to kill other people based on some arbitrary criteria, but I sure as hell won't accept being kept alive because "all life is sacred." It's not.

  2. I agree, 100% by NitzJaaron · · Score: 5, Insightful

    The thought of living to an age where I can no longer contribute anything of value to society, while simultaneously becoming a drain to those I love - both emotionally and financially - is not appealing to me at all.

    1. Re:I agree, 100% by Feyshtey · · Score: 3, Insightful

      Who determines when that time comes? Maybe it's 65. Maybe it's 55. Hell, for some it's in their 30's when they start getting fat and lazy.

      Basically what this dickhead is saying is that if you're not valuable to someone for some tangible product, you should just die. He's probably also of the opinion that if you get Muscular Dystrophy in your 30's you should just check out. If you're born with Downs Syndrome, and will always have to be cared for you should just be aborted at birth (murdered). It's not like a severe mental handicap provides the ability to make a "rational" decision to take yourself out of everyone worries about you.

      This philosophy relies on the premise that if you aren't providing money, or food, or talent in some field of productivity, that you are also unable to provide (and receive) love, joy and positive experiences. The philosophy is callous and inhuman, ironically coming from a man who will tell you all about how we should behave exactly in a specific way if it can "save just one life".

      Emanuel is a dyed in the wool liberal progressive the likes of which Bernard Shaw (https://www.youtube.com/watch?v=t3lBdyFvPps) would be quite proud of.

      --
      "But we have to pass the bill so that you can find out what is in it,..." - Nancy Pelosi
  3. His Life by Anonymous Coward · · Score: 4, Interesting

    His choice. I for one intend to drink every bit of snake oil that I think will keep me alive a little longer, until such time that I decide I don’t want to live any more. George Carlin pretty much summed up my views on all this stuff with his "And don't be pulling any plugs on me either" bit.

    Worried about tax dollars pointlessly keeping my mostly useless ass alive (yay for socialized medicine)... hell no. I’ve paid taxes most of my life, many of which have been wasted on stupid nonsense, they can waste a few on me.

    I get it if people are in pain, or feel like they can no longer contribute anything, and sitting there watching TV all day just isn’t doing it for them. If you are tired of life, fine, I’m all for giving people the option. On the opposite end you’ve got my Grandfather who is well into his 80’s and just finished remodeling his bathroom, and my friend’s Grandmother who while physically is showing her age, can still hold her end of a conversation, enjoys spending time with people, plays cards, etc.

  4. Only 5 years of retirement by irrational_design · · Score: 5, Insightful

    If I'm lucky I'll be able to retire by 70. 50 years of work and then 5 years of retirement? That sucks.

    1. Re:Only 5 years of retirement by ceoyoyo · · Score: 5, Insightful

      Enjoy your life, don't wait for your retirement. I don't see an especially good chance of ever being able to retire. Plus there are a lot of things I want to do while I can comfortably walk for eight hours a day, see, hear and smell well, and take a hit or two.

  5. I propose the Extreme test. by gurps_npc · · Score: 4, Interesting

    Every year, past 70, take up a new extreme sport. One day you will simply forget to pull the parachute cord. Go out with a bang, doing something that will make the news "80 year old surfs Tsunami"

    --
    excitingthingstodo.blogspot.com
  6. Right... by ceoyoyo · · Score: 4, Insightful

    Because exercising, eating well and being mentally engaged don't help keep you healthy to an older age.

  7. Re:Quality, not quantity by Chas · · Score: 4, Insightful

    Pretty much this.

    The points he addresses have nothing to do with age and everything to do with "quality of life".

    So, if we could, somehow, manage to prolong life *AND* maintain quality of life, great!

    Otherwise, yes, growing decrepit, feeble-witted, etc and wishing for an end is something people have realized for a long, long time now.

    Like the myth of Tithonus

    --


    Chas - The one, the only.
    THANK GOD!!!
  8. Speak for yourself, Mr. Emanuel by c0d3g33k · · Score: 3, Insightful

    You lost me when you assigned an arbitrary number as your cutoff rather than defining the cutoff on reasonably definable measures of physical and mental health. I exercise, eat healthy, avoid smoking and drugs etc. because these activities provide *measurable* benefits to my health based on measurements made by my doctor. Not to mention that I feel better.

    Does the fact that I do things that measurably improve my health and prolong my life as long as possible mean I am "obsessed"? Does "I don't smoke, overeat, take drugs or engage in dangerous life-threatening activities (extreme sports, for example)" mean I am obsessed? I find it completely rational, and my insurance company sure loves it because I'm a low risk according to their actuarial tables. Because science.

    If I take your advice, I should just sit around and passively wait to die after reaching a certain age rather than doing things that measurably increase my ability to be "vibrant and engaged". Sorry, but no thanks. Save me a place when I get to the Pearly Gates - I might be a little late to the party. And when I get there, we're going to blow the roof off of that sucker.

  9. Bah by Charliemopps · · Score: 4, Insightful

    I hate fatalism. My goal is to live forever. I'll go out kicking and screaming every bionic body part I can get.

    Watch this: https://www.ted.com/talks/aubr...

    You can all die if you want, leave me out of it.

  10. A man goes to the Senior Center by Latent+Heat · · Score: 4, Funny
    (also on topic with respect to aging)

    Woman says to him, "You look new here, where were you before?"

    Man says, "I just was released from a long prison term . . . for killing my wife."

    "Oh, so you're single, then!"

  11. Re:Why put a number on it? by Moof123 · · Score: 4, Insightful

    Yep. A much better argument would be to encourage people to have clear expectations for old age, and to make options to check out much easier. I would welcome the ability to choose my exit day while I still have the faculties to do so. The US's lousy options are deplorable. Old folks have few options in most states to pull their own plug when they determine the time is right.

    In my Grandmother's case she knew it was time a few weeks before she died, but ended up in a lot of misery and humiliating circumstances for her final days due to a lack of legal options. Little has made me angrier at the religious set than listening to my grandmother beg God to let he die, and there being no legal avenue for any of her family to grant that wish thanks to those selfish bastards keeping euthanasia illegal.