Ezekiel Emmanuel – dwkcommentaries

Further Reflections on Ezekiel Emmanuel’s Desire To Die at 75

A prior post set forth this blogger’s negative reactions to Dr. Ezekiel Emmanuel’s essay “Why I Want to Die at 75” in the October 2014 issue of The Atlantic Magazine. Another post referenced others’ reactions.

Now the December issue of that magazine contains extensive readers’ reactions. Here are some of those comments, all to my surprise by women, along with Dr. Emmanuel’s response.

Readers Responses

Arlene Pollack of Yarmouth Port, Mass. Said, “We octogenarians . . . have grown more understanding of our fellow elderly, more grateful for the love and companionship of our mates, more intent on remaining deeply involved in the lives of each and every family member, and more determined to set an example for our children and grandchildren of how to age in such a way that we don’t leave our loved ones with a dread of incapacity, a horror of diminished vitality. I understand that we cannot anticipate what will befall us, that we may not be able to fulfill this goal, but having this positive philosophy brings a certain peace of mind.”

Felicia Nimue Ackerman, Professor of Philosophy, Brown University, Providence, RI, who thought Dr. Emmanuel’s reasons for his desire to die were elitist, stated, “If Dr. Emanuel hopes to die at 75 because he thinks this would benefit his children, that is his prerogative, although other people might doubt that children selfish enough to welcome this parental sacrifice deserve it. Moreover, Dr. Emanuel’s suggestion that it would be good for ‘each of us to ask whether our consumption is worth our contribution’ will hardly attract those who think that even the unproductive have an unalienable right to life, liberty, and the pursuit of happiness.”

Caroline M. Simon of Louobressac, France offered these comments: “If . . . Dr. Emanuel is saying that there is no sense in leading a life in which one is not able to climb Mount Kilimanjaro, gain great applause at professional meetings, direct the behavior of one’s family members and friends, and implant memories in loved ones of an energetic, risk-taking guy so that children and grandchildren, students and friends can hope to emulate one’s nonempathetic ways, then I couldn’t disagree more. . . . Who is to define what is a life worth living? Certainly not the middle-aged Dr. Emanuel. He can see little pleasure in helping future generations mature, in continuous learning, in days spent enjoying the company of others when we are not at the head of the table. He ignores the blessings of performing everyday tasks and attending routine events and basking in the joy of memories. He gives little value to happiness gained from kindness, generosity, shared wisdom, unselfish love, a walk with a cane in a beautiful garden, and a lifelong search to discover who we are and what our role is in the continuum of life in our community and on Earth.”

Ruth Marcus, a Washington Post columnist, said “there is no sin in slowing down. There is satisfaction in completing the crossword. You don’t always have to bike past the roses on your way up the mountain. In high gear.”

Margaret Connolly of Niles, Illinois said, “It seems sadly obvious that Dr. Emanuel’s desire to leave his children and grandchildren with memories of his vitality is the genuine dream of the American immortal. To actually believe that one can shape the memories of our progeny with a possibly truncated life is sheer hubris. It’s an unattainable aspiration.”

Dr. Emmanuel’s Reply

Dr. Emmanuel’s characterized this group of comments as “the troubled” and said they “tend to describe his article as ‘thought-provoking.’ They are challenged by it. They object to my view of a meaningful life. As Caroline M. Simon says, ‘Who is to define what is a life worth living?’”

This was his reply to this group, “Who else but each of us individually for ourselves? My goal was to challenge these people to not live the habitual life, to not avoid the ‘big questions’ about the ultimate worth of our lives. We carefully construct our lives, filling them to overwhelming with activities in order to assiduously avoid such spiritual and existential questions, I think at our peril.”

Conclusion

I do not see how Dr. Emmanuel legitimately can call this group “troubled” or as calling his article “thought-provoking.” Instead, they object to his view of a meaningful life as I did in my posts.

I also believe his response to this group is totally inadequate. He apparently does not acknowledge the criticism that his view of a meaningful life is twisted and needs to be re-evaluated.

Additional Reactions to Ezekiel Emmanuel’s Desire To Die at 75

A prior post discussed Ezekiel Emanuel’s article “Why I Want To Die at 75” and my reaching the opposite conclusion. Many other reactions to the article have been registered in the online version of The Atlantic Magazine, where the article first appeared; in Minnesota Public Radio’s “Friday Roundtable” program; and in various other places. Here are four of those additional reactions that deserve attention. They are from Ruth Marcus, Harold Pollack, Victor Davis Hanson and John O. McGinnis.

Reactions to Emanuel’s Essay

Ruth Marcus, a Washington Post columnist and a friend of Emmanuel, says his essay arrives during Rosh Hashanah when “Jews [like Marcus and Emmanuel] begin a period of repentance during which, we are told, God decides who shall live and who shall die. One of the Torah portions read during this time reminds us that Sarah gave birth at age 90, an event so unlikely she named her son Isaac, derived from the Hebrew “to laugh.”

Marcus also recalls “the traditional Jewish birthday greeting . . . [of wishing] that the celebrant live 120 years — the lifespan of Moses” while the Torah relates that, while Moses’s years were advanced, his eyes remained undimmed and his vigor unabated.” In addition, Sarah’s having a baby at age 90 reminds us that “we cannot know what surprises, and joys, our later years may hold.”

Marcus agrees with my criticism of Emmanuel’s finding creativity as the sole or deciding criterion on determining when he wants to die. She says, “there is no sin in slowing down. There is satisfaction in completing the crossword. You don’t always have to bike past the roses on your way up the mountain. In high gear.”

Another critic of Emmanuel is Harold Pollack, the Helen Ross Professor at the School of Social Service Administration and co-director of the Crime Lab at the University of Chicago and a nonresident fellow of the Century Foundation. He says his “experiences over the past few years have left me optimistic about what the future holds. Much of my most satisfying research and journalism entails talking to interesting people and relating their stories, applying historical knowledge and interpersonal skills, mentoring others on a team. I hope to do these things well for a long time.”

His father, now 85, has survived various medical problems, but Pollack’s helping to care for him with his sister serendipitously enabled them to recall and share the many ways their father had helped them over the years. Recently Pollack visited his father (and now grandfather) with his wife and daughters, and Pollack treasures the conversations and activities his daughters were able to have with their grandfather.

Pollack adds, “My life, my children’s lives, are tangibly better because our elders avail themselves of valuable, sometimes-costly medical care well past the threshold of 75.” Pollock’s father may not be as creative in some ways that he was when he was younger, but “creativity comes in many domains and forms. He’s finding new ways to be joyful and useful, to cast warm light rather than sad shadows on surrounding lives.”

Victor Davis Hanson reminds us that our present lives would be poorer had we taken away history’s 75-year-olds with these six examples:

The great Athenian playwright Sophocles (who wrote until his death in his 90s) would never have crafted some of Greece’s greatest tragedies.
The Founding Fathers would not have had the sober wisdom of Benjamin Franklin in his later years.
The late Jacques Barzun, the greatest contemporary student of Western values and history, published his masterpiece, “From Dawn to Decadence,” when he was 93.
Henry Kissinger, at 91, just published a magnum opus, “World Order.”
“Some of the most gripping volumes about World War II would never been written by a supposedly too old Winston Churchill.”
Had Ronald Reagan refused medical care and hoped to die at 75, the world would never have heard at Berlin, “Tear down this wall, Mr. Gorbachev.”

Moreover, Hanson says, if Emanuel’s point is that living beyond 75 is unwise given the odds that society will reap less achievement per unit of resources invested, then that frightening anti-humanist argument can be extended to almost any category.

For example, should we do away with health care for those with chronic debilitating diseases on the theory that society inordinately gives them too much time and capital and gets very little in return?

Similarly Emanuel’s argument could be used to eliminate life sentences for convicted criminals and instead increase use of the death penalty because they would be unlikely to produce anything significant behind bars. So too we could just as easily choose not to treat severely wounded veterans, given that they are unlikely to return to the battlefield.

John O. McGinnis, the George C. Dix Professor in Constitutional Law at Northwestern University, asserts, “Youth and good health do not measure humanity. Millions in diminished health enjoy life, being with their relatives, laughing at old movies, even just sitting in the breeze and sunshine. And their relatives and friends enjoy being with them. Indeed, they may find in the elderly’s struggle with aging an inspiration and a reaffirmation of life. In caring for the frail, weak and sometimes woebegone, they may also expand their own sympathies and express some small measure of gratitude for the debt of a good upbringing that can never be fully repaid.”

Other Thoughts

Perhaps Emmanuel’s desire to die at 75 grows out of his advocacy for physicians having an ethical obligation to work for the greater good of society in addition to the obligation to meet the patient’s needs. According to a Wall Street Journal article, Dr. Emanuel and others have presented a “complete lives system” for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. “The appropriate maximizing strategy for Emanuel involves saving the most individual lives,. . . . Other things being equal, we should always save five lives rather than one.” Although Emmanuel says the focus for medical care cannot be only on the worth of the individual, such care for individuals who are irreversibly prevented from being or becoming participating citizens like those with dementia, he has argued, should not be guaranteed.

Underlying this focus on any individual’s desire to die or to seek to prolong life are important public policy questions regarding what health care costs should be covered by the government or by private insurance, especially for those near death. A recent report by the federally funded Institute of Medicine—“Dying in America”—observed that the current system’s financial incentives reward harmful transitions among homes, hospitals and nursing homes and make it difficult for someone to be released to his or her home in order to die there and that fundamental changes to the system need to be made. This problem was made personal in a New York Times article about the inability of a frail 91-year old man aided by his loving adult daughter to get released from a nursing home to go to his own home to die in peace.

These policy issues, in my opinion, should challenge our current laws about voting. In the U.S. it is common knowledge that older citizens, who are increasing in numbers, tend to vote in higher percentages than younger voters. As a result there are legitimate concerns about this leading to inadequate resources for children and young adults. One response is to lower the age for voting. Scotland’s allowing citizens 16 or older to vote in their recent referendum has raised the issue of whether the U.K. and the U.S. should do likewise. I am in favor of such a change although I do not think it goes far enough. In my opinion, all citizens from birth or from a very early age (say one year old), should be permitted to vote. Such a system would require careful thought and development of procedures for such younger citizens to vote. But each citizen, regardless of age, has an interest in what happens in our society, and there needs to be a counterweight to voting by senior citizens like myself.

An assumption of many, and perhaps Emmanuel, is an aging population like ours is a net drag on the economy. A Washington Post article, however, calls our attention to a report by a group of international researchers who assert that an aging population for an industrialized democracy might be an advantage. First, an aging population could lead to productivity gains throughout the economy due to expected increases in workers’ educational levels. Second, leisure time will increase which might lead to increased tinkering and innovation. Third, older people consume less and thus reduce their contributions to carbon emissions. Fourth, longer lives should mean postponing intergenerational wealth transfers and thereby increasing financial benefits to grandchildren. Wow, these assertions need pondering.

Why I Do Not Hope To Die at 75

Under the provocative title, “Why I Hope To Die at 75,” the 57-year-old Dr. Ezekiel Emanuel, the 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, sets forth in The Atlantic Magazine what he claims to be his firm conclusion that he hopes to die in 18 years at age 75.

As a 75 year-old-man who was graduated from high school in 1957, the year Emanuel was born, I do not hope to die in the remaining months before I turn 76 or at any other set time.

Let us explore the reasons for these different conclusions.

Dr. Ezekiel Emanuel’s Reasons

According to Dr. Emmanuel, “[L]iving too long is . . . a loss. It 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.” He then backs up this opinion with what he asserts as facts:

“We [in the U.S.] are growing old [in terms of increased life expectancy], and our older years are not of high quality.” Studies show, he says, that “increases in longevity seem to have been accompanied by increases in disability.” Another study found an “increase in the absolute number of years lost to disability [including mental disabilities like depression and dementia] as life expectancy rises.”[1]
Another medical researcher said, “health care hasn’t slowed the aging process so much as it has slowed the dying process.”
“[O]ur mental functioning deteriorates as we grow older: mental-processing speed, working and long-term memory, problem-solving and creativity.”
The “most dreadful of all possibilities: living with dementia and other acquired mental disabilities” while our society is expected to experience a “tsunami of dementia.”
As we age, we “accommodate our physical and mental limitations. Our expectations shrink. . . . [W]e choose ever more restricted activities and projects, to ensure we can fulfill them.”

He recognizes that “there is more to life than youthful passions focused on career and creating. There is [mentoring and] posterity: children and grandchildren and great-grandchildren.”

But these benefits of aging are outweighed for him by “the very real and oppressive financial and caregiving burdens” often imposed on other family members and by the psychological burdens on children unable to escape from the shadows of living parents.

Although Emanuel does not embrace euthanasia or suicide for himself, he has executed “a do-not-resuscitate order and a complete advance directive indicating no ventilators, dialysis, surgery, antibiotics, or any other medication. . . . In short, no life-sustaining interventions.” In addition, if and when he reaches age 75, he will seek to avoid any visit to a doctor and any regular preventive tests, screenings, or interventions. He says he “will accept only palliative—not curative—treatments if he is suffering pain or other disability.”

A desire to die at age 75, he says, “forces us to think about the end of our lives and engage with the deepest existential questions and ponder what we want to leave our children and grandchildren, our community, our fellow Americans, our world.”

He concludes with this caveat. “I retain the right to change my mind and offer a vigorous defense of living as long as possible. That, after all, would mean still being creative after 75.”

Responses to Emmanuel’s Reasons

I agree with Emmanuel that as we age we lose some of our physical and mental abilities and that executing a complete advance medical directive forbidding extreme life-sustaining interventions, as he and I have done, is a reasonable thing to do.

Otherwise I vigorously disagree with Emmanuel’s conclusion that a desire to die at age 75 is a reasonable conclusion and reject his argument that what others think of us or how they may remember us after we are gone is relevant to this issue. Apparently creativity is a central virtue for him, and its predictable decline as we age appear to be the major motivation for his stated desire to die at 75. Yes, creativity is important for many of us, but it is not the only virtue.

I also wonder why he does not contemplate retirement from actively working for a living as another stage of life with certain benefits. Nor does he really grapple with the facts, he briefly concedes, that many older people are happy with new interests like “bird watching, bicycle riding, pottery, and the like” and that “there is more to life than youthful passions focused on career and creating. There is posterity: children, grand children and great-grandchildren.” He also glosses over the fact that his own father (Dr. Benjamin M. Emmanuel), now about 87 years old, had a heart attack 10 years ago and since then has slowed down appreciably, but still says he is happy.

My Reasons for Not Wanting To Die at 75

At age 62 with some trepidation, I retired from the active practice of law. I wanted to escape the pressure of being a litigator who oftentimes was forced to be in professional relationships with opposing counsel who were disagreeable people. This produced stress that I wanted to eliminate as life-threatening. I also wanted to create time to do other things beside working while I was still in good health: travel, spend time with my grandchildren, learn new things and write. After my first 10 years of retirement I assessed my retirement and concluded that these years had been productive and enjoyable. That confirmed for me the wisdom of retiring when I did. These conclusions have been reconfirmed by my subsequent three additional years of retirement.

In this period I became actively involved in my church’s global partnerships and made three mission trips to Cuba and one to Cameroon and in the process made new international friends and learned a lot about the two countries. My involvement with Cuba prompted me to become an advocate for changing U.S. policies regarding the island. I could not have done this while still practicing law.

I also have reflected on my own life and affirmatively set about determining the many people and activities for which I was grateful. Yes, this could have been done while still working, but the pressures of working, I believe, would have meant postponing such reflections to another day that would never have come. This process of reflection, aided by worship at Minneapolis’ Westminster Presbyterian Church, has also enabled me to see certain of my activities as vocations in the Christian sense.

One of my activities in this first phase of retirement was being a part-time Adjunct Professor at the University of Minnesota Law School to co-teach international human rights law. In the process I learned a lot about this field of law and enjoyed interacting with law professors and students. I could not have done this while still practicing law.

At the end of 2010 I retired from law teaching in order to create time for sharing things I already had written and for research and writing on new topics that came along. In the spring of 2011 this desire lead to my creating and writing this blog. It is exciting to come across new things, like Emmanuel’s article that prompted this post. I frequently find that such things immediately start my composing an article in my head. Often this triggers a desire to do research, frequently using “Google” searches, but sometimes going to a library or sources of original documents. I enjoy this kind of puzzle and challenge as well as the writing.

In my retirement I also have thought about mortality, especially as friends, acquaintances and others my age die. But such thoughts are not depressing, but rather reminders that I too am mortal. Therefore, try to make the most of each day you have.

I do not worry about when I will die or wish that I will die at a particular age. Nor do I worry about what happens to me after death even though Christianity has a promise of eternal life.

Be happy! Enjoy life! Love one another!

This point was raised in an article entitled “Too Young to Die, Too Old to Worry” by Jason Karlawish, a professor of medicine, just after the publication of the Emmanuel essay, but without citation to same. Karlawish said, “Age seems to be a blunt criterion to decide when to stop” and “we desire not simply to pursue life, but happiness, and . . . medicine is important, but it’s not the only means to this happiness.”

Here are some of my blog posts that relate to the previous statement of reasons why I do not desire to die at 75.

Post #	Date	Title
19	04/22/11	Retiring from Lawyering
21	04/23/11	My First Ten Years of Retirement
226	03/15/12	Gratitude I
242	04/11/12	Gratitude II
243	04/13/12	Gratitude III
276	06/13/12	Gratitude Revisited
221	03/08/12	Intimations of Mortality
489	04/08/14	Mortality
492	04/11/14	Death Certificates’ Documentation of Mortality
466	02/06/14	My General Thoughts on Vocation
475	02/23/14	My Vocations

[1] Emmanuel makes no reference to the immediately preceding article in the magazine by Greg Easterbrook, What Happens When We All Live to 100?, The Atlantic at 61 (Oct. 2014) that discusses research into further increases in vibrant life span.