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.
[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.