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.