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Die at 75? No, Thank You

Why this long-term care expert opposes Ezekiel Emanuel's view

Editor’s note: This is one of two blogs Next Avenue is posting in response to a provocative Atlantic article positing that 75 is a good age to die. Here's the other.
In a recent issue of the Atlantic, a distinguished physician/bioethicist, Ezekiel Emanuel, describes why he wants to die at age 75, before all the bad things associated with aging occur.

He catalogs a long list of failing organs and functions associated with aging. Emanuel has plans for a memorial service before turning 75, which — like Huckleberry Finn — he plans to attend.

His ideas are not new. Daniel Callahan expounded on the obligation of older people (he chose 85 as the target age) to step aside and leave resources for the next generations. This train of thinking has brought us advance directives.

(MORE: Is Age 75 the Right Time to Die?)

Life at the end is certainly filled with challenges, but so was being a teenager. Most of us fear death. Most of us fear disability, too. Freud addressed the relationship between disability and mortality differently. He said: “Maybe the Gods are merciful when they make our lives more unpleasant as we grow old. In the end, death seems less intolerable than the many burdens we have to bear.”

Near 75, Not Ready to Die

As an almost 75-year-old, I am not ready to die. I certainly feel the twinges of aging, but I am still functioning and at least intellectually vigorous. I am not ready to cash it in. I recognize that I will likely develop some serious health problems and that they will affect my functioning. Hopefully, they will affect my body and not my mind.

(MORE: TED Talk: How to Live Passionately at Any Age)

I take great solace in the large body of literature that suggests that people’s fears about living in states of disability are much greater than the feelings of those living in them.

Basically, human beings are remarkably adaptive creatures who cope with various adversities beyond expectations. One need only think about concentration camps or today’s refugee camps to marvel at the capacity of people to survive and their tenacity in clinging to life.

Who Gets It Wrong

Besides individuals like Emanuel, the other group to get this wrong are the economists. To facilitate their abstract calculations (economists could never survive as a species if they had to give up Greek symbols), they decided to put a value on life. They invented the quality-adjusted life year (QALY), which posited that a year spent in a state of disability was worth less than one spent in a state of perfect health. They then went on to use these QALYs as the basis for assessing the value of care.

As a result, many of us are living discounted lives. In essence, frail older people start from a situation where they can never gain much from care; they have shorter life expectancies and their survival is less valued. Talk about stacking the deck.

(MORE: Transforming Life As We Age)

This kind of thinking might be tolerated in an economist who is constantly trying to make things that work in practice work in theory, but it is dangerous in the hands of policymakers (who can quickly become program destroyers). The Tea Party is one thing; this is the Kool Aid Party doctrine. How could any logical thinker invest in care of the old or disabled as opposed to childhood immunizations?

We need to carefully examine our premises. Many of us old timers still see lots of value and even pleasure in lives. Someone needs to protect me from bioethicists and economists — quick, before it’s too late!

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