The peripatetic bioethicist and health policy scholar Ezekiel (Zeke) Emanuel has attracted widespread outrage with his most recent Atlantic article: “Why I hope to die at 75.” As he put things:
I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.
But here is a simple truth that many of us seem to resist: living too long is also 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."
When Emanuel reaches age 75, he won’t actively end his life. But he will stop seeking medical treatments to actively prolong it: no cancer screenings or treatments after 75, no pacemaker or bypass surgery, either. Not even flu shots or antibiotics.
Not surprisingly, people are linking his argument to rationing, death panels, and the like. That’s not what Emanuel is advocating. He is a vociferous opponent of euthanasia and assisted suicide. This is a more personal essay about what he wants in his own life, how he wants to be remembered by his family and friends.
Much of the joy and accomplishment of Zeke’s life rely upon his great physical vigor, cognitive skills, and intellectual creativity—capacities that tend to decline with age. He does not wish to become a burden to his children. He wants to free his adult children to become the leaders of their own families, outside of their parent’s long shadow.
There’s one more thing, too:
"We wish our children to remember us in our prime. Active, vigorous, engaged, animated, astute, enthusiastic, funny, warm, loving. Not stooped and sluggish, forgetful and repetitive, constantly asking “What did she say?” We want to be remembered as independent, not experienced as burdens."
I admire the blunt, unsentimental humanity with which Emanuel presents his case. Aging and death are realities in every life. No insurance policy, gym membership, or superfood can fully protect us against a frightening, sad, depressing, or burdensome trajectory in our final days. We should discuss these issues lovingly but plainly, long before these become immediately pressing.
I share some of Zeke’s views as I confront my own fate. I have spent much of my adult life trying to provide basic financial security for my wife and my children. I would end my life if it could only be prolonged by creating huge financial burdens—not because I will have lost my zest for living, but because I don’t want to defeat one of my life’s most important efforts. I would derive greater satisfaction using my wealth to help finance a grandchild’s education than I would rolling the dice on some uncertain chemotherapy for metastatic cancer.
I also worry about the decline in my intellectual powers. This week I’m submitting a grant application that required hours of intricate computer programming to analyze a large, unfamiliar, and complex dataset. I doubt that I will be able to accomplish such tasks when I’m 75.
Still, my 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.
I have also become hopeful as I watch my parents deal with the practical realities of their senior years. For the past three decades, my mother has spent each summer vacationing at the Chautauqua, Institution in upstate New York. Now 82, she enjoys good health. She strolls the grounds, has wonderful friends and community there. Of course, she’s seen the other side, too. She has witnessed friends and family members with more serious challenges ranging from heart attacks to Alzheimer’s, disability, and stroke.
My 83-year-old stepmother Arlene has required quadruple bypass surgery, a hip replacement, and surprisingly costly hearing aids. She’s now being fit for a pacemaker. My wife’s parents suffered more tragic fates. Janice and Greg died far too young from lung cancer. Greg died with such dignity, two decades before his time. His trajectory was all too rectangular. He was movie-star handsome and healthy only a year before he died.
Almost fifteen years ago, my dad required a difficult and surprisingly-risky aortic aneurysm repair. Last summer, he survived a scary bout with cancer at 85. I’m grateful for the kind and proficient care provided through Brigham and Women’s hospital. I’m even more grateful to my sister Gail and my step-sisters who converged on my dad’s Cape Cod home, putting aside our various family dramas to help care for him after his cancerous kidney was removed.
I fondly remember the days right after the surgery. My step-sister Dana and I worked long hours maneuvering him in and out of bed, keeping him clean, protecting the wound site, managing his medications, and more. Dana is a single-mom who lives in Texas. She didn't have to fly 1,000 miles to do this gritty work. As we were cleaning up, she started to list many kind things my father had done for her over thirty-five years. “I had to come.” There was no Twitter or Facebook. The work email was off. It was hard work. It was also a great blessing to have the opportunity to do that.
A year later, my dad remains a little stooped from his surgery. He needs physical therapy to build muscle mass and greater strength in his abdomen. He has some other health issues, too. He forgets some names, but still sends me emails with hard questions about quantum mechanics. He got a snazzy new car. He leased it because, hey, he’s 85.
Three weeks ago, I accompanied my wife and daughters on a trip to see him. He drove us to the beach. He showed me how to adjust the complicated manual settings in my digital camera. He cooked omelets for my girls, telling them stories about life on the Grand Concourse in 1940. The girls told Arlene about their hopes for college and about the merits of different boy bands. I wish I could have had such conversations with my own grandparents, three of whom died before I was born.
I offer no criticism of Emanuel’s fine essay. But I will plan my own life differently. I’m grateful that my parents do, as well. 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.
By continuing to live into their eighties, my parents—all of us, really--run the risk of living too long. They do crossword puzzles. They follow a low-salt diet, trying their best to ward off Father Time. They will someday experience greater difficulty and loss. Right now, they’re on a good ride.
I don’t know if my dad can win patents for aerospace gyroscopic systems the way he once did. Yet 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.
That’s a calculated risk at any age. So far, so good.
Harold Pollack is the Helen Ross professor at the School of Social Service Administration and co-director of the Crime Lab at the University of Chicago. He is a nonresident fellow of the Century Foundation.