My friend Ezekiel Emanuel, in his typically smart, provocative and bullheaded way, has decreed that he hopes to die at age 75, which would give him just 18 more years during which to exasperate friends and family.
Zeke’s wrong, of course. Yet he’s wrong, as always, in an interesting way, one that usefully prompts the rest of us to consider not only our mortality but also how we would like to live out the measure of our years.
“Doubtless, death is a loss,” Emanuel, a bioethicist, physician and health policy expert, writes in the Atlantic. So, too, he argues, is living too long:
“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.”
As a result, Emanuel’s plan, on reaching 75, is to issue new instructions to his doctors. No life-prolonging measures. No screenings such as colonoscopies or cardiac stress tests; no treatments such as chemotherapy or cardiac bypass. Not even flu shots or antibiotics — nothing but palliative care, to alleviate pain.
Emanuel’s essay arrives in a fitting season, as Jews 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.”
It is fitting, as well, that the traditional Jewish birthday greeting is to wish that the celebrant live 120 years — the lifespan of Moses. Relevant to Emanuel’s concern about descending into a doddering old age, the Torah relates that, while Moses’s years were advanced, his eyes remained undimmed and his vigor unabated.
These two stories help explain why Emanuel is wrong.
Emanuel says that by age 75 he will have had the satisfaction of seeing “my grandchildren born and beginning their lives.” Why stop there, when you could dance at their bar mitzvahs or even, God willing, their weddings? Moses didn’t just leave the Israelites at Sinai and wish them luck; he lived long enough to watch them mature and enter the Promised Land.
Likewise, advances in reproductive technology notwithstanding, nonagenarian births are not likely to happen to modern-day Sarahs. But her story offers the reminder that we cannot know what surprises, and joys, our later years may hold.
Where Emanuel veers off-course, I think, is in his conviction that the capacity to be productive is what makes life worth living. He bemoans the sad decline, from authoring papers to taking up hobbies until, eventually, “life comes to center around sitting in the den reading or listening to books on tape and doing crossword puzzles.”
This goes, I know, against the Emanuel family DNA, but 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.
Where Emanuel makes a powerful point is in condemning the “manic desperation to endlessly extend life.” Medical choices should not be dictated by a patient’s age, but they should be informed by it. Extreme treatments to save or even minimally extend the life of a young mother are not necessarily appropriate for an 80-year-old grandmother. Physicians fail their patients by automatically defaulting to treatment.
Here I break from Emanuel. He opposes euthanasia and physician-assisted suicide, but this position does not give adequate weight to the dignity with which we would like to live and die.
Why must a terminally ill cancer patient suffer an agonizing decline when there is a more merciful alternative? Why, and this is a harder question, must an Alzheimer’s patient be condemned to slowly lose mental and physical capacities? Facing that terrible situation, I would prefer the choice not to be remembered, in Emanuel’s words, as “feeble, ineffectual, even pathetic.”
Emanuel concludes with an escape clause: At 75, he writes, “I retain the right to change my mind and offer a vigorous and reasoned defense of living as long as possible.”
I look forward to that uncharacteristic about-face, and to sitting down to more of Zeke’s excellent cooking — at 76, 80 and beyond.