Thursday, October 2, 2014

Aging: Why Would a 57-Year-Old Man Want to Die at 75?

Ezekial J. Emanuel has written a thought-provoking article for The AtlanticWhy I Hope to Die at 75.  Emanuel is currently 18 years away from this target age, but from his current position, it appears that by the age of 75, life is sufficiently degraded that it is not worth fighting for.  His title is a bit misleading; he does not actually wish to die at 75; rather, he believes that at that age he should not take measures to extend his life.  As one who is less than five years from Emanuel’s target age, I find this topic rather interesting.

Emanuel cites positive factors that have entered into his decision.

“By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations. Dying at 75 will not be a tragedy.”

He also cites negative factors that were determinative.

“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.”

He plans, when he reaches 75, to stop taking measures intended merely to extend his life.  There would be no more screenings or preventive tests looking for problems to fix.  Life prolonging measures that will no longer be allowed include things like getting a flu shot or taking an antibiotic to fight an infection.  The only care he would allow is palliative care to treat pain and discomfort, not curative treatments.

One might counter Emanuel by claiming that 18 years is a long time and medical advancements are likely to greatly alter what life might be like when he reaches 75.  However, Emanuel has an excellent counter for that logic.  He points to a study by Eileen Cummins and Hiram Beltran-Sanchez that spanned the years between 1996 and 2008 and concluded that we are not living longer and healthier lives.  In fact, we are acquiring chronic, debilitating diseases at an earlier age and suffering decreased physical mobility at an earlier age as well.  Our longer lives are due to medical interventions that keep our bodies running a bit longer.  Emanuel summarizes this observation with some apt words from Crimmins:

“As Crimmins puts it, over the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process.”

The life expectancy of a male at 75 is about 86 years.  Emanuel seems to believe that those extra ten or eleven years would likely not be worth living through.  He implies that those are years of debilitation and lessening ability to pursue positive experiences.  Perhaps it would have been wise to query those who are actually living through those years in order to discover how they view their life. 

An interesting article appeared in The Economist a few years back titled The U-Bend of Life.  It begins with this lede:

“Why, beyond middle age, people get happier as they get older”

The article reported on a number of studies of how people viewed their lives at various ages in life.  What persists as a universal phenomenon is a “u-bend” in the curve of personal satisfaction versus age as illustrated in the following chart.

“….interest in the U-bend has been growing. Its effect on happiness is significant….It appears all over the world. David Blanchflower, professor of economics at Dartmouth College, and Mr Oswald looked at the figures for 72 countries. The nadir varies among countries—Ukrainians, at the top of the range, are at their most miserable at 62, and Swiss, at the bottom, at 35—but in the great majority of countries people are at their unhappiest in their 40s and early 50s. The global average is 46.”

There does not appear to be a single compelling explanation for why people are, on average, happier and more satisfied with their lives as they become elderly.  This article suggests physical and mental changes that occur as part of the aging process and are not related to economic or other circumstances.

“….control for cash, employment status and children, and the U-bend is still there. So the growing happiness that follows middle-aged misery must be the result not of external circumstances but of internal changes.”

“People, studies show, behave differently at different ages. Older people have fewer rows and come up with better solutions to conflict. They are better at controlling their emotions, better at accepting misfortune and less prone to anger.”

It seems clear that, one way or another, the elderly come to terms with increasing sickness and debility and continue to find ways to derive satisfaction from life.  The elderly themselves have proclaimed this to be true.

It is also informative to assess the feelings of those who have already lived longer than any of us have any right to expect.  A couple of nonagenarians have recently looked back at their lives, expressed feelings about their current precarious state of health, and discussed how they deal with the nearness of death.  Roger Angell produced This Old Man for The New Yorker.  Doris Grumbach provides The View from 90 in The American Scholar.  Both authors continue to work and have produced fascinating and exquisitely constructed essays.  The word “fortunate” appears often—and no one would consider them “feeble, ineffectual, even pathetic.”

Emanuel, while dwelling in the darkest part of man’s life-experience, looks to the future and despairs.  He has formed and expressed his opinion while residing in a relative chasm of human discontent.  There are conditions that could lead one to decide that life is not worth living, but would appear wise to wait until they actually occur before one makes life-termination decisions.  Perhaps he would be better served, now and in the future, by accepting the “u-bend of life” and looking forward to an interesting and satisfying old age.

Emanuel worries that he will no longer be “creative” at age 75.  If one were to grade the essays produced by Angell and Grumbach with that of his on content and style (creativity if you wish), the nonagenarians would win hands down.  If Emanuel feels he is not creative and cannot enjoy life when he reaches 75, he should examine his own character to discover the problem.

I especially enjoyed Doris Grumbach’s final thought on her 90-plus years.

“However death arrives, in installments or in one instant stroke, I regard myself as fortunate. I will be able to echo the last words of Lady Mary Wortley Montague (who died in 1762):

‘It has all been very interesting’.”

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