Friday, November 14, 2014

Ezekiel's Flawed Ethics - the Die at 75 Plan

Ezekiel Emanuel wrote an article for the Atlantic on "Why I Hope to Die at 75 - An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly."  As an Oncologist and Ethicist, he says he speaks for himself but implies not so subtlety that it may be best to avoid the consequences of aging and declining health (which probably really begins around age 25).  For himself he would not want any medical tests or therapeutics after age 75.  He argues that the productive years of life are over, that accomplishments should be complete, and that prolonging aging and its consequences is something he wishes to avoid.

Recently, I gave a talk called "Your Life Your Choices" to a couple of life-care communities where the average age was near 80 and most were still in independent living.  Many had lost their spouses and most, by definition, had some degree of declining health.  Sounds depressing doesn't it?  Yet these folks were active - in their faith groups, with their grandchildren, swimming, singing, playing and performing in bands or quartets, line dancing, playing tennis (a few), golf, and enjoying each others company.  There was keen recognition and understanding about end-of-life issues.  Many had POLST forms saying they would never want CPR, but they would accept removing an appendix, taking an antibiotic, and even a new knee or hip. 

I showed these groups a video of CPR, and talked for about 90 minutes about having "the conversation" with loved ones, designating a durable power of attorney for health care, etc. It seems that Emanuel wants to shock us into accepting that we need to face up to the declining years and make plans so I discussed Emanuel's proposal in these groups.  None of them felt they should have died 5 years ago!

Emanuel states that his family disagrees with his wishes.  I hope he can find someone to follow them and respect his autonomy.  But what if he comes in with an infected hangnail with an ascending infection threatening his life with septicemia.  At age 74 take an antibiotic, but decline at 75?

So I think I get his over-exaggerated point that we need to think carefully about prolonging the dying process when we are at an end.  But, with due respect, I think his ethics are flawed.  He is discounting the delight of being old and still functional.  Yes, we won't win a Nobel Prize.  But how about the joy of attending a grandchild's concert, going up to the lake cabin once more with the family, traveling together to Alaska, singing old favorites, volunteering at the food bank or library, or going to the opera.  Ezekiel, there is no age cutoff for enjoying family, friends, and the pleasures of life.  Even though you say you don't support "death with dignity", you are basically proposing that for yourself when you would even decline taking an antibiotic after age 75.

As we die, we leave a legacy for those we leave behind.  Ethical wills, sharing our values, showing love, and supporting our loved ones - yes, even as our spouses age.  There's nothing wrong with a cane, a walker, or a wheelchair - enjoyable life can still be there for many of us.  There can be growth in our spiritual life and new-found loves even as we experience loss.  The old saying "getting old isn't for sissies" rings true because aging does have its trials.  Personally I think rekindling an old forgotten friendship is more important, and perhaps as satisfying, compared to your climb of Mt. Kilimanjaro.

At age 76, as I write this, I think your ethical view of aging is at best cloudy and seems based on fear of loss rather than autonomy.  Yes, there are problems of cost, resources, and "getting out of the way" for the next generation.  But with my new corneas, I can drive safely again.  I love playing tennis doubles with my 80 year old friends twice a week.  Should I have resigned to go blind at 75?  At your healthy age of 58 Ezekiel, you seem to have a peculiar disconnect with those aging and declining in health.  So please re-write your article at age 74!


  1. Thanks for this. I think both you and Ezekiel Emanuel make good points. But end-of-life planning, like life itself, is not 'one size fits all.'

    I'm so glad you wrote to counterbalance the Atlantic article. My comment got so long I discovered I'd written a blog post of my own, so I guess I'll go post my remarks on Facebook.

    From my perspective, no one can say what the right 'age' is, as it will vary so much. But we all have to be thinking about what we will want ... because if we don't, the decisions are likely to be made either by some bureaucrat or lawmaker, or by a hospital afraid of being sued. Neither of whom will know us or have our genuine 'best interests' (about which they will know little or nothing) at heart.

    Thanks so much for writing!

    1. Thanks. Your points are well taken. If we can have "the conversation" with our loved ones and then appoint a surrogate (durable power of attorney for health care), then we will have an advocate to speak on our behalf - when we no longer can. About half of the time we're too sick to be part of the discussion near life's end, so having that advocate is key. Also, certainly agree that there is no "right age."

  2. Wow, the joy that my 71 year young parents, and 77 and 86 year young in-laws, give to my 6 year old daughter - and have her entire life - is PRICELESS. then again, they are relatively healthy. I can't imagine her not having that. My father in law didn't retire until after 80, and he is still an amazing reservoir of information and still had his brain picked by colleagues and former co-workers.
    my then 90-year-old neighbor had her hip replaced and not gets about better again. Age is not necessarily JUST a number, but clearly it is not the only factor in someone's ability to contribute to society.

  3. Hello and thank you for your writings. Your comments on Mr. Emanuel's opinions are interesting. I just wanted to point out that over 60 Nobel Laureates have been over 75 years old (the oldest being 90!). So there is still plenty of time!

  4. I met a dear friend at church when he was 89 years old. He is still going pretty strong at 94 yrs old. (I am 52). I treasure the conversations we have, but I would never want to live to be his age. (Even he says he has lived too long). I already think I have lived too long with the many health problems that seem to pop up every day, the costs to treat issues, etc. Each to his own.