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When Do You Want to Die?

September 28, 2014

There was a fascinating article in The Atlantic written by one of America’s leading bioethicists, Ezekiel Emanuel, who is the brother of Rahm Emanuel, who left the Obama administration to become the mayor of Chicago. The article is entitled Why I Hope to Die at 75.

Dr. Emanuel starts by debunking some of the myths of prevailing attitudes of policymakers about morbidity and mortality. He does a great job presenting data that shows that advances in healthcare have not compressed morbidity into the final years as some dreamers dreamed would happen in the 1980s. Basically, they thought that better treatments would delay diseases to manifest in people until just before they died: heart disease, COPD, etc. The data show that over the last several decades, we live longer as a country, but the extra years are largely spent with a decreased quality of life.

For every spunky 80-year-0ld shown on morning TV shows, there are legions of 80-year-olds who live with varying degrees of pain, limited mobility, limited mental capacity, etc.

Dr. Emanuel goes on to say he will not commit suicide at age 75. He lists some things in his control though, such as not undergoing any more disease screenings or preventive interventions. He talks about receiving comfort care, but not curative care, even if he is diagnosed with a disease like cancer. He reminds us of the description of pneumonia as the “old man’s friend” and talks of not taking antibiotics in some situations.

He doesn’t want anything in return for this — no rebate for the reduced healthcare costs Medicare will pay for. He only describes this journey as representative of his wishes to maximize the quality of his life.

But as I wrote in American HealthScare, I wish he and other similarly-minded people were allowed to pool themselves into insurance or Medicare pools and enjoy the savings realized from their more balanced expectations of what a healthcare system should provide them in the first place.

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One Response to When Do You Want to Die?

  1. Chris Gregory on September 29, 2014 at 6:51 am

    So many seniors are burdened by medically-induced longevity, when quality of life has been taken away by aging. Dr Emanuel wisely considers various factors and sets a rational timeline beyond which he does not wish to take further steps to catch things that may ultimately lead to death (e.g., screening diagnostics). He chooses not to intervene in his own biology in ways that might catch or slow the progression of disease by way of diagnostics or treatments. It sounds a pretty sensible way to recognize that at some point, “the cure is worse than the disease”. I recall a friend, who at age 71, was diagnosed with fairly advanced pancreatic cancer. He underwent a massive surgical procedure, and the balance of his short life consisted of uncomfortable adjustments and little quality. Not heroic, just the beginning of an uncomfortable end.

    Following his trip to the UK, Dr Young wrote about the Brits more philosophical approach to death, placing quality of life ahead of medical heroism. One elderly lady said she had no intention of taking a particular test at her advanced age. Maybe she was wisely planning her own exit strategy as well.

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