Wednesday, September 24, 2014

Ezekiel Emanuel and Wanting to Die At 75: What The Media Gets Wrong - And Emanuel!

All kinds of kerfuffle has now blown up over Ezekiel Emanuel's  Atlantic Monthly piece entitled 'Why I Hope To Die At 75?" , e.g.

Most of those who oppose his thesis, like David B. Agus two mornings ago on CBS, admit to being "optimists",  which is understandable. They all share the typical, pie-eyed American conviction that we are all on track to live to 100 and will carry a high quality of life with us. All of which is balderdash.

As Dr. Emanuel pointed out in a segment on 'Morning Joe' 2 days ago, all the stats back up his arguments in the Atlantic piece. Alzheimer's will continue to claim more elderly brains, and medical treatments in the last years will create enormous costs while delivering few good results. (Most elderly will die in hospitals, often at the mercy of the medical-industrial complex which only sees life extension or preservation as its goal.)

His central point about bad aging is unarguable:

"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."

So why would you not want to go out before you slide into total physical weakness, forgetfulness, or feeble thinking? Are you really ok with letting others take care of you, change your diapers and clean you for the rest of your days? Obviously no, but most Americans brainwashed by the media can't see themselves as older and infirm -  only re-invented "semi-youthful" types who can hike on the Swiss Alps at 75 and do integral calculus.

But that's largely a myth. The boffo, well-lived quality elder years only happen to the relative few. The few who manage to escape debilitating cancers, or injuries or diabetic collateral damage and Alzheimer's.  The proportion of such lucky ones is maybe 5 percent, if that. Even my hale  and hearty sister -in-law Krimhilde, see below, is now experiencing more and more frequent memory deficits and problems. She was 80 in August and has kept herself as mentally and physically fit - including eating a vegetarian diet-  as anyone could. If SHE can experience problems with what she's done then any of us can.

Dr. Emanuel, who has been misquoted in the media - which portray his piece as suggesting we all need to off ourselves at 75 - is clear this is not what he means:

"Let me be clear about my wish. I’m neither asking for more time than is likely nor foreshortening my life. Today I am, as far as my physician and I know, very healthy, with no chronic illness. I just climbed Kilimanjaro with two of my nephews. So I am not talking about bargaining with God to live to 75 because I have a terminal illness. Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority."

This is a fair précis of his position but I have my quibbles, most especially with his opposition to euthanasia. This is especially when the more consistent position would be to embrace it given his willingness to abandon extraordinary measures to prolong life, say be getting special treatments or preventive tests. If you are willing to eschew those measures - say like  getting chemo for an incurable pancreatic cancer (or as he later suggests - doing without colonoscopies after age 65) you should be willing to allow euthanasia under specific conditions. His take that most people seeking it are "depressed" is also flat out wrong. In the case of pancreatic cancer the pain can be devastating. The outlook grim. Most "good, compassionate deaths" are only possible if those suffering are allowed to curb the extreme pain, for example,  by the suitable dispensing of enough morphine - as is done in Barbados. There is NO reluctance there to alleviate patient pain, and the result is a speedier death - though not technically "euthanasia". But this is what most pain paranoid doctors in the U.S. fret over. They shouldn't.

The more controversial case for euthanasia is Alzheimer's disease, and euthanasia ought to be allowed as a rational option if the person desires it. (In Switzerland now, many people  - including those diagnosed with Alzheimer's - are arriving for "tourism euthanasia" to be accommodated by a group called "Dignitas")   The rationale may not necessarily be pain here, or depression, but the realization the person faces a long, degrading  and dependent path toward an inevitable end which s/he desires to terminate. Is it anyone's place to say "No, you can't! You need to tough it out, lose all your identity and perish!"  No, I don't believe so.

Janice's cousin Desmond, when we caught him in one lucid moment, back in 2010,  see e.g.

He understood the track he was on and agreed that if he could have foreseen what was going to happen to him he would have elected euthanasia in a country that allowed it. It is not for any of the rest of us to question that or make moral pronouncements.

Where Emanuel is spot on is when he excoriates the American obsession with perpetual youth - "exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible."   As he observes, this fetishism has become so pervasive  "that it now defines a cultural type: what I call the American immortal."

The issue then becomes exactly when Americans are prepared to grow up and face their mortality. I suspect, somewhat like Dr. Emanuel, this is when more health problems accumulate than one's financial resources can accommodate or time allows. (It's a notable stat often circulated, e.g. in the AARP Bulletin, that most medical expenses occur in the last two years of life and the mean life extension for all that expense - about 200 grand- and effort- is a measly 6 weeks.)

Thus, if one simultaneously should be diagnosed - say at age 74 - with bowel, pancreatic and metastatic prostate cancer- I'd say it's time to throw in the towel and move thyself into hospice care. Forget about going to the hospital so the medical-industrial complex can turn you into their latest life extension zombie experiment.  (Interestingly, to reinforce this, though most Americans aver they wish to die at home, fewer than 1 in 4 actually do - because of medical interventionism and people being brainwashed to accept it)

So, let's let Emanuel again restate his argument and position:

"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. Indeed, I plan to have my memorial service before I die. And I don’t want any crying or wailing, but a warm gathering filled with fun reminiscences, stories of my awkwardness, and celebrations of a good life. "

All well and good, but let's bear in mind the acceptance of each person's mortality should be his alone to make. For some like Emanuel that may be at 75, for others it may be at 80 or 85 Each person's acceptance will largely depend on the quality of life at that point, and how caregivers respond to that life quality. In the end, there is no one size fits all answer, and though "dying at 75" when he has met all his life accomplishments may work for Emanuel  - it may not work for someone else.

As a footnote: wifey will be 75 next week and she has no intention to die! This is irrespective of how much she's already accomplished with her life - because heck, her Ravens still have another Super Bowl to win and she wants to be around cheering when they do!

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