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.

http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

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.
http://brane-space.blogspot.com/2014/05/an-alzheimers-blood-test-would-you.html

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!

Americans' Ideal Age to Live to? 90! WHY?

The recent Denver Post article (Wednesday, Aug, 7, p. 13A) on Americans preferred desire to live to 90 has me scratching my head. According to this Pew Research Center longevity study and the prospect of a "fountain of youth" (scientific goal) to get us to at least 120 years, most Americans aren't totally buying. That's good because it is pure poppycock to talk about any such life extension until the problem of Alzheimer's dementia is solved. Right now, as Susan Jacoby notes in her book 'Never Say Die',  on aging in America, the rate of Alzheimer's DOUBLES every five years past the age of 65.  Is that a form of age roulette you really want to play?

That means any person who does manage to live until 120 will likely have this horrific disease which in its ultimate form,  "turns you into a living cabbage".  Right now, as Jacoby points out, the extent of Alzheimer's research is stuck on neutral in terms of reducing those neuron-destroying tangles and beta amyloids. The degree of care basically halts at palliative.  Jacoby documents that nearly all the so-called measures and meds used to try to control its progress (such as displayed in HBO's 'The Alzheimer's Project) , don't really help.

Yet Americans, true to their delusional pie-eyed optimism, somehow believe in dramatic exceptionalism. That in fact they will not be brought down by a disease that took out one of the greatest minds in history, Isaac Newton.

According to the DenPost article:

"Pew took the public's pulse and found that most Americans wouldn't want a treatment that would let them live to 120. Fifty-six percent said 'No thanks' - although two -thirds expected that most other people would want to try such a step, said the report issued Tuesday."

That perception is downright frightening and weird, given that current financial -retirement  information collected from diverse sources on Americans' saving shows barely anyone has enough moola to survive to such a ripe age via self-support.  According to a recent report issued by the National Pension Rights Council, the median amount a family nearing retirement has saved for their post-work lives is a measly  $12,000. As for the magical 401(k)? If a household where the earners are between the ages of 55-64 does have a retirement account, they barely hit the six-figure mark at $100,000—a far cry from $1 million we’re told we need.

Even if these people somehow managed to find a company that'd hire them to work at least until 90 or so, it's still doubtful they'd amass enough. Given increased health care costs, the fastest rising aspect of the national budget - and no end in sight - most people would probably need to at least win a state lotto of ten million to be able to live to 120 without being in penury. (Fortunately, 51% in the survey said that living to 120 would be bad to society. Well Duh! Given Social Security and Medicare are already under attack.)

In any case, "few expect such a radical idea to become reality, at least by 2050", although most expected "more gradual medical advances could extend life expectancy".

Well, let's see: By 2050 at the rate the ice caps are melting and global temperatures increasing, we are very likely to be in the maw of the runaway greenhouse effect.  Blistering heat that will make the recent heat waves look like a walk in the park, power grids crashing from over use, storms of such magnitude no one can now imagine their ferocity, floods that will drown whole towns and cities, invasions of  insect, parasite vectors with exotic diseases not seen for a long time, including  schistosomiasis, cholera, dengue fever, malaria. DO people really want to live with that shit? I don't.

Thankfully, the same 51% who said living to 120 would be bad for society also add in the obvious threat to natural resources, given you're going to have 9-10 billion people on this little orb as it is, then add increasingly more numbers because of life extension? It's nuts! But in reality, 2050 will - for example - likely see mass loss of life from multiple mammoth natural catastrophes the worst of which is the runaway greenhouse.

 What's the ideal life span? To most Americans, according to the Pew study, it's between 79 and 100. The median answer reported was 90, Pew reported. But those who gave those results may have failed to process that only 14% of those over 90 are free of Alzheimer's or other forms of dementia. That's not a terribly promising stat.  It means the odds of you're being a person needing serious care soar and you'd better have a ton of money (for a nursing home) or, alternatively,  a loving -caring family to assume the burden of care or pay for the care.

The Post piece does note that "given concern about the growth of Alzheimer's disease and an overburdened Medicare system, caution about the idea of one day living longer may not be surprising."

But longevity researcher Cynthia Kenyon of the University of California - San Francisco (where I received my prostate cancer treatment) "wonders whether the public understands the real goal of this research which is better health."

In other words, if the extension is predicated on better health then peerless aging in good form ought not be a problem To quote Kenyon: "It would be the equivalent of a 90 year old person looking like a 45 year old."

Maybe, but the Alzheimer's problem remains, given that as Jacoby shows (op. cit.) no research has found anything that positively works to stave off Alzheimer's, whether a vegetarian diet, special supplements, or doing 1,000 Sudoku puzzles a week - or working out 100 differential equations. Many think they know, or have the magic formula,  but no one really does. So again, until the Alzheimer's issue is first resolved, and yes - it could be as part of a health first paradigm, it is useless to try to push life extension significantly beyond what it is.

Again, the other point is no matter how healthy these advanced people are, what kind of economy can support them? We already have tens of millions of Millennials - new college grads- who can't find work because many seniors are still working either from having not saved enough (after being down sized) or to pay for added health care costs. So now you're going to add tens of millions MORE healthy elders to the work force which,  as it is,  can barely grow 200,000 jobs a month? This is  perhaps 25% above the population replacement level when you'd really need to have at least some 500,000 jobs added over population replacement level! But given the structural infirmities of our Neoliberal market economy, which sees workers as added liabilities-  costs, that ain't  gonna happen!

The idea portends a rolling demographic and economic disaster for the young - who will either have to fight for an even fewer pool of jobs, most of which won't pay duck squat, or help support these added advanced age healthy elders - say if they themselves don't have jobs.

In any case, from where I sit, radical life extension even in a 'healthy mode' is a fool's errand. Besides, we have too many other pressing problems and issues to turn our resources, minds and energy, as opposed to increasing the human population even further beyond carrying capacity!