Dr. Ezekiel Emanuel takes a bit of heat for his views on healthcare and end of life issues. Some of the criticism is reasonable; some is just political posturing. In the October 2014 issue of The Atlantic, Emanuel turned his opinions inward with the reasons he wants to die at age 75 – and why you should, too.
Let me be clear up front that he’s not talking about a death panel or any such nonsense that he’s been accused of. He just thinks it’s a wise choice for the individual to wind down any life extending interventions – antibiotics or pacemakers for example – after age 65 and let nature take its course toward a natural end around 75.
I think he’s chosen he wrong age for a lot of reasons. But his arguments bring up some interesting topics to consider as we plan what types of healthcare we will accept and what we will decline as we age.
I’ve got real world experience on both sides of this coin. My father died on his 83rd birthday, far later than was right or good. He suffered multiple strokes in his final years and the man he was faded into one none of his children recognized. Unable to feed or bathe himself or remember many of his family, it was an end not suited to the Air Force pilot who flew 123 missions in the Berlin Airlift.
My mom, on the other hand, died at age 76 after stopping all treatment for metastatic lung cancer. She was still able to work in her garden, drive herself around town, and enjoy her friends. Her cancer would not have been cured, but she left a lot of quality time on the table. At the time of her death, my oldest child was 20 months old, and I was five months pregnant with my second. Her decision to quit at that time in my life left a wound that’s still raw.
So I come at this as someone who has been deeply affected by watching a loved one hang on far too long and one let go too soon. It’s a rare person who would want to spend their last couple of years the way my dad did, but most of us would try to hang in there longer than my mom did or Emanuel plans to. We each have a threshold of disability that we don’t want to cross. It’s probably not the same for any two people, but there is a threshold nonetheless. Emanuel chose a threshold that I think is way too low, but I have one, too. Somebody probably thinks mine is too low.
The point is I don’t disagree with Emanuel’s concept; I simply disagree with the point on the spectrum he chooses to place himself. When we grasp at every last medical treatment or intervention, we are, in a sense, trying to control our death. We refuse to admit to ourselves that death can’t be controlled.
What Emanuel is promoting then, is taking a little control of how we die - emphasis on a little. As we age, we need to start thinking of healthcare as a rifle, not a shotgun. When we use healthcare as a shotgun, we might hit the intended target, but we’re going to do a lot of unnecessary damage, too. If we treat healthcare as a rifle, we have a better chance of limiting a cascade of other problems from our intervention. The part that’s tough is deciding to shoot only when we have a clear shot.
With these thoughts in mind, how do we approach healthcare choices as we age?
First, we need to plan ahead. The truth is we aren’t such great decision-makers in our old age. Thinking about what types of medical care we want to pursue during which decades is a reasonable exercise to engage in before the deadline arrives. Will you accept cancer screening at age 80? Will you continue to add medications to your daily regimen for medical problems that don’t make you feel bad? Do you want life-saving measures to be carried out if you will be left with significant disability (where you get to define significant)? Write these thoughts down. Discuss them with your spouse, your children, and your doctor.
Second, become an active participant in your health care. Get in the habit of asking, “Why?” when a new treatment is prescribed by your physician. Do your part now to prevent diseases that will lead to disability in your golden years. Diabetes, heart disease, and hypertension can be prevented or lessened with lifestyle adjustments. The impact of these diseases on your retirement years can be devastating – a little prevention can make a big difference in what those years look like.
As for me, I still hope to live well into my 90s, traveling the world, visiting my grandchildren, pounding out my opinions on a keyboard. Certainly none of Emanuel’s arguments apply to me.
Do they apply to you?
Amy Rogers MD is not a practicing physician and nothing written here should be taken as medical advice from either Amy or AssetBuilder. Medical decisions should be made with care in consultation with your health care provider.