75 and Out?

The past week or so, an article by Ezekiel J. Emanuel, M.D., in The Atlantic magazine, titled "Why I Hope to Die at 75," has captured a lot of the nation's attention. Doctor Emanuel is the older brother of Rahm Emanuel, the mayor of Chicago. Both he and his brother were instrumental in helping design the Affordable Health Care Act. And Doctor Emanuel is both a prominent cancer specialist as well as director of Clinical Bioethics at the National Institutes of Health. So we can presume that his opinions, even if "Obamacare" is riddled with flaws, are well thought out, even if we might choose to disagree with his conclusions.

Dr. Emanuel's main target in his provocative article is what he what he sees as the "American immortal" -- people who pursue the goal of trying to live, if not forever, at least as long as possible. Armed with the latest facts and statistics, he argues that although adult life expectancy has undoubtedly increased in the USA, it is coming at a very steep price, with an alarming increase of the population suffering not just from severe physical disabilities but even more from Alzheimer's and other age-related forms of dementia. As he puts it: "...death is a loss... but...living too long is also a loss." It's a question of which we prefer, a shorter more vibrant life, or a longer one in which we eventually will have to cope with the challenge of a slow decline.

Emanuel is careful not to be misunderstood. He is not advocating reckless lifestyles, suicide or self-destructive behavior of any sort. But he does question so many of the tests or other precautions being urged upon us by modern medicine, especially when these procedures promise the chance of extending our life beyond age 75 -- which also happens to be midway between the ancient biblical norm of "... seventy years, or if we are strong, eighty" (Psalm 90:10). Beyond that, unless we are exceptionally robust, we are probably asking for trouble. In other words, as Emanuel puts it, beyond a certain point, we should just give up and "Let nature take its course."

But aren't there and shouldn't there be exceptions? He admits that practically anyone can draw up a sizable list of extraordinary people, many of them Nobel Prize winners whose intelligence or wisdom continued to benefit humanity, often long after their major contribution was first recognized. Yet, as Emanuel points out, the contributions for which they are most honored seem to have usually been the product of their earlier years. For example, Einstein's most celebrated theories were introduced to the world when he was only 26 (Special Relativity in 1905) and 37 (General Relativity in 1916). He was only 42 years of age when he was awarded the Nobel Prize for Physics. And although for the next thirty-four years he had much to say about many other subjects, including war and peace, politics, ethics, religion and human behavior in general, the fact is that he even spent a good many of those remaining years resisting the theory of Quantum Mechanics, now almost universally accepted, that had been launched by his earlier speculations. Nor did he ever succeed, with the still unfulfilled goal of arriving at a single "theory of everything," even though he inspired many to attempt the same. Instead, as he lay dying of an aortic aneurysm at age 76, he was reported to have said: "I want to go when I want. It is tasteless to prolong life artificially. I have done my share. It is time to go. I will do it elegantly."

Yet I wonder. Had the aneurysm that killed Einstein back in 1955 been able to be repaired by the insertion of an endovascular stent, as has become the standard treatment today, would Einstein have refused to consent to that procedure? It is hard to say for sure, but it is my guess that, as long as he felt his mind remained clear or unimpaired, he might have agreed to it. One of my reasons for saying this is that he had been continuing, almost to his dying day, his efforts to formulate that universal theory or (as he sometimes described it) "to know what God thinks."

My other reason for saying this is also based on science, but this time more on biology and psychology rather than physics. Although we all have to undergo death, our evolutionary drive is geared not simply toward the survival of life but even its enhancement. Otherwise it is hard to explain why so many, not just Americans, spend so much time (often much of it in church), or even more money, trying to become, as it were "immortal." Even Einstein, who supposedly admitted that he had made the biggest blunder of his career -- before the Big Bang was revealed -- in assuming that the universe always had been essentially the same, continued to try to find new ways (as has his wheelchair-bound and voice-synthesized successor Stephen Hawking, now 72 years in age) to assure us that the universe will always, in one form or another, continue to exist.

If nothing else, I think that this on-going quest to know more and ever more about the universe, and to insure, if possible, its survival, is in itself an answer to Dr. Emanuel's serious questioning. In fact, towards the end of his long article, he admits perhaps that eighteen years from now, when he reaches 75 years of age, he will have changed his mind about dying.

My now being already 82 years of age -- but still searching for all the answers -- I suspect I will not be likely I'll be around to witness the good doctor's decision. But I can't help but hope that he will have changed his mind and that somehow I'll hear about it.