As I approach my 65th birthday -- January 25 for those wishing to send a card or Medicare application -- I find myself compulsively reading about aging. And just so you know, I'm one of those people who is aging but not getting "old" -- if you get my drift. I work hard, I play harder; I look and feel much younger than my years. And yet I am very much aware of the fact that that won't always be the case and so I like to read about what the next couple of decades might hold for me.
Which is why Ezekiel J. Emanuel's story in The Atlantic headlined "Why I Hope to Die at 75" was such an eye-opener: I have never thought of dying as something I had a say in.
Yes, I own my life. But I have long believed that our deaths belonged to the doctors. Emanuel makes the case that by age 75, we have accomplished most of what we are going to accomplish in our lives and that frankly, it's pretty much all downhill from there. Rather than become a burden to his children or loved ones, and certainly rather than bear witness to his own slow and possibly painful decline, he wrote that at age 75 he no longer plans to see doctors, have medical screenings or take medication for what ails him. He is prepared to let what will be, simply be.
It's a bold approach (and personally I would bump that number to 82 just to give me more time to know my future grandkids) but what he proposes, in a nutshell, is revolutionary: Let's wrestle control of our deaths away from the medical establishment.
Count me in. I'm happy to rush life's exit doors before the going gets tough.
I have witnessed the dying of both my parents, several aunts in their 90s, and friends who have lost brutal battles to cancer. In each case, I watched in horror -- sometimes retrospectively -- as the doctors and hospitals stayed laser-focused on administering measures to prolong life that wound up just prolonging dying.
Death isn't what scares me. Dying is.
And that's because the act of dying today is too often accompanied by medical interventions long passed the point where the patient's prognosis would suggest their futility. Why should dying be so hard?
I had a friend with cancer who received chemotherapy literally up until the day before her death. Why would anyone want to spend their last day on Earth hooked up to chemo drip? They wouldn't, of course, if they knew it was their last day. But despite the superhuman powers we may want to bestow on doctors, they are mere mortals and can be just as inaccurate as the rest of us in predicting death dates. So given that no one knows which day actually will be our last, what's really being dispensed in many treatments is this: Hope. We are subjected to days, weeks and months of medical misery in the name of hope.
While the idea of saying no to medical treatment isn't new, it's a difficult thing to actually do. I know from watching the prolonged deaths of loved ones that most medical interventions are doled out in small bites -- today's breathing tube follows last week's feeding tube which came on the heels of this or that new technology -- all of which makes it hard to know when to wave the white flag of surrender. And we can't ignore our own role in this. Doctors aren't sadists; they are doling out treatments because many of us can't accept the idea of death -- ours and that of our loved ones.
Even the idea of rationing health care to save money feels offensive or morally wrong to many of us. And the idea of denying medical treatment to a patient based on age or prognosis is not any less controversial. Remember the talk of "death panels" charged with deciding which patients got medical care and which wouldn't? It's scare tactics like this that stymied the conversation decades ago and raised their ugly head again in the recent ACA debate. But as more and more people join the ranks of the elderly every day, this is a conversation that needs to be had.
Daniel Callahan, senior research scholar and president emeritus/co-founder of the Hastings Center -- a research institute dedicated to the study of bioethics -- proposed in his 1986 book "Setting Limits: Medical Goals in an Aging Society" that there be a cap on expensive medical treatments for people at age 80. The author of 17 books recalls how that proposal propelled him to fame -- or perhaps infamy.
For those wondering, now that he is 84 he has softened his view -- but only somewhat. He sees doctors, but has a living will and a very clear medical directive. He suffers from emphysema, was diagnosed with Parkinson's disease, has high blood pressure and says he gets up to use the bathroom about five times a night. All his health issues began since he turned 80, he said. Since he predicts it will be his emphysema that kills him, he has specified that he doesn't want to be put on a ventilator.
"That's where I draw my line," he told The Huffington Post.
The country -- the world actually -- doesn't have the financial resources to pay for the coming health-care tsunami of the elderly. At the heart of the problem is modern medicine, where the possibilities of medical progress and technological innovation are "essentially unlimited," said Callahan.
"The ancient duty of physicians to instill hope in their sick patients is now matched by the necessity of inspiring constant public hope in the medical research enterprise," Callahan said.
And while the financial crisis of caring for an aged population is certainly a big part of why something needs to change, it isn't the only part. Anyone who has been able to euthanize a dying pet knows what a gift it is to end suffering in cases where recovery is not possible.
Callahan recalls the death of a friend -- a professor who taught a medical ethics class. After successfully beating cancer once, his friend suffered a reoccurrence five years later. The prognosis was grim. But when Callahan went to pay him a final visit, the man's mouth was filled with so many painful sores that he could barely speak. The friend said he had been encouraged to try a new last-ditch effort treatment and the mouth sores were the result. Why had his friend -- who had taught and prosthelytized the exact opposite message his entire career -- accepted the treatment? The doctors had encouraged him to try it, he told Callahan.
Like Emanuel and Callahan, I hope to find the courage to say "enough" when my time comes. But the beauty, of course, is that for now, I can always change my mind.