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Pennsylvania oncologist: “Why I hope to die at 75” — and will reject chemotherapy


University of Pennsylvania professor Ezekiel Emanuel, M.D., Ph.D.



Ezekiel J. Emanuel has a distinguished resume. He is a joint appointment as a professor at both the University of Pennsylvania and the distinguished Wharton School of business. He is now Vice Provost for Global Initiatives at Penn and chair of the Department of Medical Ethics and Health Policy.


He earned both an M.D. and a Ph.D. from Harvard. In short, he is a brilliant man.


Nevertheless, Dr. Emanuel argues that America has a problem in that it is encouraging people to live too long.


Seriously.


He made this argument nine years ago in an article in The Atlantic — and he repeated it on CNN last month. He is now 65, but argues that in nine years, he will refuse most medical treatment — and all treatment that will prolong life.


Essence of the argument


Since I am now 75, and I am in reasonably good health, that number immediately struck me. Next month, I will be 76, but I have been concerned more about mortality in the last few months than ever in my life even though I have no serious ailments and take no pharmaceutical medication.


Here is what Dr. Emanuel wrote in 2014,


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.


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. After I die, my survivors can have their own memorial service if they want—that is not my business.


Ezekiel J. Emanuel, M.D., “Why I hope to die at 75,” The Atlantic, October 2014.


He is not a morbid, pessimistic man. Quite simply, he is a realist. He has seen what is happening in America right now, and it frightens him. This article is a long analysis of why he believes that he is right about this — and it is convincing.


Not about Euthanasia


The physician makes clear that he is not talking about Euthanasia or physician-assisted suicide. He is talking about the quality of life that most Americans live after 75,


I am talking about how long I want to live and the kind and amount of health care I will consent to after 75. Americans seem to be obsessed with 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. This has become so pervasive that it now defines a cultural type: what I call the American immortal.


I reject this aspiration. I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop.

Americans may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me.


Ezekiel J. Emanuel, M.D., The Atlantic, October 2014.


Now, our life expectancy is decreasing


Last week, in his CNN interview, he emphasized that after years of increasing, the longevity of Americans is declining. However, while many blame Covid for that, but it is moving in a downward trajectory because of a number of aspects of life.


However, Emanuel pointed out nine years ago that the longevity numbers were misinterpreted,


In the early part of the 20th century, life expectancy increased as vaccines, antibiotics, and better medical care saved more children from premature death and effectively treated infections. Once cured, people who had been sick largely returned to their normal, healthy lives without residual disabilities. Since 1960, however, increases in longevity have been achieved mainly by extending the lives of people over 60. Rather than saving more young people, we are stretching out old age.


Ezekiel J. Emanuel, M.D., The Atlantic, October 2014

.

The truth is that many people in their 80s and 90s do very well. Anecdotally, I would surmise that these are more likely female than male. However, what the doctor is focusing on is the quality of life of most people after 75.


He uses his father as an example. I could use my own.


Fears


The truth is that disabilities are increasing faster than life expectancy. That did not make sense nine years ago, and it makes less sense today,


How can this be? My father illustrates the situation well. About a decade ago, just shy of his 77th birthday, he began having pain in his abdomen. Like every good doctor, he kept denying that it was anything important. But after three weeks with no improvement, he was persuaded to see his physician. He had in fact had a heart attack, which led to a cardiac catheterization and ultimately a bypass.


Since then, he has not been the same. Once the prototype of a hyperactive Emanuel, suddenly his walking, his talking, his humor got slower. Today he can swim, read the newspaper, needle his kids on the phone, and still live with my mother in their own house. But everything seems sluggish. Although he didn’t die from the heart attack, no one would say he is living a vibrant life. When he discussed it with me, my father said, “I have slowed down tremendously. That is a fact. I no longer make rounds at the hospital or teach.” Despite this, he also said he was happy.


As Crimmins puts it, over the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process.


Ezekiel J. Emanuel, M.D., The Atlantic, October 2014

.

I saw my father’s health deteriorate over the last decade of his life. While he was physically in good shape, he started his decline more because of his loss of memory. His dementia started when he was in his late 60s. At first, it was simply forgetting things. Then, he could not remember what day it was. I had him circle the day and date on the calendar in the morning, and then circle it when he went to bed.


After a while he could not remember to do that. He visited my sister in Minnesota in 1984 when he was 78. When I picked him up at Johnstown airport, he was a wreck. In short, he had gotten off the plane in Pittsburgh and had no idea where he was or where he was going. Some of the personnel with the airline and airport finally were able to take him to the commuter and try to explain things to him.


He said that he would no longer fly, and he never did. I had never seen him so frightened. Things went downhill from there, and he was diagnosed with a rare form of cancer at the age of 82 and passed away a year later. When in the hospital, they had to strap him in because he wandered away onto other floors.


A man who was in great shape mentally and physically was brought down in his later years, with most of the problems after he was 75.


As for me


Now that I will be 76 in about seven week, this article had an effect on me. I have worked hard to avoid dementia, and what I am doing now has kept my mind sharp. Tutoring young people and reading have been positive, but after reading this, I realize that my life now may be more difficult that it has been thus far.


Who knows?


I will end with what Dr. Emanuel has said about what he will do in about nine years,


Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either.


This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.)


After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.


Ezekiel J. Emanuel, M.D., The Atlantic, October 2014.


Food for thought.

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