Why Would a Perfectly Healthy, Wealthy, and Happy Person Hope to Die?

In the October 2014 issue of The Atlantic magazine, oncologist Ezekiel J. Emanuel published a 5,000-word article with the provocative title “Why I Hope to Die at 75.” The article was accompanied by a photo of the author with a broad grin on his face. He did not look forward to an early death because he was depressed, but rather for some, to my mind, dubious philosophical reasons.

Emanuel predicts that by the time he reaches age 75 he will have lived a complete life. He will have lived to see his children grow to adulthood and have children of their own. He will have made whatever contributions to the world that he is likely to make. He wants to go out while still on top, avoiding the downsides of hanging on too long.

Addressing fellow Americans specifically, Emanuel made several assertions, including:

  • Americans today may live longer than their parents, but they are likely to be more incapacitated.
  • Over the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process.
  • Medical science has been ineffective at countering Alzheimer’s disease and other dementias.
  • Older people become slower, both physically and mentally, and are less creative.
  • Living longer puts a caregiving burden on the next generation.
  • Parents sticking around prevent their offspring from assuming the mantle of the head of the family.
  • Children and grandchildren will remember you as stooped and sluggish, and forgetful and repetitive, rather than active, vigorous, and engaged.

Emanuel looks at the glass and to him it appears to be half empty. I look at the same glass and it is clear to me that it is half full. There is still quite a lot of water in it.

When Emanuel wrote his piece for The Atlantic, his seventy-fifth birthday was 18 years in the future. For me today, my seventy-fifth birthday is less than three years away. From where I stand, his assertions seem to ignore the major strides being made in knowledge of healthy living and in learning the causes of and remedies to the declines caused by aging. Let’s take them one by one.

  • Americans today may live longer than their parents, but they are likely to be more incapacitated.

This does not reflect my experience, or that of many of my contemporaries. Both of my parents were in worse shape than I am now, at a much younger age. They were overweight and sedentary, suffered from high blood pressure, and had heart problems and diabetes. None of those things are true of me.

Both of my parents have now passed on, my father at an age seven years younger than what I am now. Sure, there are some people today who are in worse shape than their parents were at the same age, but I believe they are in the minority. Fewer people are smoking today than was true a generation ago. More people may be obese today than a generation ago, but you will not find among them the people Emanuel derisively calls the American immortals. He is referring to people who exercise, watch their diet, and take nutritional supplements. These people have the biological age and disease profile of people of a significantly younger chronological age. They are not chasing immortality. They are merely working to keep robust health and high functionality for as long as possible, based on current knowledge.

  • Over the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process.

The fallacy with this observation is that medical knowledge and practice of the past 50 years is not the same as the medical knowledge and practice of today. Fifty years ago, twenty-five years ago, even ten years ago, there was no field of study whose object was the halting and reversal of age-related decline. Today, the new field of regenerative medicine is exploding, with major advances being announced on almost a daily basis. The old rules don’t apply any more.  Whereas Western medicine has traditionally relied on drugs to cure disease, now genetic engineering, molecular machines, and other recent technologies are opening entirely new avenues to treat the damage caused by aging and thereby to restore robust good health.

  • Medical science has been ineffective at countering Alzheimer’s disease and other dementias.

The fallacy of this assertion is the same as the previous one. The medical science of the past had no idea what was causing Alzheimer’s disease, so of course was ineffective in countering it. With powerful tools that have recently come on line, researchers are finally figuring out causes, and effective interventions are appearing on the horizon.

  • Older people become slower, both physically and mentally, and are less creative.

This assertion is largely true, but so what! I cannot run as fast or as far as I could when I was 30, but I still run. Perhaps regenerative medicine will someday return me to the physical ability I had at age 30, but even if that does not happen, I expect to be able to continue to engage in many activities that I enjoy. Today, it may take me a little longer to solve a hard sudoku puzzle than it did when I was younger and I may not be as successful at blitz chess as I used to be, but I can still be as competitive as ever at classical chess.

I don’t think I am any less creative than I was at a younger age. I didn’t win any Nobel prizes back then either. I am still writing books and articles and am about as prolific now as I have ever been. I expect that to continue until I am well past age 75. Even Emanuel mentions an eighty-year-old collaborator who was still making major contributions to his field. He dismissed him as an outlier. I suspect that there are a lot more “outliers” than Emanuel imagines, many of them among the American immortals.

  • Living longer puts a caregiving burden on the next generation.

Regardless of whether lives are longer or shorter, a caregiving burden will be placed on the next generation. If lives are longer, the next generation is more mature and better able to handle the responsibility. Not only that, but the caregiving burden is much diminished if it is healthy life that is extended rather than prolonged illness. People who are consciously trying to live longer are doing so by making lifestyle choices that extend healthy life, not just calendar years.

  • Parents sticking around prevent their offspring from assuming the mantle of the head of the family.

This is a pretty weak argument. But at any rate, should not be an issue for most people. My grown children have become the heads of their own households. I didn’t have to die for that to happen. I don’t think my experience is unusual.

  • Children and grandchildren will remember you as stooped and sluggish, and forgetful and repetitive, rather than active, vigorous, and engaged.

This argument is even weaker than the previous one. What people think of me after I am gone is no concern of mine. They will have their own lives to live and they will think what they will think. My legacy will be the things I have done to help people throughout my life. Regardless of that, I don’t believe I am fated to end up stooped and sluggish, forgetful and repetitive. I am working hard to maintain my health and vitality, and as new medical advances are made, I intend to take advantage of them to extend healthy life.

After 5,000 words on why Emanuel does not want to live past age 75, in the last paragraph, he gives himself a golden parachute. He says “And I retain the right to change my mind and offer vigorous and reasoned defense of living as long as possible.”

What a cop out.

My advice to you? “Live long and prosper.”

Leave a Reply