Dr. Ezekiel Emanuel is certainly not the first - and won’t be the last - to argue that life past a certain, arbitrary point is not worth living and one should have the good sense and patriotic spirit to stop being a drain on society – especially on the health care system.
For Emanuel, that age is 75, which in his case is 18 years away. Of course, as he reminds us emphatically in a recent essay of almost 5,000 words in The Atlantic, he is not calling for euthanasia.
This is just his own personal decision, he says, that by age 75 he will have lived a full life, will be in inevitable decline, will no longer be capable of achieving what he could in his prime and therefore he will no longer seek or accept medical care for anything other than easing suffering if he has a terminal disease.
So, relax, it’s not about the rest of us.
I don’t think so. Emanuel is not some anonymous country doc whom The Atlantic decided to publish because he turned out to be a surprisingly good writer.
He is the brother of Rahm Emanuel, current mayor of Chicago and former chief of staff to President Barack Obama. He is one of the chief architects of Obamacare, about which anyone who suggested that it might ultimately include such a thing as “death panels” – boards that would decide whether treatments and care were worthwhile for certain patients or groups of patients – was relentlessly mocked.
Besides those uber political connections, he is director of the Clinical Bioethics Department at the U.S. National Institutes of Health and heads the Department of Medical Ethics and Health Policy at the University of Pennsylvania.
So when he issues as persuasive an argument as he can that the sensible and ethical thing is to stop receiving health care upon age 75 – and that he is prepared to set the example – it is not just about him.
He marshals statistics about how medicine and technology have prolonged life but have not prolonged the quality of life; they have simply elongated the process of dying. He warns of a “tsunami of dementia” among elders still taking up expensive space beyond their sell-by date.
It is not just the cost of medical care and a loss of productivity. His theme is that while death is a loss, so is living too long. “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,” he writes.
Is that just about him? Notice he said “we” not “me.”
It is important to note that this is the way fundamental and sometimes transformational shifts in societies begin – with an engaging “conversation” that seeks to mask the endgame. I recall meeting an attorney representing gay and lesbian couples sometime around 2001 who said repeatedly and emphatically that she and her clients had no interest in legalizing gay marriage, they just wanted “tolerance” for civil unions.
Sure. “Civil unions” sound almost quaint these days, don't they?
So, whether Emanuel is personally opposed to euthanasia or not, he is urging us to head in that direction.
Quick disclaimer: I would agree with Emanuel if he simply argued that “heroic” measures to prolong life are unnatural, ethically questionable and a waste of resources. I have already put in writing that I don’t want any of that on my behalf.
But he is talking about refusing (or withdrawing) basic care of those whose lives are otherwise not threatened – treatment for the flu, setting a broken leg, repairing a hernia, etc.
There is deep irony in his declaration that he is opposed to assisted suicide or euthanasia because those who seek it suffer mainly from “depression, hopelessness, and fear of losing their dignity and control.”
How, then, does he expect elders to feel when he says that, past 75, they are "feeble, ineffectual, even pathetic?" Depression and hopelessness come to mind.
What does he think will happen if America’s leaders adopt his thinking, that health care past age 75 is a waste of the country’s resources?
Beyond that, Emanuel misses the reality that age and infirmity can teach all of those involved - i.e. friends and family members - powerful lessons about love, even when it is not easy and we are no longer beautiful, strong and smart.
My own father, a prominent intellectual, was so disabled by dementia that he didn’t even know his children at the end of his life. We did not seek to prolong his life when death approached.
But those last months were still precious to us, because they allowed us to honor and care for him when he was no longer able to do it for himself. And we remember him not only as he was at the end, but as strong, vigorous and brilliant.
It is also ironic is that this is coming from a member of the liberal intelligentsia – the party that supposedly subscribes to the line that “a civilization is measured by the way it treats its weakest members.”
The final irony is that Emanuel ends his essay by saying he reserves the right to change his mind once he reaches 75. Good luck to him. By that time, if society embraces his philosophy, he will not have that choice.
Taylor Armerding is an independent columnist. Contact him at firstname.lastname@example.org