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Ezekiel Emanuel
Emanuel: Let me die at 75.

It’s good to be old, just not too old.

That’s the crux of The Great Longevity Debate, reignited last week by David Brooks in The New York Times. Brooks takes issue with University of Pennsylvania oncologist Ezekiel Emanuel, who proclaimed rather loudly in a recent essay in The Atlantic that he’d like to die at 75, thus avoiding the decrepitude that typically accompanies life after 80. That would be a mistake, Brooks writes, because Emanuel would be missing out on the happiest years of his life.

“When researchers ask people to assess their own well-being, people in their 20s rate themselves highly. Then there’s a decline as people get sadder in middle age, bottoming out around age 50. But then happiness levels shoot up, so that old people are happier than young people. The people who rate themselves most highly are those ages 82 to 85.”

I don’t like to take sides in this sort of thing, because it’s not particularly helpful to generalize about aging and quality-of-life issues. Everyone has their own ideas about what constitutes a happy life; you’re the only one who really knows when and under what circumstances you might be ready to die.

The other night, I brought the topic up at the dinner table. “I’ve lived a pretty full life,” I told My Lovely Wife. “If it was all over tomorrow, I guess I’d be OK with that.”

She gave me that look. “Well, I wouldn’t be,” she said.

It was not meant as flattery. “It’s not all about you,” she noted. Family, friends, colleagues would all feel the loss in ways I obviously haven’t yet calculated. Besides, she added, “You don’t get to choose.”

Emanuel mentions his wife and family only in passing, noting that his daughters are not overjoyed by his life-limiting declaration, but he argues that letting nature take its course in later life (avoiding tests, screenings, surgery, and other medical interventions) will save them from having to watch him linger on into helplessness and being burdened with his care. This is one of the results of our culture’s embrace of what he calls the “American immortal,” the notion that extending life at any cost or consequence is always preferable to death.

“I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy. What I am trying to do is delineate my views for a good life and make my friends and others think about how they want to live as they grow older. I want them to think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging. Are we to embrace the “American immortal” or my “75 and no more” view?”

Emanuel admits that 75 is a pretty arbitrary number, and at 57 he’s still got 18 years to reconsider his position. He’s in good health (he and his nephews climbed Mount Kilimanjaro last summer), at the top of his game, so I’m sure it’s a rather appealing thought experiment. I mean, who’s going to bring it up on his 75th birthday?

But I can’t help but think his larger point here is buried slightly beneath the provocative headline: Maybe it’s not really that great of an idea to conform to the conventional Western medicine approach to healthcare. Especially as you enter Geezerville, but perhaps during your younger years, as well. We’ve seen plenty of evidence in recent years that skipping those routine health screenings and generally staying away from the doctor’s office might have salutary health benefits for folks who exercise regularly, eat right, and manage their stress.

In fact, I’d encourage Emanuel to launch his new health directive sooner rather than later. I’ve got a feeling that if he actually goes through with his plan, he’s going to live way past 75. And I’ll bet he’ll be happy that he did.

Thoughts to share?

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