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A doctor’s argument against living longer

October 3, 2014 at 6:17 PM EDT
Dr. Ezekiel Emanuel, an oncologist and one of the country's leading health care experts, says by age 75 he would opt out of medical treatments in order to not prolong his life in favor of letting nature take its course. Emmanuel joins Judy Woodruff to discuss his provocative essay published in The Atlantic, "Why I Hope to Die at 75."
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JUDY WOODRUFF: Next: a provocative piece of writing from one of the country’s leading health care experts.

In the current “Atlantic” magazine, Dr. Ezekiel Emanuel argues that the quality of human life begins to drop off by age 75, enough, he says, that he will opt out of medical treatments and let nature take its course.

A trained oncologist, Dr. Emanuel is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and a former Obama administration policy adviser. He is also older brother to Chicago Mayor Rahm Emanuel and Hollywood talent agent Ari Emanuel. I sat down with him earlier today.

Dr. Zeke Emanuel, thank you for talking with us.

DR. EZEKIEL EMANUEL, University of Pennsylvania: It’s my great pleasure.

JUDY WOODRUFF: So, you have created quite a stir: “Why I Want to Die at 75.”

Why 75? Why not 85? Why not 70?

DR. EZEKIEL EMANUEL: Well, first of all, let’s clarify, I expect to be alive at 75, and I’m not going to kill myself. I don’t believe in legalized euthanasia or assisted suicide, but I am going to stop medical treatments.

And I look at 75, when I look at all the data on physical disability, dementia, Alzheimer’s disease, loss of creativity, slowing down of the mind and the body, and 75 seems like that, albeit somewhat arbitrary, moment where you get the maximum chance you’re still going to be vital and alive and vigorous.

JUDY WOODRUFF: So it’s kind of arbitrary.

DR. EZEKIEL EMANUEL: I say that, yes.

JUDY WOODRUFF: And you talk about something you call the American immortal. Who is this being?

DR. EZEKIEL EMANUEL: My brother. The American immortal are people who want to put off death as long as possible, want to live as long as possible, get every day out of it. They take all these — they change their diet. They exercise like mad. They take protein concoctions and all sorts of other supplements.

And it’s almost a religion for them to live as long as possible. And I think they — in their mind, they will be as vital as they are when they’re, say, 50 all the way to the end. But, of course, we all do deteriorate, we all do slow down, we all do get disabilities.

JUDY WOODRUFF: You looked at a lot of research for what you have written, and you talk about how, as you age, you really don’t get healthy. No matter how hard you try, a lot of things creep up on you.

DR. EZEKIEL EMANUEL: Yes, so there’s a theory which was developed in the early 1980s at Stanford, of course, that there will be a compression of morbidity.

So, as we age, as we get older, we are actually going to become healthier, that the falling apart, the disabilities, the dementia, they’re going to become ever smaller parts of life. And that was a very, very compelling theory, and a lot of people grabbed on to it.

Turns out that’s not true. The data are that, as we age, we have actually added more years of disability, so there’s not a compression of morbidity. There’s actually been an expansion, and that I think is — it’s somewhat distracting for people to realize, yes, we will live longer, but we will also live with more functional limitations, less able to move around, more mental limitations, more psychological depression, and other mental problems.

JUDY WOODRUFF: You put — you’re pretty critical in this piece, Zeke Emanuel, of slowing down, of living a quieter life, of spending time smelling the roses.

(LAUGHTER)

JUDY WOODRUFF: You talk about riding a bicycle and making poetry as if it’s just, you know, a throwaway. What’s wrong with having that quiet phase of life after a certain point?

DR. EZEKIEL EMANUEL: I do — I mean, that is part of my view, that, you know, we’re on the earth for a very short period of time, no matter what we do. Even if we’re an American immortal, it’s not going to be for centuries.

And we have to get the best out of it and also get the most out of our life. It’s a privilege, obviously, slowing down and being a little sort of self-indulgent. I don’t find that as meaningful to me. And I find it a little sort of focused on me, instead of focused on what I can contribute and what I can do for bettering the world and bettering, you know, my family and my community.

JUDY WOODRUFF: So, you’re kind of saying unless you’re contributing actively every minute of every day, practically, then really there’s not much point in living?

DR. EZEKIEL EMANUEL: Well, first of all, that’s my personal philosophy. And I do believe that contributing can happen in a number of different ways.

JUDY WOODRUFF: You know there’s a lot of pushback from people who point to all the people we know of who are very contributing well beyond 75.

I just look — you look at anywhere you turn. I mean, in the world of entertainment, it’s so easy, the Jack Nicholsons, the Willie Nelsons, the  Sidney Poitiers. I mean, Betty White is 91, I.M. Pei. Queen Elizabeth is 88. Jimmy Carter just turned 90.

DR. EZEKIEL EMANUEL: So, that’s almost everyone’s first reaction is to begin listing lots and lots of people who are over 75 and still creative, productive and engaged. And of course there are going to be people.

It’s a bell-shaped curve and it’s some-shaped curve, there are going to be outliers, people over 75. But let’s remember we live in a country of 300 million people. In the developed world, Western world, there may be a billion people. Giving me a list of 20, 30, even thousands of people who are creative after 75, you have to understand those are very select outliers.

They are not the common thing. And I believe that we shouldn’t — we can’t live our life as if we’re going to be a very rare outlier. Odds are, you won’t be an outlier, and I tend to go with the odds. I’m a sort of — I live life by, you know, what does the data show? And that’s most likely to happen.

JUDY WOODRUFF: What does your family think about this? You have how many daughters?

DR. EZEKIEL EMANUEL: I have three daughters.

JUDY WOODRUFF: Three daughters. Don’t you want to see your grandchildren grow up?

DR. EZEKIEL EMANUEL: Absolutely. And I want…

JUDY WOODRUFF: But you have put kind of a limit on it, haven’t you?

DR. EZEKIEL EMANUEL: Well, I am very, very committed to seeing my grandchildren.

And what I really, really care about is how they remember me. And I want them to remember me vital, doing crazy things with the kids on the swings and the slides and the playgrounds, maybe taking them on trips and, you know, kayaking around the Everglades or in Alaska. I don’t want them to remember me as frail or demented or repeating myself. I would think that would actually be a tragedy.

JUDY WOODRUFF: But isn’t there something, some value in the — just being there for family, whether you’re 75, 85, 95, and your family is around you, and isn’t there some personal value…

DR. EZEKIEL EMANUEL: Connection?

JUDY WOODRUFF: Connection.

DR. EZEKIEL EMANUEL: Look, I think there is a very important connection, and — but I think if you’re just confined to a chair or you’re demented or you’re sort of just very slow, it may not be as meaningful as we try to project.

JUDY WOODRUFF: One last thing. You said you have heard from doctors, medical professionals. You have heard from a lot of people who are very critical of what you have written. What are doctors saying?

DR. EZEKIEL EMANUEL: Well, I have heard from hundreds, if not thousands of people now. One category is people who violently disagree with me and think I’m crazy, one category of people who do agree with me and think I have got it exactly right.

And that, about half of those people are in the health professions. They’re doctors, they’re nurses, they work at health insurance companies, they work at home health care agencies. And they almost uniformly — I have been racking my brain to think of one who’s a health professional who doesn’t agree with me. They almost uniformly say, yes, you’re absolutely right.

JUDY WOODRUFF: And, by the way, you also say in this piece at the end you reserve the right to change your mind.

DR. EZEKIEL EMANUEL: Look, by 75, it really is a complete life. You will have grown up. You will have picked a career, worked hard in the career, had kids, raised them, had grandchildren. What more could you ask? That’s a very rich, rich life.

JUDY WOODRUFF: But it’s a number that could change, right? In 100 years, it could be 85 or 95.

(LAUGHTER)

DR. EZEKIEL EMANUEL: I know there are many people who think that will be true.

JUDY WOODRUFF: Well, we’re going to continue this conversation online.

But, for right now, Dr. Zeke Emanuel, thank you.

DR. EZEKIEL EMANUEL: Thank you for having me. I really appreciate it.

 

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