In the controversial article “Why I Hope to Die at 75” Dr. Ezekiel Emanuel shares his own personal reasons why he would prefer not to live past the age of 75. He portrays life beyond age 75 as a relentless journey into disability, enfeeblement, and desperation in which the quality of life becomes so impaired that dying becomes a better option to living. Dr. Emanuel invites us to consider one of the core questions of aging; “When is it better to die than to continue living?”
“By the time I reach 75, I will have lived a complete life… Dying at 75 will not be a tragedy… At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless… Seventy-five years is all I want to live.”
– Dr. Ezekiel Emanuel, Why I Hope to Die at 75
Dr. Ezekiel is not saying that he is planning on ending his life through euthanasia or physician-assisted suicide when he reaches age 75. At the time of writing this article, he was healthy with no chronic illness; he is not living under the burden of a terminal illness.
“But here is a simple truth that many of us seem to resist: living too long is also a loss… I think this manic desperation to endlessly extend life is misguided and potentially destructive.”
One of the more horrific aspects of aging is the possibility of living past our time. Living too long, however, may also create profound loss in the sense that aging is a process of deterioration that inevitably places constraints on the quality of our experience and the nature of our interaction with the world around us.
The idea of living too long provokes the possibility that the integrity of our life can become so frail that the experience of being alive is subsumed in pain and suffering. To live too long is, in one sense, a loss of dignity. The medical extension of life merely as a means to extend life may only serve to prolong our pain and suffering.
Dr. Emanuel reasons for not wanting to live past age 75 portray a grim and dark vision of old age:
- Incapacitation: Although we are living longer, we are more likely to become incapacitated past 75;
- Desperation: Extending life as an “American immortal” is a form of manic desperation originating in our fear of death;
- Compression of Morbidity: The notion that we can live longer and then abruptly die with a minimum of pain and suffering;
- Functional Decline: Increases in longevity have been accompanied by increases in physical and mental disability;
- Extension of Dying: We have not slowed the aging process as much as we have extended the process of dying;
- Loss of Creativity: By 75 creativity, originality, and productivity are in severe decline;
- Burden of Care: Living too long burdens our children with emotional weights that impair their quality of life beyond reason;
- Living as Long as Possible: Longevity as an end unto itself is not a requirement in living a good life.
Age 75 is an arbitrary chronological marker that Dr. Ezekiel uses to clarify a profound threshold of aging, that is to say, the point of no return between “a good life” and life no longer worth living.
Our Year of Death
The first year of our life is known as our year of birth. Selecting age 75 defines our year of death and arbitrarily defines our remaining life expectancy. While our birth year constitutes a chronological fact, proposing our year of death is a chronological fabrication.
What is the benefit of imagining a specific year of death?
Our fear of death causes the avoidance of life.
To some extent, we live as though we will never die and the inevitable consequence of that approach is regret. When we fail to think about death and dying in an open, honest, and truthful way we are are failing to live.
In a certain sense, proposing age 75 as a year of death shocks us out of our habits and routines and provokes consideration of how we wish to live the remainder of our time. By defining a year of death areas of our life that have been buried and exiled are mercifully revealed.
Of course, the use of age 75 as a marker for the end of life is arbitrary. However, imagining a personal year of death, regardless of the age selected, can become a powerful source of personal change, growth and development.
One remarkable effect of this exercise is that it expands and broadens our relationship with time.
To propose a hypothetical year of death is to reach into the primal truth of time itself. Our felt-meaning of time becomes imbued with the reality of our impermanence and the realization of how fragile, uncertain, and temporary our journey really is.
This realization makes our time here feel far more precious and valuable. The benefit of imagining our year of death is to focus our efforts on leading a life of meaning, purpose, and integrity in the here and now.
My mother died at age 90 and I continue to feel as though she lived past her time. The quality of her life during the final year or two of her life had become so deprived that physical and mental suffering had become the norm. Medical intervention kept her alive but did nothing to improve the quality of her life.
“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, and 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.”
Perhaps Dr. Emanuel’s controversial vision of aging is the most unappealing aspect of his article. However, he is speaking about fierce truths of life and does not insult us with frivolous one-sided optimism about how wonderful old age can be. The simple fact is that old age increases our vulnerabilities, but how they emerge into our life is unique to each individual.
Unfortunately, there is an absence of resilience and also a sense of giving up combined with an unwillingness to adapt to the inevitable circumstances of life in the article. This is one perspective in the article that has inspired harsh criticism.
In addition, his notions of what constitutes “productivity” and “contribution” seem quite limited. He expresses a desire to maintain an existing lifestyle for as long as possible, and once that is no longer possible he concludes that it is better to die than to creatively and spiritually adapt to the natural unfolding of life. This is an unfortunate perspective.
When is it better to die than to continue living?
When do the conditions of living become so painful that death is a better option than life?
I sense that we can live past our time, that is to say, our lives can be medically extended while the quality of our life deteriorates into an irreversible spiral of physical and mental suffering. In these circumstances death can be portrayed as a merciful release from profound irreversible pain.
“And I retain the right to change my mind and offer a vigorous and reasoned defense of living as long as possible. That, after all, would mean still being creative after 75.”
However, it is absurd to imagine a healthy and vibrant 75 year old simply deciding to die because of bloated statistical probabilities that paint a grim image of old age. To “hope” to die at a specific age in a literal sense when the experience of actually being that age has yet to emerge is unreasonable.
In an imaginative sense, defining a year of death establishes a clear point in time when our time here ends. It is a chronological fabrication that provides an approximation of how much time we have left to live. It forces us to have the conversation we don’t want to have.
The value of imagining our year of death is that it ultimately leads us to consider that what we value the most in life, and most importantly, how we can fully embrace life in the limited and uncertain amount of time that we have.