In a recent article in The Atlantic, Dr. Ezekiel Emanuel says that he wants to live until he is 75 years old and no longer. There are a lot of ways in which one might take issue with the arguments he makes in that article. I disagree with him that euthanasia and physician-assisted suicide should be illegal. I’m all for them. My only regret is that, living in Texas as I do, there is no way that such practices will become legal in time for me to avail myself of them. Others, such as Peter Thiel, may disagree with his acceptance of death, preferring to fight it instead. Others still may agree with Emanuel’s acceptance of death, but argue that 75 years of age is not necessarily the optimal time to die. Finally, if we grant that 75 years is all one should live, is his strategy for achieving that goal a good one?
There is a lot to sort out here, but the first thing that jumped out at me is that Dr. Emanuel is 57 years old. It has often been noted that “old” is 15 years older than whatever age you are. Since 75 is 18 years away for Dr. Emanuel, he has that and 3 to spare. This leaves us with the suspicion that his blasé attitude toward death is a function of its being remote. His arguments would have greater force if he had just turned the very age he regards as the perfect time to die. James Boswell notoriously visited David Hume on his death bed to see if the skeptic (and likely atheist) would renounce his philosophy and pray to God for forgiveness so that he might have the hope of eternal life. Instead, Boswell generously reported in Hume’s favor, recounting the lively chat they had, including a debate about the existence of life after death, in which Hume argued forcefully that there is no reason to believe in such a thing. And it may be that 18 years from now, Dr. Emanuel will be consistent in his views about death, but like Boswell, a lot of us will be curious to see what his views are when it really counts. Of course, not everyone has to wait until he gets old to start taking death seriously. I have known people to dread the prospect of death even though they were young, in good health, and in no physical danger.
I saw Dr. Emanuel on Morning Joe yesterday discussing the article he had written. He appeared to be in good spirits, and he is apparently in good health. Just as we cannot help but wonder if he will hold the same views when he is older, we likewise wonder if he would say the same things if he had a serious disease. And this question leads to what might seem to be a total change of subject. Film critics disagree about the reasons film noir became so popular after World War II. These movies were somewhat downbeat in nature, with their doomed victims of fate, femme fatales, hard-boiled private eyes confronting the dark side of human nature, sex and crime gone wrong and leading to death. Some critics argue that these films matched the mood of the American public, having been through the Great Depression and the Second World War, and then confronting the threat of communism in a nuclear age. As such, the public was in no mood for facile films with happy endings. Other critics argue quite the opposite, saying that with the war’s being over and the improving economy, people could finally allow themselves the luxury of watching these dark films. It was when times were hard that they needed uplifting movies, the point being nicely illustrated by the movie Sullivan’s Travels (1941), where a director who wants to make a serious movie ends up in prison and discovers how much comedies benefit the lives of those who are miserable.
For a while, I preferred the first argument. But then I got a PSA result indicating that I probably had prostate cancer. From the time I called the urologist to make an appointment until I had the prostate removed and was given reasonable assurance that it had not metastasized was about 6 months. I would characterize my mood during this time as somber. And during this time, I had no interest in watching a film noir, even though it is one of my favorite genres. Instead, I watched almost nothing but comedies. But as soon as I found out that my cancer was probably gone for good, I was ready once again to see a movie about some hapless victim of fate fall under the spell of a femme fatale leading him into a nightmare of murder and death. If I am any indication, it was the second theory about the emergence of film noir that was true. It is when people are feeling good that they can enjoy depressing movies. And so it is that I suspect that it is because Dr. Emanuel is feeling good right now that he can blithely throw away the years of his life after 75.
Speaking of prostate cancer, Dr. Emanuel tells about how his urologist tested him for prostate cancer even though he, Dr. Emanuel, said he did not want the test done.
When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.
Dr. Emanuel tells this story as if it were in line with his position, but it actually undermines it. Had he said instead, “The doctor told me what the PSA level was, and I told him he should not have bothered because I don’t intend to do anything about it,” that would have been consistent with his professed attitude. But the fact that he hung up before the doctor could tell him the result makes it clear that he did not want to know. It is hard to avoid the conclusion that he fears the knowledge because it might weaken his resolve. If he cannot face just knowing what his PSA level is, we cannot help but wonder how much resolve would be left in the face of more serious symptoms.
Another weakness in his argument is his position on suicide.
Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide.
What is he afraid of? Breaking the law? A person might reasonably argue that legalizing physician-assisted suicide is a bad idea for all the reasons stated in the article, and still end his life by his own hand when he decides he no longer wants to live. In other words, anyone who says he does not want to live past the age of 75 must give a better reason for not committing suicide than simply talking about his position on whether euthanasia should be legalized.
He does, however, give one reason that applies to both situations. He says, “The people they leave behind inevitably feel they have somehow failed.” Our friends and family will accept our death better if it appears to be natural than if we have committed suicide.
However, Dr. Emanuel carries this concern for the people we leave behind into a rather bizarre realm:
But parents also cast a big shadow for most children. Whether estranged, disengaged, or deeply loving, they set expectations, render judgments, impose their opinions, interfere, and are generally a looming presence for even adult children. This can be wonderful. It can be annoying. It can be destructive. But it is inescapable as long as the parent is alive…. Living parents also occupy the role of head of the family. They make it hard for grown children to become the patriarch or matriarch. When parents routinely live to 95, children must caretake into their own retirement. That doesn’t leave them much time on their own—and it is all old age. When parents live to 75, children have had the joys of a rich relationship with their parents, but also have enough time for their own lives, out of their parents’ shadows.
No one wants to become a burden to his children. But the idea that merely by continuing to exist, you make your children feel small and inadequate, and thus it would be better for them if you die so they can sit at the head of the table for a while is one of the strangest arguments I have ever heard. I get the idea about living in your parents’ shadow, for I have lived in that shadow myself. And I recall Carl Jung saying that some of his male patients could not reach the final stage of growth as long as their fathers were still alive. It is the part about this being a good reason to die that is peculiar. Besides, if you die, who will do all that babysitting?
Finally, there are the strategies he intends to employ in order not to live much past 75. He seems to be intent on avoiding any test or procedure whose function is simply to prolong his life. One hopes, and I will give him the benefit of the doubt, that he will see the doctor for quality of life reasons, such as getting a glaucoma test. If he ends up living to be 95, I am sure he would just as soon not be blind for 20 years.
But that distinction is not always so easy to make. Usually when people talk about prostate cancer, for example, they say that men often die with prostate cancer but not from it. When my doctor first discovered my elevated PSA, she mentioned how long I could be expected to live with such a cancer as opposed to how long I could be expected live even if I were cancer free. But what she did not mention was what it is like to have metastatic prostate cancer. When I was first diagnosed, my urologist wanted me to have a PET scan to see if there was a tumor on my spine. I didn’t have one, but it started me thinking. A tumor on the spine would eventually hurt. Maybe I would not live any longer by having the prostate removed, but living without a tumor on the spine would definitely be a plus.
And then Dr. Emanuel said he would stop getting flu shots at 75. When I get a flu shot, I don’t get it because I think it will prolong my life, even though I know that influenza can kill you. I get the vaccine because the last time I got the flu I wanted to die. In fact, I dreamed that the universe had become locked up, and everything was frozen in place. And that meant I would have the flu and all its symptoms for eternity. I woke up but I really did not wake up, but was caught in a kind of hallucination. Tears came down my face because I remained convinced that something terrible had happened to the universe and I was trapped in it.
So, I will continue to get the flu shot and lots of other medical care, not because I want to cling to life, but because it is not always easy to distinguish what will merely prolong your life and what will help maintain its quality.
And I don’t have any children living under my shadow who need for me to die in order for them to complete their journey through life. As a confirmed bachelor, I never let the little bastards out of the void.