You know the story on US healthcare and the elderly: Our current default is an American tragedy. It’s devoid of truth and candor; it’s inhumane and it’s wasteful. Recent gains in longevity have come by extending the period of disability right before death. Aggressive care treatment is often hoisted onto the frail because caregivers lack the courage to see and state the obvious. But death-denial doesn’t come only from caregivers; patients, families and American culture itself also deny human mortality.
The problem with death-denial is that it leads to inhumane treatment of people. A recent Tweet from Dr. Madhusree Singh (@thinkalot) said it well: “dying is not optional, suffering is.”
As an electrophysiologist, I am a steward of aggressive life-prolonging therapies. I face death-denial nearly every day. “John, this guy needs an ICD.” Then you see him. It’s clear he needs lots of things, not hardly an ICD.
Solving the problem of death denial, infusing care back into the healthcare of the elderly, and cutting wasteful spending will be a tough job. America isn’t Denmark.
The barriers to smart compassionate care are many. One is surely a policy matter: the fear of death-panel-think. Many reasonable Americans fear that changes in policy will eliminate healthcare for them in the future, eg, rationing. Sarah Palin’s fear-mongering greatly impeded progress in end-of-life care. But she’s a politician, such nonsense is normal.
We expect more from physicians, who have a duty to do good, not cause harm. Dr. Ezekiel Emanuel is no normal doctor. He is a bioethicist, a health-policy leader, and an adviser to President Obama. He recently wrote a controversial essay about wanting to die at age 75. My initial reaction to the inflammatory piece was to leave it alone. Don’t promote it. Then it took off on social and mainstream media.
The thing about Dr. Emanuel is that he makes many valuable points. He tells some hard truths about end-of-life and the limits (and dangers) of aggressive treatments in the elderly. I agree with a lot of what he says. But his essay went way too far. And in doing so, he, as a physician-writer, created harm rather than benefit.
I hope you want to read my 1200-word take over at Medscape Cardiology. If you do, click on the title of the piece: Dr Emanuel’s Death Wish Harms Rather Than Helps
JMM
6 replies on “New post up on theHeart.org — Dr Emanuel’s Death Wish Harms Rather Than Helps”
Your rebuttal to Emmanuel was very finely written and well argued, but I find myself leaning heavily towards his view. My father was one of the three smartest people I’ve ever known. At 75 he was still sharp as a tack, if starting to watch Fox News a little too uncritically. He’s now in his mid-80s with mid-stage Alzheimer’s, rapidly declining quality of life, and an allopath who is keeping him on beta blockers – he’s never had a cardiovascular event – because she thinks they just hafta make him live longer somehow. (Principle of nonmaleficence?) He was too healthy to have a chance to die of something else at the average life expectancy – but it would have been fortunate for him if he did. I’ll be happy to accept natural death a little earlier if it saves me from the choice between shooting myself – which I do consider preferable under such circumstances – or ending up as a nursing home zombie.
It’s my understanding that Emanuel has made the personal choice (In no way a recommendation for others) to forego extraordinary measures IF any serious health issue arises after he reaches the age of 75.
The title of the piece was not his doing.
Emanuel explains himself in this interview:
http://onpoint.wbur.org/2014/09/23/end-of-life-care-health-care
Nutrition and exercise are also key to health and optimal functioning as we age.
One reasonable theory explaining the onset of disability and dementia is the consumption by most of us of the increasingly unhealthy standard American diet, and our inert, sedentary lifestyles lived in front of the computer or television screen
But it is our human gift to be capable of learning and progressing throughout our lives, and to be able to change our minds and lifestyles taking into account new information.
Great strides are being made in the science of aging every day. Read the latest on Brain-derived neurotrophic factor (BDNF) research.
Vigorous exercise has a neuroprotective effect, especially in the elderly.
It could well be that by the time Dr.Emanuel turns 75, thanks to the advancements of science and the optimistic vision of the “immortalists”, 75 will really be the new 45.
Sounds like he had a bad experience with his last colonoscopy. Ha!
I feel sorry for someone who measures life’s value in terms of productivity rather than quality of relationships with family and friends. After I stopped laughing at the dumb graph, I started thinking about the movie “Soylent Green” and drifted off.
Writing like this is why people in academia need to get off campus once in awhile to get in touch with reality.
Oh and I thought he was already 75. All he needs now is a “Hurry Cane”.
My father died at the age of seventy-five. He was strong, active, had all his wits, and he was still ambitious. In the seven years he had after retirement he built a cottage at the South New Jersey shore and rebuilt a twelve foot sailboat, teaching himself how to sail it. He exercised daily — moderate weights and hiking.
He had much more planned when he died of a massive stroke due to AF.
He had refused to see a doctor. But then, in 1973, what would a doctor have been able to do for him?
So, my father fulfilled Emanuel’s prescription precisely.
What a loss!
I’m seventy. I see an electrophyiologist, you betchha!
John,
Spot on – once again. The title of his article alone is downright irresponsible. While he raises important questions that all individuals need to wrestle with, he just goes a step too far in implying that his way of thinking is better. The point that his way of thinking is only right for him and may not be right for others is completely lost even if he gave some lip service to it.