Zeke Emanuel has unleashed a bit of a stir with his recent article in The Atlantic Monthly, “Why I Hope to Die at 75.” In just the past week, two responses to Emanuel have appeared in the Chicago Tribune, one by Mary Schmich, a regular Trib columnist and the other presenting an opposing view from a Chicago physician. My own posting of the link to the article on the Facebook page for clergy in my denomination generated a flurry of responses.
Manuel’s musings carry some weight. He’s the Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and was the founding chair of the Department of Bioethics at the National Institutes of Health until a few years ago. And besides it all, he’s an oncologist.
He makes a pretty strong and reasoned case for 75 years as a complete life. Even though there is loss for family when someone dies at that age, he writes, there is an equally compelling loss for living beyond that. (Really you should read the article.) I don’t think you have to agree with everything Emanuel argues to be grateful at way he has opened up and important and significant conversation. Emanuel labels our obsession with prolonging life, “The American immortal.” We snicker at the ancient Spanish explorers galavanting around the Americas searching for the fountain of youth; yet we have made their search look sane compared to the amount of money we spend to put off the inevitable. He writes, “I think this manic desperation to endlessly extend life is misguided and potentially destructive.”
I couldn’t agree more. As someone whose vocation is in part to help guide people spiritually through the end of their life and into the life beyond, I have seen the incredible burdens the denial of death places on persons and their families.
And it has often struck me in the middle of it all that we seem to pay only lip service to what is at the heart of our faith, namely, that the gift of life that we have here, while important and significant, is temporary, the down payment on a life that will last through our physical death. What does it mean, for instance, for Paul to write in his letter to Philippians, “For me to live is Christ, and to die is gain?” We’re happy to talk about the part about living in Christ now; but we act as if we don’t believe the part about dying as gain.
Even more troubling to me is the way we clutch on to this life with a white-knuckled grip. We seem to be willing to go to any expense, any trouble, and grasp at any thin hopes in order to prolong what we know rationally to be only temporary in the first place. Eastern religions have long suggested that we can only find happiness, fulfillment, and satisfaction in life by letting go, holding on loosely, if you will. And while this thematic thread hasn’t been emphasized in western Christianity, I wonder if it might be in part what Jesus was getting at when he said, “Whoever tries to keep their life will lose it, and whoever loses their life will preserve it.” (Luke 17:33)
I wonder further about how the notion of the stewardship of life plays into all this. Emanuel makes a glancing reference to the matter of stewardship when he talks about using up resources that might support the coming generation when we enter into costly treatment after treatment only to stave off for a time when we all know is inevitable. I think the matter of the financial cost of extraordinary medical treatment is worth thinking about, but I think it goes even deeper than that. The emotional energy required to care for the feeble and frail is staggering and often issues in both emotional and physical exhaustion. I ask again: for what purpose? To stave off for a time what we know is inevitable.
Some of the criticism of Emanuel has been of his equivalence of creativity and productivity with the worth and value of a life. What about relationships? Relationships give value and worth to people; relationships are important, enduring, and nurturing beyond physical and mental vitality. There’s no question about that. Yet that’s only one side of the equation. These relationships, too, are only temporary; we talk about the persistence of relationships beyond death, though I’m not willing to say with precision what that means. At the least, it’s not necessary to put a one-sided value only on relationships this side of physical death as if that’s all there is.
Some of the negative reaction has been to point to examples of creative and productive life after 75. Emanuel doesn’t dispute that. Neither do I. What’s at issue is that at some point, all of us have to come to terms with this reality: our life is temporary; we are going to die. And to grapple with the question of the cost of prolonging life by medical intervention, often extensive and expensive medical intervention.
I’m prone to agree with the heart of Emanuel’s argument. I might argue about whether 75 is the age; maybe it’s 80 for me. More than that, I want to cultivate now the character of hanging on to this life loosely. I want to live it in gratitude, to steward well my physical, emotional, and intellectual health, to live in the vitality of good relationships with my family, friends and others whose accompaniment on this journey brings delight. I want to participate in the work God has given me and us toward the redemption and healing of the world. And I want to live every day in the knowledge that it’s temporary. When it’s over, I want simply to give thanks and live into the fulfillment that I cannot even imagine.
About ten years ago, I taught a several session adult forum at our congregation exploring the Christian theology of death. Through the course of those six weeks, we had some pretty amazing and candid conversations. There was something significant about opening a necessary and helpful conversation for which no one seems to want to break the ice. I’m glad Zeke Emanuel has given us another opening.
Generally I agree with your postings, but on this one I am horrified. I have just completed four grueling years of treatment for breast cancer that included six surgeries, chemo, radiation and three life threatening infections. I am now 66 and very excited about the arrival of my fourth grandchild next spring. I have a lot left on my bucket list and the thought that I should want to “check out” in nine years is appalling.
True, I would love to die suddenly in my bed with no fuss. I am a psychologist (now retired) who worked in rehabilitation and oncology. I am appalled by families who insist on every possible life sustaining intervention when death is inevitable. I have an advanced care directive in my wallet that outlines what sort of care I want if and when I cannot direct my own care.
However 75 seems way too young for a “best before date”. My church community includes a 110 unit independent apartment for people 55+, although the average age is 86, and a 22 bed assisted living unit where the average age is 92. Most of the “past their sell by date” seniors there have great quality of life and contribute actively to the community. Many still travel, exercise daily and attend theatre and other events. I have seen several congregational members move into the apartments when their health deteriorated and are given a new lease on life in the community. Our church recently debated the purchase of a defibulater. The residents council asked us not to purchase one as most of them have advanced care directives that preclude resuscitation.
During my cancer voyage, I had to face the possibility of death several times. I learned that I am not afraid to die but I don’t want to die yet. I certainly don’t want to live in persistent vegatitve state and have many that clear to my family. However I hope to have many more years than just the nine you suggest that I deserve.
Thanks so much for your response, Jo. First, let me say that I’m sorry to hear about the struggle you have faced with cancer. I hope that your cancer is in remission. It sounds like there are some commonalities in how we view the end of life. As I said in my piece, I’m not sure whether 75 is the magic number. I’m not sure what it is. Still I agree with Dr. Emanuel that at some point, the stewardship of this life calls for making a pretty clear decision about heroic medical treatment. I have had the same experience that you describe, of people well into their 80s and 90s who live active vibrant lives. We have a 102 yr old who still comes to church each week in high heels and was working at a local dress shop until she was 97. She has been able to do that without teh kind of intervention described in Emanuel’s article. He acknowledges that; and suggests that they are the exception rather than the rule. That is true in my experience, too. I would take issue with your statement that I have suggested that you only deserve 9 more years of life. I’m not sure how we talk about how much life we deserve. In my view it’s all gift, years to be lived gratefully, and when death comes, at whatever age that is, that we can enter our new life with that same sense of gratitude and wonder. Again, I’m really grateful for your response, and I hope that you will find ways to engage this conversation in your faith community and with the people around you. Oh, and thanks for reading!!