<p>I found the argument that the older generation needs to get out of the way so that their adult children can live their lives freely very strange. There is really something wrong if an adult over 30 feels overshadowed by his or her parents. </p>
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<p>Both of my parents died this way. Several years apart, in different parts of the country (they were divorced), each of them sat down on the couch and never got up. Both were completely independent, living alone, and able to drive at the time. Both had some health problems and limitations, but nothing that required hospitalization or nursing home care. My mom was 75; my dad was 83.</p>
<p>During those “extra” 8 years, my dad acted as the caregiver for a sister who was in poor health – a major responsibility that would have been difficult for anyone else in the family to handle since no one else lived in the same geographic area. He also enjoyed his family and friends, as well as various interests and hobbies. He made a real contribution, and he also got a lot out of the extra time. Would you have cut off his life at 75?</p>
<p>My mother is 88. She just sold her truck and bought a new (2015) car. She can still run mental rings around any of her children.</p>
<p>I strongly agree with #58: there is more to productivity and contribution to society than making money or producing goods.</p>
<p>I can’t bring myself to read the article, but a person who thinks that people over 75 have nothing to contribute to society is a paltry excuse for a human being, IMNSHO.</p>
<p>Ultimately, Emmanuel does a huge disservice to those who want medical providers to tell terminal people that further surgery, chemo, whatever will be futile. No one wants to suffer with a breathing tube or writhing in agony undergoing chemo that may extend life a few days but those few days will be in misery. But by making this huge leap to ‘I don’t want medical care after 75’, he only gives more ammunition to those who think that end of life counseling will eventually lead to sending the old out onto the ice flows to die or the Medicare equivalent, that is non-payment for health treatment of those over a certain age. And by putting the value of elderly life in terms of dollars and cents or productivity, he only furthers those fears. </p>
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<p>Therein lies the rub very often. Each step seems reasonable at the time, and then you look around one day and say “How the hell did we get here?” A lot of times there’s no obvious off-ramp before the crisis</p>
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<p>I also think that care providers are not good at explaining the ramifications of the medical choices we make with people who are in physical decline, and families are not good at accepting the situation and understanding tradeoffs.</p>
<p>What often happens is that the person is rushed to the hospital after a critical event, but the legal documents instructing the medical people on their final wishes are back home, in the safe or in their desks. In the absence of those documents, the medical people do what they have to do. </p>
<p>Maybe the author should just quit eating after his 75th birthday. Oh, and perhaps he can stop heating his home, too. Why expend valuable resources like food and fuel if he has decided that he wants to be useless at that point.</p>
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<p>Me… I’m going to live until age 93. That seems to be the general expiry date for women in my family. But I’ll be happy to receive medical treatment for whatever ails me as long as I am reasonably mobile and able to attend to my own basic needs. I assume that sooner or later I will probably develop chronic ailments that will impede my enjoyment of life - but it’s not the age that matters, it’s quality of life. And I probably would refuse some type of prolonged and heroic medical procedures, even at my current age (60) – but it would be a cost/benefit analysis - and I am talking about quality of life issues, not so much dollar costs . </p>
<p>My great uncle was teaching economics at our flagship U and playing doubles tennis through his 90s. I think he was performing a valuable service. My folks are long past 75 and I believe they are still living active, fulfilling lives. Am currently traveling with a group of folks who graduated HS in 1960–several are still practicing medicine and a range of other careers. They’re getting close to 75 but none look ready to quit any time soon.</p>
<p>As mentioned above, “there is often no obvious off ramp before a crisis.” There is a tendency to accept just one more intervention/treatment/test/ which can lead down a path we’d never have chosen. Some of this is natural optimism, and things can turn out well. Or not. We all like to think we’d be in that special minority to survive a poor diagnosis, and beat the odds. </p>
<p>That this ethicist is looking at the problem, and deciding to disengage well before difficult decision points, is an interesting idea. With an increasingly elderly population, these issues might deserve more discussion as the years go by, given the expense of our current policies. As per examples above, there are many, many folks living productive lives at advanced ages. This fellow is choosing a rather early point at which to say no. Have all of us really considered the point at which you would say no, and had appropriate discussion with loved ones about that point? </p>
<p>I really doubt we are going to go around suffocating people in their beds, but we shouldn’t be spending so much money to extend someone’s life for three months.
Let’s spend it at the beginning, more prenatal care & well baby checkups.>>>>>>>>>>>></p>
<p>I agree with this. Honestly, people need to accept reality when things start going downhill. Perhaps it’s nothing more sinister than a “movement”, to educate people to accept when to say “when”. </p>
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<p>Well, you should have no problem instituting it for yourself and leave other people alone to decide their fate. </p>
<p>Anyway, the construct of the post is wrong re the article. Emmanuel is not talking extremes here. He would institute reduced healthcare of HEALTHY people over 75, as well. That is the problem here. We are not talking about the last three months of life issues or cancer at age 80. We are talking major generality here that people, healthy or not, are not worth it after 75. Pure nonsense and not some bureaucrat’s or the government’s decision to take. </p>
<p>This is like people who say that they have no problem paying higher taxes, but then never write an extra check to the IRS on April 15. They can pay higher taxes if they want. What they really mean is everyone pays higher taxes, as if it is their decision to take for everyone else.</p>
<p>Emanuel is instituting reduced healthcare for himself. What is the problem?</p>
<p>It’s too bad that people see this discussion as a slippery slope to government dictating our mortality. Sheesh. Why shouldn’t people discuss these issues while they are younger and healthier? They will be better prepared to act before or even AS they are confronted with cascading levels of intervention, expense, and pain. I don’t think he conveys that this should be determined by the government, but rather, says that it’s a personal decision that he admits, may likely not be within his control, and ultimately up to god or destiny.</p>
<p>I love life and all it has to offer…however…I do not want to live in pain, be kept alive by a ventilator or permanently attached to a hospital bed, be unable to manage my own personal care, be in a coma or a vegetative state. I want my family to have final memories of me that do not include month after month of taking turns to go sit by my bed at the care center. </p>
<p>I wish there was a medically and socially acceptable way to die with grace and dignity once it is determined that there is no hope or that the quality of life will be extremely poor. </p>
<p>I am beginning to think that there should be a gentle pill taped to the medical directives of those who have similar thoughts. </p>
<p>It’s the context - since he is/was a shaper of public health policy, people will read his words in that context.
It’s like if someone who was Fed Chairman (say, Greenspan) starts railing against low interest rates, or if the Pope starts talking about maybe divorced people should have access to sacraments.</p>
<p>If you asked most people, it’s quality of life, not one’s age, that determines if life is worth living/or saving. Making up a number as this author is doing - any number- is just being provocative, and just not that helpful. What is helpful is for families to discuss among themselves what their wishes are regarding end-of-life heroic measures. I have a mother-in-law who is 93 and in good health. She is diabetic, but she controls it with diet and moderate medication. She lives independently, drives and is sharp mentally. It would be heartless to suggest that she just stop taking care of her illness so she would die faster, or to not provide an antibiotic for a urinary tract infection, as the author seems to promote for himself. On the other hand, were she to land in the hospital, lose all mobility and be reduced to a feeding tube, I believe that she’d be the first to say, let me go now. Most of us have an idea of what constitutes quality of life, and it’s different for each of us, and each of us should be allowed to make that determination for ourselves, with the help of a physician. </p>
<pre><code>There’s nothing in Obamacare or any other insurance program that ties old age to termination of treatments, so dumping on a law that basically has made insurance possible for many who otherwise would have none isn’t a reasonable response. There may be problems with the ACA, but this issue isn’t one of them.
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<p>I’ve actually said the same thing he has only I won’t choose 75 as in my long-lived family, that seems awfully young. If I’m pretty healthy, I would say 80 or 85. Then stop all meds and tests etc and “let nature take its course”, as folks had to do 100 years ago. Die of “natural causes” whatever they may be.</p>
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<p>You obviously have not read his work or seen his panel discussions, and if you have, then you do not take what he says seriously. Well, I take him seriously. </p>
<p>He has been advocating reduced services for the elderly (even healthy elderly) for a while now (not just himself) and for changing doctors ethical obligations. He wants this to be part of the ACA. He has been upfront about that. All he is doing now is telling exactly where he wants it to head, AND he is still a very powerful person re the administrative policies of the ACA and what policies can get instituted.</p>
<p>The term “head off at the pass” was invented for a reason. It is worthy to head this concept off at the pass.</p>
<p>EDIT: If he were some doctor or government official who had no power to affect the ACA, I could care less. However, he is not that. He has the power to institute rules that essentially do what he advocates and affect real people.</p>