Ezekiel Emanuel has an interesting article at The Atlantic: Why I Hope to Die at 75 – The Atlantic.
That’s how long I want to live: 75 years.
I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.
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, 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.
While I find the age of 75 to be a bit arbitrary, I think there’s a lot of wisdom in Emanuel’s position, and it’s an attitude toward life and death I’ve read from many physicians and other people involved in medical fields. They seem to be much more aware than the average person that there are worse things that can happen to someone than death.
As a result, many of them, when diagnosed with a terminal illness, rather than fight death to the bitter end with every last treatment option, instead accept only palliative care (i.e. treatment of pain) until they expire. Having watched a couple of relatives (one of whom was my mother) go through aggressive cancer treatments, with all the suffering and loss of dignity involved, before ultimately dying anyway, I’ve long wondered if the extra life bought with those treatments was worth it.
I think this subject actually reveals something about our society’s attitude toward death, and how costly it can be, both in terms of life satisfaction and finances. Particularly since the most expensive health care is usually delivered in the last six month’s of life.
I know many people who expend great effort making sure they live a healthy lifestyle, eating the right foods, scrupulously avoiding the wrong foods, exercising several hours per week, and many other activities. I’d say that one of my relatives probably devotes most of their free time to this. When they’re not exercising, growing their own food, or purchasing only organic food, they’re researching how to do these things better and stressing about what’s in the food that they do buy.
One of the things I learned decades ago in business school that I have found useful in many aspects of life is to look at things in terms of the cost benefit ratio, and to keep in mind the Pareto principle, the 80-20 rule, which says that you often get 80% of the benefits with only 20% of the effort. I think it pays to examine exactly what we’re buying when we attempt to live healthy.
For me, the first thing that sticks in my mind is the stark fact that we are all mortal. Short of either a religious rapture or a technological singularity (neither of which I think are likely), we’re all going to die someday. So when we engage in healthy living activities, we’re really going for two things: increased quality of living while we are alive, and hopefully a few more years in which to live.
Of course, as Emanuel points out in his article, many people haven’t really thought this out and are, consciously or unconsciously, going for immortality. Unfortunately, we have to face up to the fact that immortality has yet to be achieved (at least in this world), so chances are, we are going to fail. As one of my uncles used to say (usually with a beer in hand), “Something always gets you in the end so why not enjoy life.”
So, with this in mind, how much investment in healthy living is worth it? Certainly it pays not to live destructively: smoking, drinking excessively, overeating, eating with zero regard for health, being a complete couch potato, etc. The record is pretty clear that when you indulge in these activities, you will probably live an abbreviated life, often decades short of what most people can achieve, or you run the risk of living decades with a dramatically reduced quality of life. Some people are fine with this, at least until it comes time to pay the piper, but most of us would like to live at least the average life span in reasonably good health.
But once you aren’t smoking or drinking, are eating a moderately healthy diet, and getting at least a moderate amount of exercise, how much benefit do you really get going beyond that? Certainly there will be some benefits. But along the lines of the 80-20 rule, we’ll see diminishing returns. It’s fine to exercise for hours on end if you enjoy it, but is it really worth it if you don’t?
Some might argue that they’ll take every month, every day that they can buy with increased healthy living, but as Emanuel points out in his article, this can often lead to an old age with a substantially diminished quality of life. How much pleasure in our current daily life are we willing to give up in order to live a few more years in our senescence?
I don’t agree with Emanuel on drawing a line at 75. I’d be fine continuing to live as long as I could have intellectual stimulation and good conversation, and if that ends up being denied me years before 75, my interest in life would probably fade. If it continues until 90 but with physical disabilities, I’d still find that a life worth living. But I do very much agree that it’s important to ponder what we desire in life, what in it gives us satisfaction, and to what extent life without those things would be worth experiencing.
Of course, in truth, when faced with the actual decision about whether or not to fight for life, giving up on it can be very hard. I remember reading a quote from a WWII medic who noted that many soldiers told him in training that if they lost a limb or suffered severe disfigurement, that they would prefer to die, but that in actual combat when these things happened, everyone fought for life.
But I think it’s important for us to think about these issues well ahead of time. The cost of not doing so can be high, in terms of personal suffering, burdens on our families, and to society.