August 26, 2019

In October 2014, Ezekiel Emanuela health policy expert, medical ethicist, and doctor who advised former President Obamawrote an infamous article in The Atlantic called "Why I Hope to Die at 75." Now, five years later, he sat down with MIT Technology Review's Stephen Hall to discuss his stance—and why it hasn't changed.

Download URMC's conversation prompts to start improving end-of-life care for patients

The original piece

In the original article, Emanuel wrote that he would refuse all medical interventions—even antibiotics, and vaccinations—after he turned 75 years old, saying he believes older Americans live too long in a deteriorating state.

"Doubtless, death is a loss. … But here is a simple truth that many of us seem to resist: living too long is also a loss," he wrote.

Emanuel clarified in the article that he would not end his life at 75, but rather that he would stop taking efforts to prolong his life.

How Emanuel feels now

In the interview with Hall, Emanuel said that five years later, he isn't rethinking his view, which he says is "not an extreme position."

"I'm not going to die at 75. I'm not committing suicide. I'm not asking for euthanasia," Emanuel said. "I'm going to stop taking medications with the sole justification that the medication or intervention is to prolong my life."

As for the title of the original article, Emanuel said "it's editors that choose titles and not authors."

Emanuel said that he believes people would agree with him if they thought about his position, saying that when people are asked how they want to die, they often decide they want to say goodbye to their family and have "some gentle decline" in a short amount of time.

"It makes perfect sense. I'm no different," Emanuel said. "I would like to maintain my vigor, my intellectual capacity, my productivity, all the way through to the end. But I think we also need to be realistic—that's not the way most of us are going to live."

He added "[E]very time I talk to people, it's like, 'Oh, yeah, definitely quality of life over quantity of life.' But when push comes to shove, it's really quantity of life. 'I might be a little more confused, but I'll take that extra year!'"

Emanuel acknowledged that some people will be mentally capable and active past 75. "[T]here are outliers," he said. "There are not that many people who continue to be active and engaged and actually creative past 75. It's a very small number."

Even those who do live beyond 75 aren't actually doing anything "meaningful" with their lives, Emanuel said.

"These people who live a vigorous life to 70, 80, 90 years of age—when I look at what those people 'do,' almost all of it is what I classify as play. It's not meaningful work," he said. "They're riding motorcycles; they're hiking. Which can all have value—don't get me wrong. But if it's the main thing in your life? Ummm, that's not probably a meaningful life."

Emanuel acknowledged that he does "fear death," but fears "being sort of decrepit and falling apart more" (Hall, MIT Technology Review, 8/21).

Next, get URMC's end-of-life conversation prompts

When it comes to end-of-life care, most organizations struggle to meet patients' needs. In a recent poll, 87% of Americans age 65 and older said that they believe their doctor should discuss end-of-life issues with their patients; however, only 27% of those polled had actually discussed these issues with their doctor.

Download URMC's conversation prompts to start improving end-of-life care for patients.

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