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How Much Life is Enough?

May 15, 2017 Leave a comment

Editor’s note: Amitai Etzioni is a sociologist and professor of international relations at George Washington University and the author of several books, including “Security First” and “New Common Ground.” He was a senior adviser to the Carter administration and has taught at Columbia and Harvard universities and the University of California, Berkeley.

(CNN) — No one has come out yet and explicitly suggested that old folks like me (I am about to turn 83) should be treated the way the Eskimos, as folklore has it, used to treat theirs: put on an ice floe and left to float away into the sunset. We are, however, coming dangerously close.

A recent study by Dr. Alvin C. Kwok and his colleagues finds that surgery is common in the last year, month and week of life. Eighty-year-olds had a 35% chance of going under the knife in the last year of their lives; nearly one out of five Medicare recipients had surgery in their last month and one in 10 in their last week.

Nobody doubts that some of these surgeries were necessary. But major medical and ethical figures argue that they reflect our reluctance to accept death or let go, the surgeons’ activist interventionist orientation and the way the incentives are aligned.

As the surgeon Atul Gawande put it in The New Yorker: “Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.”

It remained for Daniel Callahan, an influential bioethicist and co-founder of the prestigious Hastings Center, a nonpartisan bioethics research institute in New York, to take the next step. In a May article in The New Republic, Callahan (with co-author Sherwin B. Nuland) argues for a cease-fire in America’s “war against death,” calling on us to surrender gracefully; Americans thus “may die earlier than [is now common], but they will die better deaths.”

Focusing on care for the elderly, Callahan and Nuland warn that our present attitudes “doom most of us to an old age that will end badly: with our declining bodies falling apart as they always have but devilishly — and expensively — stretching out the suffering and decay.” They hence call on us to abandon the “traditional open-ended model” (which assumes medical advances will continue unabated) in favor of more realistic priorities, namely reducing early death and improving the quality of life for everyone. They further advocate age-based prioritization, giving the highest to children and “the lowest to those over 80.”

The journalist Beth Baker summed up this position: “After people have lived a reasonably full life of, say, 70 to 80 years, they should be offered high quality long-term care, home care, rehabilitation and income support, but not extraordinary and expensive medical procedures.”

Baker’s interview with Callahan reveals one reason this line of argument should be watched with great concern: Once we set an age after which we shall provide mainly palliative care, economic pressures may well push us to ratchet down the age. If 80 was a good number a few years ago, given the huge deficit and the pressure to cut Medicare expenditures, there seems no obvious reason not to lower the cut-off age to, say, 70. And nations that have weaker economies, the logic would follow, should cut off interventionist care at an even younger age. Say, 50 for Guatemala?

Above all, age is the wrong criterion. The capacity to recover and return to a meaningful life is the proper criterion.

Thus, if a person is young but has a terminal disease, say, advanced pancreatic cancer, and physicians determine that he has but a few months, maybe weeks, to live (a determination doctors often make), he may be spared aggressive interventions and be provided with mainly palliative care. In contrast, an 80-year-old with, say, pneumonia — who can return to his family and friends to be loved and give love, contribute to the community through his volunteering and enjoy his retirement he earned with decades of work — should be given all the treatments needed to return him to his life (which in my case includes a full-time job and some work on the side).

We should learn to accept death more readily; we should stop aggressive interventions when there is little hope; we should provide dying people with palliative care to make their passing less painful and less traumatic. Such a case may not just be that of an elderly person succumbing to a terminal illness — it can be that of a preemie born too early to survive, a youngster following a car wreck, a worker following a tragic accident. We should learn from the Eskimos — they long ago stopped abandoning their elderly just because they got “too” old.

Living on Chemicals

April 28, 2017 Leave a comment

The pharmaceutical companies encourage us to do things we ought not to do. If you get heartburn from spicy chicken wings, don’t worry. Just gulp Pepto or pop Zantac and indulge your addiction. Eat wings, eat pizza, eat salami… it doesn’t matter, because there’s a ‘medicine’ for that.

You like to jog, but your knees make you suffer. Pop a couple of Naproxen, and off you go. Just ignore the fact that whatever is going bad in your knees, it’s still going bad, but you’ve masked the reality.

My own organs are wearing out. They’ve served me well for 80 years, but the wear and tear begins to show. One’s prostate gland swells, interfering with the flow of urine. A series of pills helps somewhat, until finally, a colonoscopy fixes it, and creates another problem – one can’t quite turn it firmly off for the whole day.

The heart needs help, so there are pills for that. They do a great job on the heart, but the side effect is impotence. Along with that, there is some degree of depression. There’s a pill for that. There are pills for blood, pills for Thyroid, pills to sustain the function of almost every organ in your body.

I question myself, requiring so much maintenance. As Gloria Steinem said (she’s a year older than I am) “Most people my age are dead.”

The truth is, every day I see news of people 10 to 20 years younger than I am, passing away. Maybe I’m on borrowed time. The people I knew in high school are gone. Most of my cousins are gone. One of my brothers is gone. Meanwhile, I’m still having fun. I’ve never taken life, or death, very seriously anyway.

All My Friends But One Have Died

March 29, 2017 Leave a comment

It’s something one is unlikely to think about until one is very old. The people and pets that have occupied your life begin to die off. Several pets pass during our lives because their life span is about 15 to 25 years. Cats, dogs, horses, fish and birds live a full life in fewer years than do us primates. I admit that I enjoy being older than most people, and I love the phrase I stole from Gloria Steinem: “Most people my age are dead.”

I suppose my condition will decline before I pass away, but for now, on the cusp of 80, I’m okay. I walk, I drive, I played with my Doberman until last week, when she died of old age, at twelve. I guess I’m one of the lucky ones who inherited good genes. It’s true that I take 16 pills a day, but in my defence, I never felt the need. Each medication came into my routine when doctors had me tested during annual examinations. One of Canada’s true blessings is the health care system. They apparently realize it will cost a lot less to strengthen the age-weakened than to let them fall apart and then have expensive care to keep them going.

So Joey died first, leaving a troubled wife with three young children. He was extremely, morbidly obese, and it killed him. I believe his food addiction was because he was only about 5 feet 4 inches tall, and might have led him to take on size in the wrong direction. We’d sometimes meet for lunch in a favourite deli. My bill would come to six or seven dollars – his bill would be about ten or twelve dollars. He once told me that when he had business lunch appointments, he’d go early, eat first, then eat again when the associates arrived. That’s not all. After the lunch meetings broke up, he’d stay and eat again, alone. He was a witty, humorous friend, and I did my best to get him to control his diet, but it was impossible, and he died at 44.

Mitch died next, at seventy. He had lived a tough guy life, had been convicted and jailed when a young man, for robbery and again for marijuana marketing. He was a wonderful, colourful guy whom I completely trusted. He had much higher moral standards than do many police personnel. His wife had died from cancer decades before. One of his sons turned out to be gay, and voluntarily disappeared from Mitch’s life. Very sad. His other son, however, is a fine, handsome man, married with children that thankfully Mitch got to know before he died. The son is a successful television writer and producer.

Dave died most recently. He was never quite right, emotionally. Although very intelligent, remarkably articulate and good-looking, he could never have a typical relationship with a girl. He liked girls, and they certainly liked him, but somehow, he couldn’t ‘feel’ the mutual emotion. Frankly, he enjoyed prostitutes, and felt friendly toward them. Obviously, they represented sex without emotional stress. He declined as he aged, as I heard when I lived in a distant city. He spent 10 years like a vegetable on his aged mother’s sofa. He had been a late life child. His two older brothers and one older sister didn’t sympathize with him, which is something I never understood.

The oldest brother took over the family business, a successful retail store in a priceless location. Jack Nicholson once shopped there for things to wear in “The Last Detail.” The eldest was really just golfing while letting the business die.

The second brother was a successful pharmacist with a thriving store. Both brothers were, bright, humorous storytellers, as was Dave. The sister was just cold. She had married a foreign hustler, lived with him in Rome, in luxurious accommodations while driving around the ancient city in a Lincoln Continental convertible. The hustler husband eventually got nailed and was jailed. His wife, the sister, came back to Canada and existed as an obese welfare recipient.

I had a hobby farm in the mountains when in my sixties. I kept horses there. Dave had always been a riding fan, and had even owned a horse and beautiful tack, saddle and all. I heard he was living on his mother’s sofa, so I got in touch with him and brought him out to the farm. I gave him simple chores in horse care, in which he’d been educated, and set out to restore him to normalcy. I kept him there for six years, paid him, housed him, got him his drivers’ license back, paid income taxes to gain him pensions.

Dave declined even at the farm, doing the work he dreamed of. Finally, I gave up and took him back to his oldest brother. I drove away and have no idea what happened after that. Somebody sent me an obituary on Dave. I’d never seen one like it. There was a big photo of him, smiling, in a suit jacket and shirt and tie. I’d never seen Dave dressed like that in thirty years. I’m baffled by where the photo came from, and why. Why was he dressed like that, and why had an emotionally challenged failure gained this final notoriety? I’ll never know, and I’ll always regret that I was unable to re-light his life.

My dearest friend is still very much alive. We live about 350 miles apart, and speak on the phone two or three times a day, sometimes for more than an hour. He’s 8 years younger than I am, at 72, and we share a tenuous connection that stretches back fifty years. He and I are the survivors. I will likely go before he does. Although my mother lived to 94, his grandfather lived to 109. He’s also very active. He plays tennis almost daily, and in winter, is a successful competitive snowboarder.

I’m much more sedate. In our day, we were both amateur race car drivers, and I’ve done a lot of wilderness camping. I even lived in a wilderness cabin for four years, lacking telephone lines, cell towers or Internet. It’s a pleasurable, all day job just to survive out there. Now, in my home in this small farm village, I just draw pictures, sculpt clay, paint canvas, and most of all, write stuff like this to relax.

A Heart is a Muscular Pump

September 12, 2015 Leave a comment

It causes me a momentary discomfort when I hear someone say (either in a performance or in society) “I love him with all my heart”. “It is with heartfelt gratitude I thank you for your generosity”. “This heart-rending story has ended”. “This will tug at your heart”.

On and on, and I don’t understand why all these emotional characteristics have been attributed to the heart. It is a pump. It is an amazing pump to be sure, but a pump all the same. It is a muscle, perhaps superior to all our other muscles. I honour the muscle for all that it is, but it is not a thing which emits love, gratitude and emotional contact.

The heart is obviously a fabulous pump. Mine has been working for seventy-eight years now. For the first seventy-six years it performed brilliantly. Even then, some minor servicing by talented doctors (much like talented mechanics), and on it goes. It has seen me through a vast number of adventures, four marriages, many canoe voyages, millions of miles driven through mountain ranges, across prairies and deserts. It was pumping happily when I raced sports cars, raced motorboats, survived sailing mishaps, several trans-ocean flights, several domestic flights, several small plane adventures, grand-fatherhood fatherhood, and a rigorous career as a creative professional.

Through it all, it just keeps pumping. Never did it fall in love, feel remorse, harbour hate, or get tugged at by a tragic event. The heart is a fabulous pump… but just a pump.