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Choosing death brings up many questions

Perhaps you read Dr. Zeke Emanuel’s article in The Atlantic: “Why I Hope to Die at 75.” His deliberately provocative piece makes a powerful point in criticizing our “manic desperation to endlessly extend life.” He isn’t advocating euthanasia or suicide, but says that when people are riddled by disease and dementia or are in constant pain, it is foolish for doctors to make extraordinary efforts to keep them alive.

In these later years, our expectations shrink and our capacities diminish. We do less and less to accommodate our physical and mental limitations.

Emanuel says we also lose our creativity. The productivity of people with high creative potential peaks at age 40, with last contributions generally in the early 60s. It’s difficult to generate new, creative thoughts because we can’t develop a new set of neural connections: We can only hope to slow the erosion of the existing ones. Although brain plasticity persists throughout life, we don’t get rewired as we age.

There is also the question of how we want to be remembered by our loved ones. We usually want them to recall us as independent and active, not stooped and sluggish, forgetful and repetitive.

Because life expectancy has extended to about 79 now, this doesn’t mean the later years have gotten healthier. There are increases in disabilities – in both physical and intellectual functioning, depression and dementia. Eileen Crimmins, a researcher at the University of Southern California, says health care has not slowed the aging process, it has slowed the dying process.

After 75, Emanuel will not visit a doctor or take any medical test or treatment to prolong his life. No more preventive screenings or interventions. And, no antibiotics. He will die, “When whatever comes first takes me.”

Meanwhile, 29-year-old Brittany Maynard of Oregon, worked with Compassion and Choices to end her life on Nov. 1. Diagnosed with a malignant brain tumor, she chose not to experience the erosion of her brain, loss of motor and cognitive control and extreme pain this disease inflicts. Brittany was assisted by a doctor with an injection of a lethal medication, to die peacefully in her own bed with her family around her. She chose death with dignity.

I think both of these people deserve our attention. They make us think about how we want to live as we grow older and to die eventually. They force us to consider the anxious and uncomfortable questions about life and death and ponder how we want to leave our children, grandchildren, community and world. What is that line we will cross when we no longer want to be part of this world?

Big questions! Most of us fear the demise of our bodies, minds and spirits from living too long. Is it really so terrible? Learning, lessons and wisdom come from every stage of life. Our sense of mortality sharpens as we grow old, and possibly, we have the opportunity to rest in a certain peace and spirit of transcendence. Maybe it is then we learn acceptance and appreciation of our lives and those of others. Sharing wisdom with our descendants may be another benefit. Perhaps this doesn’t even begin until past age 75.

Also, do caregivers in our later stage of life receive a rich, deeply spiritual lesson in compassion, selflessness and human mortality? Do we deny them this when we choose death? Is it honorable to surrender to dependence on others, or even to suffer?

I’m not sure about any of this, but these people really make me think. These are discussions worth having, and I applaud these people for instigating them. I have seven more years until I’m 75 ...

Martha McClellan has been a developmental educator in early childhood for 38 years. She has moved her focus now to the other end of life, and has written the book, The Aging Athlete: What We Do to Stay in the Game. Reach her at mmm@bresnan.net.



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