Life: does longevity trump quality?

“We have to get out of the way,” she said; “make room for other, new people on the planet.” Accomplished author/editor Cyra McFadden, at a recent dinner party, was talking about a group of women scientist friends’ excitement over discoveries they have made which show promise of extending life a fraction longer. Cyra was in fierce, though silent, disagreement.

It may be time for those of us who disagree with the rampant prolong-life-at-all-costs theories  to stop being silent.

Americans are, in fact (as reported in Epoch Times below, and elsewhere) living longer all the time. Sometimes that’s just fine, especially if we’re in reasonable health. But what if we’re not? What if we’d just as soon be getting on with whatever follows this temporary time on earth? Millions and millions of people are living for hours, days or extended months and years in circumstances they would not choose simply because we have created a culture that says we must be kept alive no matter what.

Average life expectancy continues to increase, and today’s older Americans enjoy better health and financial security than any previous generation. Key trends are reported in “Older Americans 2008: Key Indicators of Well-Being,” a unique, comprehensive look at aging in the United States from the Federal Interagency Forum on Aging-Related Statistics.

“This report comes at a critical time,” according to Edward Sondik, Ph.D., director of the National Center for Health Statistics. “As the baby boomers age and America’s older population grows larger and more diverse, community leaders, policymakers, and researchers have an even greater need for reliable data to understand where older Americans stand today and what they may face tomorrow.”

Where do we stand right now? Well, the same source that says we’re living longer and enjoying better health and financial security (hmmmm on the financial security business) reveals that Americans are “engaging in regular leisure time physical activity” on these levels: ages 45-64: 30%; ages 75-84: 20%; geezers 85 and over: 10%. Hello? Better health and financial security, just no leisure time physical activity? Could it bear some relationship to obesity factors in the same data: 30+% for men, 40+% for women?

Does living well need to be assessed in the compulsion to live long? Why not? Everyone should have the right to live at whatever weight and whatever level of inaction he or she chooses. But the system is weighted toward keeping us alive under all conditions, and bucking the system is not easy. A poignant, wrenching tale of her father’s slow decline and death — and her mother’s refusal to go down that same path — was recently told by California writer/teacher Katy Butler in the New York Times Sunday Magazine.

Almost without their consent, Butler’s gifted, educated parents had their late years altered to match the system’s preferences:

They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Given the limitless sources of victimization floating around, we should not have to add just-try-to-keep-them-alive-forever health care to the list.

My husband and I, having long ago signed advance directives with additional specific issues sheets (“If this happens, do that; if that happens, don’t do this,” etc) recently got them out and talked things over again, a very good thing to do for EVERYbody over 18. We will add dementia provisions to the existing documents while we can remember to do that (the closest you can come to avoid being warehoused in a memory-loss facility for umpteen years.) We are clear, and our friends and family understand, about having no interest in hanging onto life in a greatly diminished state if such an opportunity presents itself; for increasing thousands, it presents itself every day.

All this being said, there’s still a reasonable chance that I’ll be out of town one day when I’m in my 80s (which aren’t that far off), get wiped out by a speeding cyclist and picked up in a seriously mangled state by the paramedics, taken to a hospital that’s not Kaiser (which has all my directives on file,) miraculously brought into some heavily-sedated state of being because the hospital doesn’t consult Kaiser or the living will registry (which also has my directives) and kept alive by assorted mechanisms. By the time my husband or children get there to insist everything be unplugged — which of course will involve long hours and possibly court action — hundreds of thousands of dollars will have been needlessly spent.

I consider myself a highly valuable member of society, and my life a gift from God. But would those dollars not be better spent on a few kids needing specialized care?

Epoch Times – Americans Are Living Longer, According to Federal Report.

14 responses

  1. My recently deceased father planned to live well into his nineties. His lineage predicted it was possible (at least, he thought). When dementia set in, his cognitive decline was rapid. He lost the ability to swallow. At the urging of medical professionals, we okayed the installation a feeding tube. We were told that otherwise he could suffer a slow painful cruel death by starvation. Others saw that prediction differently. Fortunately for my Dad, leukemia showed up and swept him away in a short period (2 weeks) from what could have been years in a bed-ridden technology-maintained “life”. To this day, my siblings and I do not know what the correct call was on the feeding tube. Some of the people in white looked at us with a nod and a wink as if to discourage the tube. Others were emphatic that is was the only right decision. More research is needed here. I can tell you this: I will not leave my family with the same decision, if I am stricken with dementia (as it is now obviously a genetically inherited risk). For me, it will be lights out. I just hope it can be done in a way that is not agonizing. As far as I know, such a solution (non-agonizing) is not lawful.
    One thing is certain: We are here for a very short time. We should whoop it up and enjoy life as best we can, while we can, and stop trying to live longer at any cost. What to do this weekend? Home repairs or adventure? A: Rack the bikes!

    • I’m sorry for what had to have been a tough time for you and your siblings, Leon, but join you in gratitude for your dad’s swift end. One fine organization that’s looking hard for answers and working to insure both expanded choice and humane death is Compassion & Choices; check them out. You can also check out the dementia provision available on the website. compassionandchoices.org; or I’m on the local board: compassionandchoicesnca.org. You’re right about solutions being few, and the logical choice for right now: seize the day.

    • Hello leonkelly,

      I have been where you were twice, once with my maternal grandmother and later with my father. There are no “right” or “wrong” answers in situations like this, you just make the decision that you can live with. You will only make decisions like this a very few times in your life so you will never get used to it. Each one will be unique and completely different from the others.

      • And the more clearly we make our OWN decisions, and let friends and family understand them, the better it is for everyone. Each individual decision is indeed unique.

  2. NO!

    It’s an offshoot of the “more is better” consumerism rampant in American life.

    Let’s figure out how to be happy and do that longer.

    • OK, Kinglsey, I have a feeling I’m a lot older than you are. I agree with the being happy as long as possible (I’ve done a lot of that for 3/4 of a century) and I’ll even go along with More Is Better when that’s true. It’s not always true. Life is finite. I really believe happiness can extend nearly to its finite end in many cases, though not all. Does ending after futile days in an expensive intensive care unit, or avoidable days in a nursing home (my advance directives say if I can’t manage my own food & hydration nobody may do it for me, a reasonably painless way to end a happy life) make sense if you can skip those? I just don’t think so. If you read all of Katy Butler’s poignant article you might agree.

      • It’s more about re-education than making policy decisions. Those selling devices and services have created fear around the question itself. Perhaps instead of assuming our goal is to promote longevity in every way possible we should begin open discourse about “if we should” at a young age.

        you look pretty good for your years. You are about the same age and fitness level as my grandmother. Are you an over consumer? Do you go to mcdonalds daily and supersize your big Mac with fries? I’m betting no.

        In the USA the young will be paying for the medical care for the elderly for the forseeable future. Social security is a joke. We are spending out young years suffering through work to pay for someone else’s refusal to accept a peaceful death. Why should I be punished for someone else’s selfishness? When did we develop this idea of entitlement that we can work for so many years and live as long as possible at our childrens cost? Same question goes for the fiscal deficit. We are a county shrugging off responsibility and costs to younger generations. Well I’m not going to accept either the costs or pitting the burden on someone else’s shoulders. That’s just selfish.

  3. Ms. Johns,

    The discussion of whether it is better to live longer or better is often discussed in terms of health, either physical or mental. However I do not think that this is full equation. My own mother is closing in on 80 and is in reasonably good health with no signs of dementia. She does not walk as well as she used to and is definitely more cantankerous but is otherwise doing well. However I do not think is very happy with her life. All of her immediate relatives are dead, as are most of her friends. She has some left and she is surprisingly good at making new ones but I can definitely sense that she is somewhat lost in the world. However there are few people alive who really understand her life, it is difficult of most of the people she knows now to comprehend how she got where she is now or that they should even wonder. It probably helps that she is living on the same block since 1955 and the same house since 1964 and both her children are close by. She knows most of her neighbors, even those who have *only* lived on the street for 25 years. Nonetheless, she is slowly becoming a stranger among strangers in her own land. I think it is this feeling of living “at home” among people who understand you that makes people want to live longer. Without it, what is the point, healthy or not?

    • I’m right there with your mom, David… the difference being I still regularly enjoy doing the par course in the park down the street, am deeply involved with a lot of causes that generally involve good friends way younger than I, and best of all as a writer I get to do things like this T/S gig. I think one has to find one’s own reasons for living, and not all of us are lucky to be able to do that. My dad did it into his 90th year in a small Virginia town; I’ll happily settle for another decade in San Francisco if I can. (Unpaid plug: I’ve a couple of books dealing with these issues on Amazon, including one about my dad.) What motivated this blog is the issue of whether we should continually push prolonging life, even when it’s life of a quality the individual involved would not choose. I wish for your mom many quality days.

  4. My wife’s mother lived to be 80 years old. She had six children, and 15 grandchildren. She saw them all frequently. Her health deteriorated some, and unfortunately, so did her mental abilities. However, she was never completely helpless.

    She passed away quietly in her bed, in her sleep, in her own home after a pleasant outing among friends of many decades.

    Nobody ever wants to see a parent die; but if it has to happen, this is pretty much as good as it can be.

    The issue of of quality versus quantity of life is really as deep a personal decision as anything gets. Live on your own terms for as long as you can. That’s as good as it gets.

    • Amen, Jake. Our own terms should be the guiding rule; I wish it were more often true. If we really looked at it — as I keep getting up on this soapbox to encourage everyone, and not just geezers, to do — most of us would choose what you describe, and would NOT choose a few days or weeks in intensive care, or a few years in a dementia facility. We can get caught in the system, as Katy Butler’s father did in the article cited, and our choices go out the window. That’s why I think the system needs to change.

  5. Hey, I’m all for offing myself when I can no longer take care of myself, when quality of life becomes an issue. But that’s no reason to pooh-pooh scientific advances in longevity. They’re not mutually exclusive, nor do the ideas behind them conflict.

    If science can let me live 1000 years as well as your average 40yo, then you can be sure I’ll sign right up. Hell, if I lived the life of a healthy 75yo for that whole time, even then I’d go for it. If your mind is basically solid and your body can be repaired and healed to keep you alive indefinitely, as is the ultimate goal of longevity researchers, then I would live every bit as long as I could.

    So while I do think it’s foolish to place longevity above quality of life, that really doesn’t reduce the value of longevity. I will tell you that if we are successful in conquering death (it could be in my lifetime), the decision to live a normal lifespan will be seen as ridiculously old-fashioned.

    • That’s a pretty nifty concept, Uriah, “conquering death.” Maybe it will indeed happen in your lifetime (I think not mine…) and I just hope we also conquer space (check out Miles O’Brien’s T/S pages) so there are enough other planets to hold everyone. In the meantime, I wholeheartedly agree with living every moment. Surely we could also work on a little less conquest and a little more peaceful coexistence.

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