Prominent Oncologist’s Death Wish at Age 75

Published in Pawtucket Times, December 12, 2014

Dr. Ezekiel Emanuel, MD, Ph.D., a nationally-recognized oncologist and bioethicist, definitely marches to a different drummer.  While millions of older Americans pop Vitamins and supplements like M&M Candy, regularly exercise at their local gym, religiously jog and carefully watch what they eat to increase their life span, the chair of medical bioethics and health policy at the University of Pennsylvania, says living past the ripe old age of 75 is not on his bucket list.  We would be doing both society and our loved ones a favor by agreeing with this belief, he says.

When I am 75…

Why not age 80 or even 85?  Emanuel admits that his 75th birthday day was just a randomly chosen number, but the year was selected because scientific studies indicate that increases in physical and mental disability occur around this age, as well as a decline in both creativity and productivity.

The renowned 57-year old breast oncologist is at the top of his professional game.  Emanuel has received dozens of awards from organizations such as the National Institutes of Health and the American Cancer Society, including being elected to the Institute of Medicine (IOM) of the National Academy of Science, the Association of American Physicians, and the Royal College of Medicine (UK). Hippocrates Magazine even selected him as Doctor of the Year in Ethics.

Emanuel is a prolific writer, editing 9 books and penning over 200 scientific articles. He is currently a columnist for the New York Times and appears regularly on television shows including Morning Joe and Hardball with Chris Matthews.  .

The prominent physician, is also considered a key designer of the Affordable Care Act (commonly called Obamacare).  At a personal level, he has two well-known brothers, Chicago mayor Rahm Emanuel, former White House chief of staff, and Hollywood agent Ari Emanuel.

With this prominence, Emanuel’s death wish to die at 75, (the year 2032) before the onset of Alzheimer’s disease and other dementias, and decreased physical stamina (it’s harder to walk a quarter of a mile, even to climb 10 stairs) is drawing the ire of critics who charge that he advocates for health care rationing and legalized euthanasia.

But Emanuel claims that these charges are not true.  Setting his death at 75 is just his personal preference, he says, leaving his mortal coil. In his writings and media interviews he notes that setting the age when he hopes to die just drives his daughters and brothers crazy.

Last October, at the BBC Future’s World-Changing Ideas Summit in Manhattan, Emanuel’s prop, a full-page AARP ad from a newspaper, featuring an older couple hiking above a line of text that read, “When the view goes on forever, I feel like I can, too. Go long.”  Reinforcing his point, Emanuel is not buying AARP’s message pushing the positives of living an extended life.  For him, he doesn’t buy it and most definitely, seventy is not the new 50.

Sharing a Death Wish on the Air Ways

On Dec. 7, on CBC Radio Canada’s Sunday Edition, Emanuel, discussed his controversial October 21, 2014 article published in the The Atlantic, “Why I Hope to Die at 75.”  His Sunday interview detailed his unconventional and controversial stance, especially to AARP, the nation’s largest aging advocacy group, and aging organizations who strongly oppose this type of thinking.

Throughout the 28.12 minute interview with Michael Enright, Emanuel, he warns listeners, “Don’t focus on years, and focus on quality.”

“A good life is not just about stacking up the years and living as long as possible. People need to focus on quality of life,” says Emanuel, noting that “Setting an actual date for a good time to die helps you focus on what is important in your life.”

“It is really about what you are doing to contributing and enriching the world.  I want people to stop focusing on just more years, focusing on quality,” he says.

Emanuel says that you need to be realistic on living forever, your body and mind doesn’t  go on forever.  You should just be satisfied with living a complete life, he says.

By age 75, people will have gone through all stages of life, says Emanuel.  As a child you begin to develop skills and figuring out your place in the world. You go to college, raise a family, work to hone your skills and talents. At the later stages of your life you give advice and mentor people, he says, noting that in your mid-seventies, physical deterioration and mental slowing along with loss of creativity, begin to be felt.

During his radio interview, Emanuel claimed he is very active, recently climbing Mount Kilimanjaro with is two nephews, stressing that he is in relatively good health and doesn’t have a terminal illness and has no plans to commit suicide.   As a matter of fact, the physician even condemned physician-assisted suicide and euthanasia, in a 1997 article published in The Atlantic, a policy allowed in the states of Oregon, Vermont and Washington.  His philosophical view of ending one’s life is to allow the body to age naturally, he stresses.

In eighteen years, Emanuel pledges to refuse all medical procedures and treatments, including taking medications such as statins, cholesterol lowing drugs, and antibiotics that could prevent life-threatening illnesses or extend his life.  He notes that his last colonoscopy will be at 65, to screen for cancer.  No more colonoscopies after 75.  And, he’ll only accept palliative care after that milestone age, too.

“I’m not suggesting people kill themselves at 75 but, rather, let nature take its course,” Emanuel says.

How Others See it

Emanuel’s personal preference not to seek medical procedures or to use medications at age 75 that might lead to his death is not the same as physician assisted suicide, says Rev. Christopher M. Mahar, S.T.L., of the Providence Catholic Diocese, noting that this choice has always been respected by the Catholic Church.

“He is not actively choosing to take his life, and as long as he is not rejecting any of the ordinary means necessary for the preservation of life, such as nutrition and hydration, and is not intentionally destroying his body, he is free to decide for himself, says Mahar.

As Emanuel says, there is a downside to aging.  My 88-year-old mother died after a 14 year battle with Alzheimer’s disease.  At age 89, my father, whose quality of life declined over his later years, died suddenly, by having a pulmonary embolism.

For me, 89 is the year I choose to meet my maker, hanging up my spurs.  Yes, I will let nature take its course, but I will most continue to take Vitamins and antibiotics, even my Lisinopril, for high blood pressure.  I will not turn my back on medical procedures or technology that might enhance the quality of my life, even lengthen it.

I agree with the statement of late Actress Betty Davis stated, “Old age ain’t no place for sissies.”   There is no alternatives, you can only hope for nature to ultimately take its course, and it will.  And so, we all are inclined to pick our own magic number.

Herb Weiss, LRI ’12, is a Pawtucket writer who covers aging, health care and medical issues.

Tips on Finding an Age-Friendly Fitness Center

    Published on November 16, 2012, Pawtucket Times

           With the cold frigid weather approaching, that 30 minute daily walk around the block may well fall by the wayside in the winter months. While this activity is just what the doctor ordered to help keep you physically fit and feeling good, many aging baby boomers and seniors ‘look inward’ by turning to a local gym, by bringing their regular exercise indoors.

Seeking that Perfect Age-Friendly Fitness Center

            According to the Vancouver, British Columbia-based International Council on Active Aging (ICAA),aging baby boomers and seniors are joining health and wellness facilities faster than any other age group today, however many of these facilities are ill-prepared or not equipped to serve those in their later years.

While older “adult-focused” small gyms like ‘Nifty After Fifty’ are available, “even the large 24 Hour Fitness chains seek to attract older adults”, says Patricia Ryan, ICAA’s Vice-President of Education, noting that “over 70 percent of YMCAs had older adult programs according to a stat cited in ICAA Active Aging in America, Industry Outlook 2010.

Ryan recommends that when shopping around for a fitness center that caters to older baby boomers and seniors, always compare and contrast information gathered, using the following checklists, created by ICAA, to identify age-friendly fitness center.

            Become a savvy shopper when touring your local fitness center, by making sure it gears its amenities and organizational philosophies towards your needs – those age fifty-something and beyond.  ICAA, the world’s largest senior fitness association, has created a check list to help older persons to rate and compare local fitness facilities so they can choose one that meets their age-specific needs.

Some specific questions to consider can ultimately ensure that the center you choose meets your specific physical needs:

  1. Are the locker rooms clean, accessible and monitored by staff?
  2. Do you feel comfortable in the atmosphere of the facility?
  3. Are the membership contracts and marketing materials available in large print?
  4. Are signs visible and easy to understand?
  5. Does the facility’s cardiovascular equipment have the following age-friendly features – a display panel that is easy to read, easy to change and easy to understand?
  6. Is the music acceptable and set at a reasonable level?
  7. Do the facility’s treadmills start slowly, at 0.5 mph?
  8. Do the recumbent bikes or steppers have a wide and comfortable seat with armrests?
  9. Does the facility’s strength-building equipment have instructional placards that have simple diagrams, easy-to read text and font, and correct usage information.
  10. Does the facility’s strength-building equipment have a low starting resistance, less than five pounds?
  11. Does the facility offer programs designed to meet the needs of those with a variety of chronic conditions (specifically osteoporosis, cardiovascular, disease, diabetes, balance abnormalities, muscular weakness)?
  12.  Do the group exercise classes have different levels of intensity, duration and size?
  13.  Is there an extensive screening and assessment process (for balance, functional   abilities, osteoporosis)?’
  14.  Is the staff certified by a nationally recognized organization to work with people who have various health issues that may arise with age (specifically osteoporosis, hypertension, arthritis)?
  15. Is the staff knowledgeable about the impact that medication can have on exercise?

To download the complete checklist, visit the ICAA website,  www.icaa.cc/checklist.htm.

Getting Healthy, Building Closer Relationships   

It’s no secret to Maureen Wilcox, 45, of the need to cater to an aging population.  Wilcox,  a certified Personal Trainer at the Attleboro YMCA located across from the City’s Public Library on South Main Street in Attleboro, MA estimates that 30 percent of the nonprofit group’s membership is age 50 and over.  Many of these members are seeking advice on how to better manage or prevent age-related health concerns, the most common being: arthritis, high blood pressure, diabetes, cardiac health and obesity.

Wilcox notes that this large constituency finds value in the Attleboro YMCA’s wide variety of programs that are geared towards baby-boomers and seniors.  These programs include resistance and strength training, aqua classes, Zumba classes, chair exercises, yoga and Tai Chi. “These classes will help you to manage a healthy body weight, stimulate your immune system, increase strength, improve posture, increase your flexibility and balance and help prevent chronic illnesses”, she adds. 

             According to Wilcox, a fitness center can also be a place to build friendships among older persons.  “A supportive community can enhance camaraderie among the participants, keeping them motivated and committed to meeting their exercise goals,” she says, adding that commitment to an exercise regime may well be more important than pushing weights around..

Over the years working, Wilcox has seen many new members in their later years forge new friendships at the Attleboro YMCA.  “Seeing people regularly allows them to develop meaningful relationships where they ultimately become an extended family,” she says.

“Relationships developed by participating in exercise classes also builds a small community among the senior age group members,” Wilcox notes, adding that they often participate in social trips and group outings outside of the Attleboro YMCA.  She notes, some seniors while exercising on their stationary bikes, read a big print book, To Kill Mocking Bird, adding health and wellness to an already established community literacy initiative.

Finally, in addition to personal training, various group exercise classes, including a running club,  LIVESTRONG is also offered at the Attleboro YMCA, says Wilcox.  It’s a free 12-week personal training program that provides a place where cancer survivors can come together.   Along with specially-trained staff to safely work in small groups,  participating members receive one-to-one attention while working toward maintaining or regaining their independence, everyday fitness, and overall health & wellness.  These participants share a bond that only cancer survivors can relate to.  “This is an inspirational program and one which we are all proud to be a part of,” prides Wilcox.

Getting to the Bottom Line

             Outdoor walking or the gym? That depends on personal preference and time availability.  “Brisk walking is beneficial, emphasizing ‘brisk,’ “says ICAA’s Ryan. “Faster walking to increase intensity has been reported in several studies in ICAA Research Review, to enhance your health, rather than the frequency,” she noted.

In addition, Ryan adds that scheduled classes in a fitness center help a person plan physical activity into their days and there should be equipment and classes for variety. There is expertise available in many (but not all) cases, especially in gyms targeting older adults and medically integrated fitness centers, a.k.a hospital wellness programs. There is recognition among most fitness clubs that older adults are not only a huge population to attract, but also a very good customer because of expendable income, she says.

“Exercise plays a vital role in healthy aging,” says Michael Fine, MD, Director of the Rhode Island Department of Health.  “Regular exercise is an important weapon in the battle against chronic diseases, such as heart disease and diabetes.  Exercise also helps us maintain flexibility, balance and mobility.  It isn’t necessary to join a gym or buy expensive equipment; a brisk walk around the block is a great place to start if you’ve been sedentary. The key is to find an activity you enjoy and to make time for it each day.”

Ryan strongly agrees with Dr. Fine. “The most important message for those late in life is to MOVE, and to add physical activity into each day.  Physical activity is the magic pill. Whether walking, raking and hauling leaves, playing soccer or even going to a fitness club, it’s the right thing to do for healthy aging.

Herb Weiss, LRI ’12,  is a Pawtucket-free lance writer who covers aging, medical and health care issues.  He can be reached at hweissri@aol.com.