What’s The Best Way To Die?

Many readers discuss Zeke Emanuel’s essay on wanting to die at age 75. One pivots off a point of mine:

Sorry, but Alan Arkin beat Leonard Cohen to that punch back in the 2006 movie Little Miss Sunshine. He plays the part of a grandfather in a nursing home who has decided to take up heroin addiction … “What’s it going to do, kill me?”

Another wasn’t a fan of the essay:

I wanted to agree with it, but as he went on, the essay went further from my expectation – a statement about dignity and quality of life in the face of our focus on more years – and into a “if it’s not going to always be awesome like now, forget it” entitlement piece. Where I really turned on him:

Today he can swim, read the newspaper, needle his kids on the phone, and still live with my mother in their own house. But everything seems sluggish. Although he didn’t die from the heart attack, no one would say he is living a vibrant life. When he discussed it with me, my father said, “I have slowed down tremendously. That is a fact. I no longer make rounds at the hospital or teach.” Despite this, he also said he was happy.

He swims, he reads, he lives independently, he enjoys his family. But he’s slowed down! Better off dead, since nobody can possibly live a vibrant life without climbing Kilamanjaro.

One of my aunts has been a cripple since childhood, when she contracted polio. She’s led a very interesting life, even with lots of outdoor activities, such as snow and water skiing. Good thing Zeke Emanuel wasn’t her father.

Another is even more harsh:

Emanuel’s piece is the kind of jibberish that makes it challenging to have serious discussions with religious people.

It’s easy to say dreamy things like that when your soul “lives” forever. When you consider the equally plausible (more plausible for me, but let’s say “equally plausible” for the sake of argument) chance that we have a limited amount of time sandwiched between an eternity of darkness and nothingness, I want every single second I can squeeze out before eternity continues on without me, and if some douchebag is willing to give up their precious time prematurely, I’ll gladly take theirs too.

Of course EVERYBODY hopes to have a good quality of life while they are alive, but what kind of dolt wants to die while there is still the potential of multiple decades of vibrant life? Not everyone is John McCain, Joe Biden, or Hillary Clinton, but to see those people in their 70s, if not 80s (McCain?) reminds me that even if a little slower, a little grumpier, and a little more prone to hyperbole, my 70s, 80s, and maybe even 90s can be a rich experience.

And I am looking as forward to those years, as my 40th year is coming up. Emanuel’s piece is a kind of preachy selfishness typically reserved for millionaire inheritance babies pining for a “normal life” in a studio apartment while most everyone else works their ass off just to get by.

Another thinks of the children, and more:

While I like several of Emanuel’s philosophical points about shortening old age, he doesn’t state one of them clearly enough: for some people, old age is just really boring. Which leads me to wonder if his comments are a bit academic when it comes to creativity, because there are a lot of people who don’t particularly value creativity and don’t practice it.

But my biggest problem with Emanuel’s proposal is that he doesn’t discuss a decision to “die at 75” if the person in question has a spouse or dependent child (such as a mentally handicapped child, perhaps one without siblings). Emanuel talks about his daughters, who are presumably independent, but he seems to think that by 75 a parent’s job is over. That’s true for most parents, but for some, there’s a dependent child who will be left without a caregiver if the parent dies. Certainly plans need to be made so the child will get decent care even when the parents are gone, but the child may need the comfort of a parent’s visits as long as possible when the child isn’t a fully functioning, independent adult.

For a couple, aging is kind of a mutual endeavor, and one person often supports the other in some way, while the other provides other kinds of support. In a lot of the marriages I’m familiar with (conventional marriages from the 1940s and ’50s), the aging male supports the wife financially, because his retirement and pension benefits are greater, and she supports him through caregiving – cooking or nursing, for instance. Each may act as an emotional anchor for the other. I knew one older couple where the husband, a physician, was warned that he might be developing prostate problems indicative of cancer. He chose to ignore the diagnosis and died a decade or so before his wife. She was devastated when he died, and when she developed dementia he wasn’t there to help her. She felt betrayed because he hadn’t cared enough about her to get medical care so they could be together longer.

I also question the decision to avoid medical care altogether after age 75 as an expedited path to a quicker death. I am thinking of conditions like Lyme disease or rheumatoid arthritis that make life pretty uncomfortable but may not lead to a quick and deadly end – just a long-drawn-out decline. It seems to me that there is a flaw in his medical reasoning, but I’m not a physician, so I’m just making guesses here.

Another makes many essential points:

As a former smoker who is also HIV positive, I want to chime in on Emanuel’s piece and the dying thread. I agree with Linker that Emanuel’s piece seems to be obsessively focused on productivity, and I have a problem with that.   But, this has been a recent topic of discussion in our family, and I would like to share my thoughts.

Both my mother and her sister (mid-80s) are in full-time assisted living.  Both have Alzheimer’s.  Both are confined to wheelchairs.  The last time I saw my mom – this summer – I lost it.  She is no longer my mother.  She can’t even put together a sentence.  You can see her trying – but that’s about it.  She’s not there.  She’s gone.  She is, sadly, a lump.

I will not die that way.

My siblings and I talk about dying well, and we talk about the fact that we have come to believe that part of living well means dying well. For my brother, that means driving a Harley into the Grand Canyon.  My sister talks about taking a rowboat on Lake Michigan in January, and then slipping overboard.  My plan is more involved.  I want to spend a full summer at the family retreat, inviting my friends in staggered groups to hang out and say goodbye.  And then taking poison.

No matter what, everyone in our family wants to die well.  No matter what – and unlike Emanuel – suicide seems a decent enough option.

For me, this is not some “out-there” concept.  During the AIDS crisis, I participated in gentle deaths. Usually it just involved cranking up the morphine.  In both cases, I was the designated look-out.  But, whether done in the hospital (with the tacit approval of hospital staff) or at home (with the tacit approval of Hospice staff), we knew what we were doing.  The disease was gruesome and painful.  Brain lesions often took away mental faculties.  You know what it was like, Andrew. Helping our friends to die well was the humane thing to do.

My cousin insists that despite our talk, we won’t take action.  And I admit I am slow at putting the plan on paper.  I also admit that it is likely at least one of us – perhaps all three of us – will fail in our dream of dying well.

But I know this: At least our generation is talking about it – something my mom’s generation never did.  We simply didn’t talk about death in our family and other than the basic paperwork (powers of attorney, wills, etc.); there was no discussion about how to die.

We are having that discussion now, and we should.  And it WILL mean a gradual and eventual embrace that our deaths are a part of our lives – and that there’s nothing wrong with shaping them, no matter how you choose to do so.

My dad dropped dead of a heart attack at 70.  It was shocking – very hard to deal with.  But, it was a good death.  He didn’t fuck around.  He split.  (He used to say, “Let’s blow this pop stand.”  And, that’s what he did.)

Seventy is my goal, too.  I figure that’s an outside shot anyway, given the fact that I’ve been HIV positive for now nearly twenty years.  I have seventeen years to go to get me to seventy.  If I make that – if I live as long as my father – I will be thrilled.  (I will have beat the odds.)

And you bet your ass I will start smoking then.  That’s my plan.  I can’t wait to taste the sweet smoke and the nicotine rush of my beginning-of-the-end celebration.

For me, dying well has nothing to do with productivity.  For me – like you – having been given a new lease on life in my late thirties – it’s about cherishing this precious gift but also knowing that part of the gift is to let go when the time is right. I hope I do it well.  I hope my brother and sister do, too.

I hope you keep this thread going. It’s necessary.

The Best Of The Dish Today

First Day Of Autumn In Richmond Park

My friend Damon Linker didn’t take so well to Zeke Emanuel’s piece on why he hopes to die at the age of 75. Money quote from Damon:

Reading Emanuel’s essay, I began to despair — not just about the moral outlook it expresses, but about whether its readers will even recognize how monstrous it is. Emanuel has taken the ethic of meritocratic striving that currently dominates elite culture in the United States and transformed it into a comprehensive vision of the human good. Viewed in its light, the only life worth living is one in which you endlessly, relentlessly strive to look as smart and clever as possible in the eyes of other smart and clever people. The ultimate goal of such a life is to be considered the smartest and cleverest person of all. Once old age or any other misfortune gets in the way of continually striving for that goal, one might as well cease to exist.

I think that’s an over-reaction. One does not need to embrace the cult of “achievement” or “success” to find old age, especially really old age, to be increasingly burdensome, and therefore not worth extending indefinitely at the cost of everything else. I suppose you could come away from Emanuel’s piece thinking that it values human productivity as the sole human good and thereby tacitly endorses a “eugenic” point of view. But that’s not what I took from it.

Here’s what I took from it. Life is not a sprint; it’s a marathon for most of us. And it has a very different pace at the end than at the beginning. Accepting this slower pace does not mean we should end the race before it’s over; it merely means that toward the end, the kind of things we might have done to our bodies to keep them fully poised for the future should not be our top priority. I’ve long joked that if things get really bad for me in my 70s, I’ll just stop taking my AIDS meds. But it isn’t entirely a joke. A graceful acceptance of one’s ultimate term limit can be a source of joy and peace and freedom, as opposed to the desperate life-extending mentality that leaves so many of us to die in intensive care. It is a more natural and less hubristic way to live. And to die. I have a feeling Montaigne would approve.

Today, we witnessed the launch of yet another bombing campaign against yet another country in yet another war authorized neither by Congress nor the UN. We observed the power and endurance of golf in China; the self-pity of most minorities and especially white evangelicals; Tocqueville’s insights into the current Middle East religious wars; and Nicolas Sarkozy’s chutzpah when it comes to saving marriage from the gays. Plus: results from one of the toughest window view contests ever. One contestant writes:

It’s obvious I can never win the VFYW contest. I mean, this week I identified Iqaluit, of all places. I found the right apartment building. I found the right apartment. I even found the right window. But I didn’t find the right part of the window! Good grief, as Charlie Brown would say. It feels like Lucy has whisked the football away again.

In other news, I finally broke down, got over my cheap ways, and bought a subscription.

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See you in the morning.

(Photo: A red deer is seen through the morning mist in Richmond Park on September 23, 2014 in London, England. Tuesday marks the autumn equinox where day and night are of equal lengths. By Rob Stothard/Getty Images.)

The Best Of The Dish Today

But first, get psyched for Wednesday:

I went to grad school and shared some classes with Zeke Emanuel, who just wrote a great piece for The Atlantic on why he doesn’t want to live much past the age of 75. Money quote:

By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations.

Dying at 75 will not be a tragedy. Indeed, I plan to have my memorial service before I die. And I don’t want any crying or wailing, but a warm gathering filled with fun reminiscences, stories of my awkwardness, and celebrations of a good life. After I die, my survivors can have their own memorial service if they want—that is not my business.

I also happened to catch this little piece on Leonard Cohen’s decision to take up smoking again now that he is 80 years old:

At any age, taking up smoking is not sensible. Both the smoker and those who breathe his secondhand smoke can suffer not only long-term but acute health problems, including infections and asthma. And yet, Mr. Cohen’s plan presents a provocative question: When should we set aside a life lived for the future and, instead, embrace the pleasures of the present?

It’s a vital question this one – and not because of the extraordinary costs of maximal healthcare at the end of many of our lives. It’s vital because it challenges our Western denial of death, our cult of life-extension, our refusal to fully absorb the fact that we are finite, mortal, obsolescent. I was horribly lucky to be forced to confront this at a very early age – 29 to be exact. The prognosis back in 1993 was not great for HIV infection, and I watched a close friend die at the age of 31. Is my life somehow worth more than his, I wondered, simply because I’m going to be here longer? Some called this survivor’s guilt. I thought it was merely addressing a core existential question.

One day, a simple thought occurred to me and a huge amount of stress and worry and anxiety lifted. It occurred to me to see life the way we see college. No one gets extra points for staying in college for longer than four years. We understand that it’s finite; and our response is to value the content of that experience rather than its length. I vowed that that was how I was going to treat life from now on. And, although, of course, those feelings waned as my prospects brightened, I haven’t ever fully let go of it.

It lies behind many of the things I did with my life since then – the apparently quixotic fight for marriage equality (the kind of nutty thing you throw yourself into if you only have a few years left); even more quixotic attempts to re-describe conservatism; the crazy idea that I could write directly for readers with no middle man; the equally risky prospect of making an independent business out of a very idiosyncratic blog. I think knowing I was living past my expiration date helped me live more fully and less fearfully. And it makes the idea of trying to live into one’s eighties as a goal a little beside the point.

There’s wisdom in Zeke’s outlook; and, of course, wit in Cohen’s. I think of Hitch. Maybe he could have lived a different, more upright life – which would have been much longer. But would he still have been Hitch? And isn’t it better to have one real Hitch for a short time than a less authentic version that lived into his dotage?

I know this much: I just want to be alive when I die.

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