27 December 2014

Why Life After 75 is Worthwhile

Stephen Kershnar
Dying at 75: Not Recommended
Dunkirk-Fredonia Observer
December 22, 2014

Recently bioethicist Ezekiel Emanuel sparked controversy with his article in The Atlantic, “Why I hope to die at 75.” He argued that it would be best for him to die at 75 because his contribution to society and creativity will have significantly declined and because he will become an increasing burden on his family. He argues that his continued life will replace his family’s memories of him as rigorous, funny, and loving with memories of him suffering from worsening disabilities and as a caregiving burden.

As Brown University philosopher Felicia Ackerman points out, Emanuel’s opinion matters because, he is the director of the Clinical Bioethics Department at the National Institutes of Health and thus in a position to transfer resources away from projects that aim to prolong life in the elderly. He is also one of the primary architects of Obamacare.

Emanuel tried to limit his argument in terms of what was good for him rather than others, but unless one thinks that what makes people’s lives go well varies at a fundamental level, his argument applies to others. Whether applied to others or himself, the argument fails for several reasons.

First, happiness makes a life go better. Psychologist Arthur Stone has found that from 65 to 85 people become happier. Here happiness is measured according to self-reported well-being. If (on average) people become happier, then during their elderly years their lives go better rather than worse. As a result, each year is more worth to them than earlier years. A common view, and I think the correct one, is that contribution and creativity matter only because they make one happier, they do not independently make someone’s life go better. 

Now if life becomes awash in pain and degradation, then the calculation might change. For example, one in three Americans 85 or over has Alzheimer’s. This along with other maladies might make life no longer worth living, but this is not the sort of case on which Emanuel and I are focusing.   

Second, even if one thinks that how well one’s life goes depends on things that are independent of happiness (for example, loving relationships, knowledge, and virtue), there is no reason to think that these things are not present after age 75. Even if they were not present at the same level, and I see no reason to think this, it is better to have them to a lesser degree than not at all. This points out the more general point, which is that even if one’s quality of life were to decline with age, this is still no reason to cut it short. By analogy, just because Martin Scorcese movies are less enjoyable now than in the past, this is no reason to stop watching them if one loves movies and his movies are still better than their competitors.      

Third, healthy families do not prefer that their elderly parents be dead rather than in a reduced state. This is true even if they factor in the loss of replacing good memories with bad ones. Assuming their preferences are well thought out, and I think they often are, this tells us that the early death is not good for the family members Emanuel is trying to help by cashing out early.

There’s not much to be said for Emanuel’s position. The correct approach is to consider whether one’s future has more happiness than unhappiness (alternatively, net positive well-being). If so, then dying is not in one’s interest. What is worth noting is how the introduction of religious ideas changes how we should think about this issue. Emanuel takes a pass on the role of heaven because introducing this factor would change how one thinks about dying early.

Judaism and Christianity are committed to an afterlife. If one knows he is going to heaven and that he’ll be happier in heaven than on Earth (this is true on any plausible theory of heaven), then it makes little sense to try to stay alive. Doing so would be like people in the 1950’s spending time in New York City during the insufferably hot part of the summer when they could be at a resort in the Catskills swimming, dancing, and eating ten different types of cured fish. Leaving aside work and family-related duties, there is little to be said for suffering unnecessarily in the city heat.

Even the family issues cut in both directions. If many of one’s family (for example, deceased spouse, parents, and siblings) are in heaven desperately missing the elderly person and one will escape both Earthly maladies and decreased productivity and creativity in heaven, then only a selfish family would want to delay an elderly person’s passage. After all, they’ll catch up with him later and he’ll be very happy in the interim. If they want him to delay passage, then perhaps the elderly person should do so, but he should be clear as to why he is delaying his passage, namely, for his family and not for himself.

If one is risking hell or time in purgatory, then an elderly person ought to focus on doing what is necessary to avoid such a catastrophe. Of course, this has little relation to declining productivity and creativity or to malady-related suffering. Here adult children of the elderly should focus on helping the elderly avoid hell or minimize time in purgatory and should give this priority as this goal is far more important than whether the adult children’s offspring go to a good college or become a physician. Even for Jewish parents, the benefit of being a child becoming a physician is infinitesimal compared to the cost of a parent going to hell.

Now one can be confident that a loving God would not send people to hell, at least a hell that did not allow people to eventually leave it for heaven. Such suffering would be disproportionate to whatever finite evil a person did and, in any case, would not achieve any worthwhile goal. To the extent this conflicts with various branches of Christianity (for example, Catholicism), this is good reason think that these branches are in error.   

Our elderly years on Earth promise to be golden ones and much should be done to make sure we get as many of them as possible. This changes if heaven exists and the failure to enter this into the calculation makes sense only if one is an atheist. 

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