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091208-ezekiel

A Life Worth Living According to Ezekiel Emanuel

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Ezekiel (Zeke) Emanuel, bioethicist and brother to Chicago mayor Rahm Emanuel, wrote an article for The Atlantic Monthly titled “Why I Hope to Die at 75” that is generating  a lot of, shall we say, discussion.

Let’s clarify from the outset what he is not saying in this article.

He is not advocating the legalization of euthanasia or physician-assisted suicide, both of which he has long and admirably opposed, fearing that their legalization would compromise treatment for chronic pain and depression and would result in non-voluntary euthanasia of mentally incompetent patients or those whose conditions others view as constituting a life not worth living.

Nor is Emanuel announcing his intent to commit suicide at age 75.

In addition to expressing opposition to both euthanasia and physician-assisted suicide, Emanuel makes some wise judgments regarding what he views as an American obsession with immortality:

Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal.

While agreeing with his criticism of obsessive efforts at prolonging life, I would disagree that the obsession with immortality is either new or distinctly American.

Facing the end of one’s life, which includes both the weakening of mind and body, is neither easy nor pleasant. Wrestling with the inevitability of aging and death is poorly served, however, by seeking futilely to prolong life or the beauty of youth through the profligate use of time, labor, and money.

Following his admirable observations about suicide and bootless quests for the elusive fountain of youth, Emanuel veers into less admirable territory, providing a litany of physical and cognitive impairments that afflict humans as they age and then concluding that “75 is a pretty good age to aim to stop.”

While acknowledging briefly the contribution aging humans make to mentoring and teaching, Emanuel emphasizes that what such activities really do is expose how aging humans accommodate their waning intellectual and physical capacities. From Emanuel’s perspective, the role and value of mentoring is dwarfed by the reality it signifies, which is “the constricting of our ambitions and expectations.”

Both aspects of mentoring in old age (i.e., that mentoring has value, and that mentoring often reflects a constricting of ambitions, expectations, and abilities) are true, but Emanuel’s emphasis matters.

While he rightly points out that the transmission of the “wisdom of elders” is often undervalued, he contributes to such undervaluation through his dispiriting account of the parade of horribles that accompanies aging. Emanuel acknowledges what for many is the greatest blessing and joy of aging: spending time with children, grandchildren, and great-grandchildren. But the way he addresses this blessing reveals his values.

While writing two sentences about the blessings of offspring, he spends three paragraphs showing how aging matriarchs and patriarchs burden others, and another three presenting his belief that living when one is “stooped and sluggish, forgetful and repetitive” will pollute the memories of younger family members:

There is more to life than youthful passions focused on career and creating. There is posterity: children and grandchildren and great-grandchildren.

But here, too, living as long as possible has drawbacks we often won’t admit to ourselves. I will leave aside the very real and oppressive financial and caregiving burdens that many, if not most, adults in the so-called sandwich generation are now experiencing, caught between the care of children and parents. Our living too long places real emotional weights on our progeny.

Unless there has been terrible abuse, no child wants his or her parents to die. It is a huge loss at any age. It creates a tremendous, unfillable hole. But parents also cast a big shadow for most children. Whether estranged, disengaged, or deeply loving, they set expectations, render judgments, impose their opinions, interfere, and are generally a looming presence for even adult children. This can be wonderful. It can be annoying. It can be destructive. But it is inescapable as long as the parent is alive. Examples abound in life and literature: Lear, the quintessential Jewish mother, the Tiger Mom. And while children can never fully escape this weight even after a parent dies, there is much less pressure to conform to parental expectations and demands after.

Living parents also occupy the role of head of the family. They make it hard for grown children to become the patriarch or matriarch. When parents routinely live to 95, children must caretake into their own retirement. That doesn’t leave them much time on their own—and it is all old age. When parents live to 75, children have had the joys of a rich relationship with their parents, but also have enough time for their own lives, out of their parents’ shadows.

But there is something even more important than parental shadowing: memories. How do we want to be remembered by our children and grandchildren? We wish our children to remember us in our prime. Active, vigorous, engaged, animated, astute, enthusiastic, funny, warm, loving. Not stooped and sluggish, forgetful and repetitive, constantly asking “What did she say?” We want to be remembered as independent, not experienced as burdens.

At age 75 we reach that unique, albeit somewhat arbitrarily chosen, moment when we have lived a rich and complete life, and have hopefully imparted the right memories to our children. Living the American immortal’s dream dramatically increases the chances that we will not get our wish—that memories of vitality will be crowded out by the agonies of decline. Yes, with effort our children will be able to recall that great family vacation, that funny scene at Thanksgiving, that embarrassing faux pas at a wedding. But the most-recent years—the years with progressing disabilities and the need to make caregiving arrangements—will inevitably become the predominant and salient memories. The old joys have to be actively conjured up.

Of course, our children won’t admit it. They love us and fear the loss that will be created by our death. And a loss it will be. A huge loss. They don’t want to confront our mortality, and they certainly don’t want to wish for our death. But even if we manage not to become burdens to them, our shadowing them until their old age is also a loss. And leaving them—and our grandchildren—with memories framed not by our vivacity but by our frailty is the ultimate tragedy. …

75 defines a clear point in time … The deadline also forces each of us to ask whether our consumption is worth our contribution.

What an unattractive picture Emanuel paints of the final chapter of life. One wonders, does he have an objective measure of creativity, activity level, vigor, animation, and enthusiasm that he looks to for help in determining human check-out time? Or is it just the diminution of creativity, activity-level, vigor, animation, and enthusiasm that marks one’s appointed departure time? I know an 89 year-old whose activity level, though diminished, exceeds the activity level of a decades younger man I know who has the disposition of a slow-moving loris—which isn’t a bad thing. He’s very pleasant and relaxing to be around.

Emanuel paints an equally unattractive picture of family life in which elderly parents “render judgments, impose their opinions, interfere, and are generally a looming presence” that casts an ominous “shadow” over the lives of their adult children and prevents them from living an independent life. (The overbearing autonomous self rears its intrusive giant head again, obsessed with its own narcissistic desires).

Yes, elderly parents set expectations, render judgments, and offer opinions, but so too do their children and even grandchildren. That’s what family members (and, I might add, friends) do.  Elderly parents also laugh and tell jokes. They cuddle and read stories. They hug and they heal. They watch and they listen. And no one will see grandchildren (or as I call mine, “golden calves”) through glasses as fogged by love as grandparents.

Emanuel could have eloquently illuminated the good that is cultivated when people are offered the privilege of serving the infirm and the disabled of any age.

He could have explored the parade of horribles that, unless we’re careful, can infect any society as blessed with material comfort as America, one horrible of which is the sense of entitlement to comfort and leisure time that has contributed to our willingness to warehouse our elderly.

He could have expressed sadness over the resentment so many Americans feel toward tending to those whose conditions deplete our often ample reservoir of leisure time.

He could have expressed frustration over the amount of time we Americans spend golfing, jogging, shopping, getting manicures, and watching television while our sluggish, forgetful, aching mothers and fathers languish in elder-warehouses with perhaps a visitor or two once a week.

He could have used his rhetorical powers of persuasion to encourage those who care for both aging parents and children to remind their children why their grandparents are stooped.

He could have urged parents to teach their children how to feel about the elderly and disabled when their children are young, long before it is only “with effort” that they are able to recall the funny, joyful memories of their grandparents.

Emanuel is wrong about memory. My “predominant and salient memories” of my grandpa who lived to 89 and of my grandma who lived to 96 are not of “progressing disabilities” and “caregiving arrangements.” Yes, I have those memories, but they are neither predominant nor salient.

My memories of my Swedish immigrant grandpa include his ceaseless tinkering with legs bowed by rickets, his selfless sacrifice of his cake frosting to me on every family birthday, and his awkward gift to my mother of a back- issue of Popular Mechanics magazine to read on the occasion of her hospitalization.

My predominant and salient memories of my grandma are of her making Swedish coffee bread and dumpling soup, of planting snapdragons—those most delightfully aggressive summer flowers—and  picking weeds by hand, all stooped over.

We have ceased to see caring for the least of these—including even our own family members—as a way to bring glory to God. We see little of value in suffering. We don’t see in our own aging any blessing for ourselves or the larger community. We don’t value sacrifice. We don’t see any of this because selfishness, pride, and the values of the world have blinded us to the strange beauty that inheres suffering and sacrifice.



 

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