It’s not that Ezekiel Emanuel, M.D., Ph.D., necessarily wants to die right after he blows out 75 candles on his birthday cake. He just doesn’t want to live to a ripe old age if it means disability, disease or dementia.
Emanuel briefed reporters on the issues of quality versus quantity of life during a Dec. 12 webinar sponsored by Reporting on Health. It was also the theme of his controversial Atlantic article, “Why I Hope to Die at Age 75.”
“You don’t actually pick your own title; I certainly didn’t pick that Atlantic title.” he told more than 200 online participants. “It probably was good for sales for the Atlantic …”
The physician, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and special adviser on health policy to the Obama administration, stressed the importance of living a meaningful life, rather than trying to stay alive well past what nature intended.
While Americans are living longer than ever, they’re also living with the burden of more chronic disease, frailty and dementia. “We’re seeing an expansion of morbidity, not a compression,” he said. Caregiving burdens also increase as people age, he reminded us.
He argued that articles like the recent David Brooks op-ed contending that older people are happier than younger people miss a key perspective, because they don’t include the millions of homebound elderly, nursing home or assisted-living residents in the story. “They also don’t include those who can’t speak, or are too ill to respond, or those with Alzheimer’s who are unable to answer questions.”
Journalists need to do a better job of asking, “What’s missing from this story,” he cautioned. Reporters should look at what’s under the data and probe more about subjective issues like happiness. He pointed out that since older people tend to restrict aspirations, they’re happier with doing less.
“Happiness is not the answer,” he argued. Meaningfulness is. These measures may or may not overlap.
“We gain meaning in our lives when we contribute to our communities and enrich people around us. We feel fulfilled,” he explained. That feeling is detached from how long we live.
Journalists should also question why such a positive spin is put on longevity, citing coverage of a recent CDC report on the topic. “Is there a negative side to this? Is this always a good thing?” he asked.
“We have a tendency to project forward and obsess with longevity. It’s counterproductive,” Emanuel argued. “Instead, we should focus on how we can live more meaningfully and contribute to society.”
On the policy side, Emanuel said he hoped that the Atlantic piece moves the conversation about how disabilities impact older adults. “We should put a priority on what things early in life will allow people to live fuller lives.” Public health priorities should include addressing the pre-term birth rate, infant and adolescent mortality, he said.
When it comes to end of life and “death with dignity,” Emanuel, an oncologist, scolded the media for sensationalizing the issue and selectively profiling only a small handful of those with terminal illness. “Ask the question, how characteristic is that story?”
He has come out strongly against euthanasia. “The picture of someone with uncontrolled pain is not accurate,” he contended. “The motivation is primarily related to mental ability to cope.” He said the proportion of those wanting assisted suicide were outliers, not the rule. “There’s been almost no coverage of the slippery slope.”
He also called for more training of physicians and nurses on how to have conversations with patients about end-of-life and palliative care.
“It’s one of the hardest conversations we can have, and we weren’t born knowing how to do it.” (For more on covering end-of-life issues, check out our tip sheet of Ellen Goodman’s presentation at Health Journalism 2013.)
Referring back to the main theme of his presentation, he again stressed that the emphasis should revolve around creating a more meaningful life, rather than just a long one. “Life shouldn’t revolve around interventions.”