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Old 09-22-2014, 11:43 AM   #21
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The article was mentioned in the recent 'sense of mortality' thread. He is a medical/bioethicist.
His words did not resonate with me but it is his life, if it works for him.......
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Old 09-22-2014, 12:30 PM   #22
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A brief but succinct summary of my position on the matter:

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Old 09-22-2014, 12:39 PM   #23
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I do agree with not pursuing aggressive life prolonging treatments in late life but if I get a urinary tract infection at 75 I am certainly going to take antibiotics. I also know a lot of people who have had knee and hip replacement in the 70s and been pleased with the results. My sister's then ~75 YO boy friend got new hips about 13 years ago and was back powder skiing into his mid 80s.

What irritated me the most was he mocked those of us who hope to age with decent health until we are old and then fall off a cliff in our final days. I recognize that it isn't highly likely but he seems to think something like that will happen to him if he stops taking antibiotics at 75. That is precisely the same wishful many of us fantasize for 85-90.
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Old 09-22-2014, 01:07 PM   #24
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Oh yes, ole 'Zeke' Emanuel. Long time left-wing "ethicist" and contributing author of "HillaryCare" from back in the early '90's. Let's just say I've read much of his work and rather sharply disagree with most (tho not all) of it.

To stay OT on this article-

The bit on obligate, inexorable declines in productivity at his arbitrary age figure is at odds with science and history. He entirely ignores mountains of data on the variability of aging. Apparently Zeke has forgotten (or ignores) the contributions and achievements of the 75+ crowd. It is illogical to label anyone as washed up at 75, or any other arbitrary age. There are thousands of those 80+ functioning at higher levels than many in their 30's and 40's. Like physicist, author, and multiple Ironman champ Lew Hollander.
My Kona: 23rd Time's a Charm
Or Ben Franklin, who in his late '70's secured critical French support for the fledgling US democracy (as Minister of France) and was still making important scientific discoveries (e.g. link between climate change and volcanic eruptions).
Benjamin Franklin - Wikipedia, the free encyclopedia
Or Thomas Edison and Henry Ford who were also quite active in their careers beyond 75.
OTOH- he seems to be quite happy that (left-wing) Ruth Bader Ginsburg remains on the SCOTUS bench at age 81

One other bit that stuck in my craw was his position on the elderly refusing flu vaccination. HIGHLY illogical, selfish, and unethical IMHO. Flu kills thousands in the US annually. As an academic physician he should be well aware that the non-vaccinated population is a vector for spread of the disease. Accepting vaccination is ethically well-justified on an altruistic basis alone. Unless he is proposing that altruism should also be abandoned at age 75
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Old 09-22-2014, 01:14 PM   #25
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Now let me tell you about post 85. It hasn't been good for anyone in my extended families. None of them had any quality past 85.

My mentor in the medical field is being honored at a dinner in two months, out on he west coast. I'm going to try to get there. He's 93.


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Old 09-22-2014, 01:49 PM   #26
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I want to die when I can no longer perform the basic functions of life, when my body won't let me do it, when it hurts too much, when I clearly become a significant burden to family, friends and the state. Not a moment sooner, whether that comes at 65 or 95.
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Old 09-22-2014, 02:09 PM   #27
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Well, we need more people like the author to control the global elderly population explosion. The world will have (if not already) too many old farts in years to come, and not enough young ones to support them. Let's make 75 the mandatory lifespan for everyone. That's will speed up ER for many including mine.
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Old 09-22-2014, 03:10 PM   #28
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Originally Posted by ERhoosier View Post

One other bit that stuck in my craw was his position on the elderly refusing flu vaccination. HIGHLY illogical, selfish, and unethical IMHO. Flu kills thousands in the US annually. As an academic physician he should be well aware that the non-vaccinated population is a vector for spread of the disease. Accepting vaccination is ethically well-justified on an altruistic basis alone. Unless he is proposing that altruism should also be abandoned at age 75
The altruism implied in his statement -

Quote:
What about simple stuff? Flu shots are out. Certainly if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs.
In the advent of a flu pandemic, there would be a shortage of vaccine, and he would forgo his shot to save younger lives.
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Old 09-22-2014, 03:13 PM   #29
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Isn't he the architect of Obamacare, Rahm Emanuel's brother and an MD/PhD to boot? True, he looks a lot older than me and he is a good 6 years younger than I am.

Then he should know better. A leading secondary cause of mortality and morbidity from the flu in the elderly is pneumonia. So he plans to not get a flu shot but take an antibiotic for pneumonia that he'll get from the flu? Gack.

There's the young 75 and the old 75. My DH at 72.5 years old exercises 2 hours a day, lost 25 lbs since retiring 4 years ago, leads an active retiree life with volunteer activities, friends, interests, hobbies; we go to concerts, movies, travel, etc. He's not going to live forever but at least he does what he can to keep himself active and alert.

The old 75's are my nursing home patients who have had a number of chronic diseases, some lifestyle-induced, like type 2 diabetes, COPD from smoking, cardiac disease from bad dietary habits and being sedentary, too much stress and strain.

There's a world of difference. Most of the ones who really really want to die in my medical experience are depressed. We usually cling onto life until the end, even when we should want to let go.

Just my $0.02 as a geriatric psychiatrist.


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Old 09-22-2014, 03:54 PM   #30
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Originally Posted by bjorn2bwild View Post
In the advent of a flu pandemic, there would be a shortage of vaccine, and he would forgo his shot to save younger lives.
That's a pleasant thought. OTOH, I keep imagining people roaming the streets with their guns blazing to get their hands on the vaccine to save themselves over others . Was it just last week that a few Ebola health workers and accompanying journalists were killed in a remote village in Africa for fear of the pandemic? Ok, I digress. Back to OT, I consider myself starting late in enjoying my life. That should buy me a decade or two over 75 before I feel I've lived my life to the fullest.
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Old 09-22-2014, 04:21 PM   #31
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I think his point is being missed. It's about quality of life and some of the horrible side effects of life extension efforts.

I get the rejecting colonoscopies and mammogram... because if it turns up bad news, you're looking at surgery and chemo... not so easy to take at any age - and hellishly awful when you're old. Not sure I agree about antibiotics... but I can see his point, and will be pondering it, about some of the other medical intrusions and treatments.

But then again - I've seen 3 family members go through the horror of chemo. Two spent their last days in the ICU with vents and pain and open surgical wounds from failed attempts to rescue them temporarily from a terminal disease. There is not dignity or quality of life in that. The third, my dad, did it on his terms. He died of cancer... and was taking an oral chemo for it, but not a horrible chemo. He died quickly when a cold turned to pneumonia which turned to septic shock. He was very afraid of the ravages of cancer, and the pain... and my sister and I believe that he somehow orchestrated this much more peaceful, and quick, death. He'd already buried my mother and brother after seeing them go through extensive painful lengths to extend their lives by days and months. (They were already terminal.)

My DNR is already filled out. I'm not sure about an arbitrary age... but 75 is about the ballpark I see as reasonable...
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Old 09-22-2014, 04:35 PM   #32
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Originally Posted by rodi View Post
I think his point is being missed. It's about quality of life and some of the horrible side effects of life extension efforts.

I get the rejecting colonoscopies and mammogram... because if it turns up bad news, you're looking at surgery and chemo... not so easy to take at any age - and hellishly awful when you're old. Not sure I agree about antibiotics... but I can see his point, and will be pondering it, about some of the other medical intrusions and treatments.

But then again - I've seen 3 family members go through the horror of chemo. Two spent their last days in the ICU with vents and pain and open surgical wounds from failed attempts to rescue them temporarily from a terminal disease. There is not dignity or quality of life in that. The third, my dad, did it on his terms. He died of cancer... and was taking an oral chemo for it, but not a horrible chemo. He died quickly when a cold turned to pneumonia which turned to septic shock. He was very afraid of the ravages of cancer, and the pain... and my sister and I believe that he somehow orchestrated this much more peaceful, and quick, death. He'd already buried my mother and brother after seeing them go through extensive painful lengths to extend their lives by days and months. (They were already terminal.)

My DNR is already filled out. I'm not sure about an arbitrary age... but 75 is about the ballpark I see as reasonable...

My brother died at age 49, after 8 years of struggle against cancer. The treatments, side effects, and pain he went through, especially, the last 12 months, was horrific. Despite it all, he clung to his life until the day he died. He could have ended sooner by just stop trying to extend his life. But he didn't. For everyone like the author, there are others who will fight until the end. 75 has no meaning in that sense.
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Old 09-22-2014, 06:04 PM   #33
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I want to die when I can no longer perform the basic functions of life, when my body won't let me do it, when it hurts too much, when I clearly become a significant burden to family, friends and the state. Not a moment sooner, whether that comes at 65 or 95.
+1. I don't know what age exactly, but when I'm no longer enjoying life due to physical and/or mental limitations, that's enough.

None would end their own life, but my 92 yo parents have lost most of their independence and DW's 87 yo Mom can't do anything for herself anymore and is miserable 24/7. None of them enjoy life much anymore...
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Old 09-22-2014, 09:28 PM   #34
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Originally Posted by rodi View Post
I think his point is being missed. It's about quality of life and some of the horrible side effects of life extension efforts.

I get the rejecting colonoscopies and mammogram... because if it turns up bad news, you're looking at surgery and chemo... not so easy to take at any age - and hellishly awful when you're old. Not sure I agree about antibiotics... but I can see his point, and will be pondering it, about some of the other medical intrusions and treatments.

But then again - I've seen 3 family members go through the horror of chemo. Two spent their last days in the ICU with vents and pain and open surgical wounds from failed attempts to rescue them temporarily from a terminal disease. There is not dignity or quality of life in that. The third, my dad, did it on his terms. He died of cancer... and was taking an oral chemo for it, but not a horrible chemo. He died quickly when a cold turned to pneumonia which turned to septic shock. He was very afraid of the ravages of cancer, and the pain... and my sister and I believe that he somehow orchestrated this much more peaceful, and quick, death. He'd already buried my mother and brother after seeing them go through extensive painful lengths to extend their lives by days and months. (They were already terminal.)

My DNR is already filled out. I'm not sure about an arbitrary age... but 75 is about the ballpark I see as reasonable...
I agree with your take on it. I have a friend, no older than 75,who has always been a most compliant patient. Nevertheless, or perhaps because of this, he has had one problem after another, many of them caused by the previous interventions of his doctors.

Ha
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Old 09-22-2014, 09:59 PM   #35
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The altruism implied in his statement -

In the advent of a flu pandemic, there would be a shortage of vaccine, and he would forgo his shot to save younger lives.
His statement was simply "Flu shots are out". I see no altruism in his words. He made this statement in the same context as his plan to refuse antibiotics for "pneumonia or skin and urinary tract infections". He made no qualifier of a vaccine shortage. In fact most pandemics are NOT associated with vaccine shortage but by folks not getting their vaccination. Ezekiel makes the erroneous assumption that his refusal of vaccine would save younger lives in the event of a pandemic. This violates the basic principle of herd immunity upon which population protection depends. Such vaccination refusal could likely INcrease the spread of infection and INcrease the risk to "younger lives".
Community Immunity ("Herd" Immunity)

I have no quarrel with someone declining medical care as they wish. I fully support one's right to refuse colonoscopy, PSA testing, cancer treatment, or heart surgery (to use his examples). However refusing to participate in public health efforts is quite different as it may be reasonably expected to have negative consequences for others.
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Old 09-22-2014, 10:40 PM   #36
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I found the article very thought provoking. I have long held the belief that simply extending my life - with a low quality - is not for me. This guy has certainly put a lot of thought into that sentiment. Kudos to him.
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Old 09-23-2014, 06:18 AM   #37
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A lot of my relatives lived without severe health issues till high in their 80s, some tilll their 90s.
So 75 looks a bit early to me.

I would not be surprised if the article writer gets a sudden attack of OMY syndrome once he is in his 74th, happy with family, friends and funds but just this one health issue that everybody tells him to get taken care of...
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Old 09-23-2014, 06:54 AM   #38
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I think his point is being missed. It's about quality of life and some of the horrible side effects of life extension efforts.
This. His point is how much preventive effort should be put into remaining alive and "healthy" given the physical and mental deterioration he (and we) will suffer. He may feel differently about some of these things once he reaches 75, but it's a legitimate view.

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The results show that as people age, there is a progressive erosion of physical functioning. More important, Crimmins found that between 1998 and 2006, the loss of functional mobility in the elderly increased. In 1998, about 28 percent of American men 80 and older had a functional limitation; by 2006, that figure was nearly 42 percent. And for women the result was even worse: more than half of women 80 and older had a functional limitation. Crimmins’s conclusion: There was an “increase in the life expectancy with disease and a decrease in the years without disease. The same is true for functioning loss, an increase in expected years unable to function.”
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Old 09-23-2014, 12:13 PM   #39
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My friend's mother was 'diagnose' with uterine cancer at 80. After one radiation treatment, she refused any more. She said to me that she has raised all her 9 children who are all successful living good lives, have seen her grandkids and great grand kids and have lived a good life and so was prepared to go. 12 years later she is very much alive, healthy and lucid.
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Old 09-23-2014, 03:13 PM   #40
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Me thinks we need more like minded people like the him. Would keep SS solvent. I am not volunteering unless I can't make it to the bathroom under my own power and wipe my own butt.
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