Why I Hope To Die At 75 Revisited (Atlantic article)

I recall reading at one time that they reason they often tell you can stop screening for a certain thing at age X is that they expect even if you have it it either will not kill you before something else does or the treatment would be quite harsh with minimal effect.

It won't be an age only thing for me - it will take into account how the rest of my health is and the impact it would have on any loved ones for me to go through it or not.
 
I just read the entire article. I wonder how the author will feel in 18 years when he hits 75? ;) Regardless, he makes interesting and reasonable points, IMO. It sure would make financial planning easier with a known expiration date.:)

I especially agree with his views on screening tests after ~75. I'm sure it will save some, but for many it will just lead to more test, treatments and significant (and sometimes long term debilitating) side effects.
 
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My maternal grandfather was diagnosed with prostrate cancet at age 82. He asked the doc about the treatments and how long he could expect to live. Doc said, with treatment, 5 yrs. Without treatment, 5 yrs. He made it 5 years and at the very end my grandmother gave him a little "extra" morphine.

Personally, I would much rather have people say "it's too bad he's gone" rather than "he's no longer suffering".
 
sengsational said:
It seems to me like too many people do "whatever they can" as opposed to weighing all the consequences. Say some procedure adds X months of lifespan, on average. That's not enough information, but I think some people think that's enough. They might say "2 months to recover." Still not enough information. How many people never make it back to their baseline health? Based on some of the interventions I've seen with my relatives, a good many of the older ones never got even close to their pre-intervention capabilities. So they took an early dive in health and maybe dragged on a bit longer than they would have, who knows. Obviously not an easy decision, especially because patients don't have as much access to quality of life measurements compared to life duration, which is required for the intervention to be approved.
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This is discussed in the book Being Mortal by Atul Gawande. Like the Dr. Emmanual, the author of the OPs article, Dr. Gawande is a practicing doctor (cardiac surgeon)... and when his dad (also a doctor) started having aging/disease issues he started exploring the trade offs of treatments and how to explore the options. He fully admitted that doctors tend to want to treat - via surgery if they're a surgeon, via chemo if they're an oncologist, it's their training and mindset. But patients need to ask hard questions about quality of life, trade offs... how much is 3 months extra life worth if the quality of life of that 3 months is full of pain. Spoiler alert - his dad was willing to do treatments as long as he could pursue his tennis games. That was his criteria for quality of life.

I've seen three family members die of cancer, two with awful chemo experiences. I would definitely be asking tough questions if I develop cancer and chemo is recommended... I would probably agree to one round of chemo if there is a significant chance of an upside.

My husband is facing this stuff right now - prostate cancer with a high PSA, high gleason
score, but entirely contained in the prostate. He's doing treatment (hormone blocking for 6 months and 5 1/2 weeks of EBRT radiation). The treatment has mild (ish) side effects with a very high cure rate. Totally makes sense to do this. He used quality of life in weighing the treatment options.
 
I am struggling with this issue for my mom right now. Age 93, Alzheimers and other health problems, in skilled nursing. Little quality of life, she says she has lived too long. She has signed DNR, Living Will, Health Care Power of attorney. But it is hard to apply all this to specific situations and my sisters and I struggle. We still have her teeth cleaned and she recently had a cavity and I took her to the dentist to get the cavity taken care of--my thinking is that a tooth abscess would be a lot of pain. She sometimes has trouble breathing and we have authorized the nursing home to give her an inhaler. We gave permission for her to have flu shot, Covid shot, RSV shot. We struggle about antibiotics if she gets a kidney infection, etc. Very hard choices.
 
I understand that some of you have friends/family that are capable well into their 90s. I personally have never known a 90+ year old who was enjoying life. I'm "only" 68, and hope to make it to 75. But no matter what, when my quality years end, I'm willing to go across the Rainbow Bridge. I had a foot on it a couple of years ago, so I've dealt with that issue already. Luckily my QoL potential was good enough to continue through the treatments needed. But at whatever point they tell me (or I figure out myself) that there's nothing left to look forward to except pain and misery, I'm outta here.
 
harley said:
I understand that some of you have friends/family that are capable well into their 90s. I personally have never known a 90+ year old who was enjoying life. I'm "only" 68, and hope to make it to 75. But no matter what, when my quality years end, I'm willing to go across the Rainbow Bridge. I had a foot on it a couple of years ago, so I've dealt with that issue already. Luckily my QoL potential was good enough to continue through the treatments needed. But at whatever point they tell me (or I figure out myself) that there's nothing left to look forward to except pain and misery, I'm outta here.
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With you Harley at "only" 66. Cancer treatment eight years ago gave me a window into mortality and the brutality of some treatments. When I can see my exit from good QoL, I'm punching the button.
 
harley said:
I understand that some of you have friends/family that are capable well into their 90s. I personally have never known a 90+ year old who was enjoying life. I'm "only" 68, and hope to make it to 75. But no matter what, when my quality years end, I'm willing to go across the Rainbow Bridge. I had a foot on it a couple of years ago, so I've dealt with that issue already. Luckily my QoL potential was good enough to continue through the treatments needed. But at whatever point they tell me (or I figure out myself) that there's nothing left to look forward to except pain and misery, I'm outta here.
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From what I can tell so far, doctors who will help factor in quality of life are rare unfortunately. They will recommend treatment (for legal reasons in part) unless it’s very obvious like a very old frail patient. It’s entirely up to the patient to research quality of life, side effects, efficacy and make a decision to forego treatment.
 
Admittedly, not the same thing, but I was told by three doctors/neurologists at the best hospitals in Boston that my brother would never walk and would be bedridden with feeding tube in a nursing home for the rest of his life. "The damage is too severe. Don't even think of him ever coming home".

Within a year he was semi-independent, fully cognizant, living alone (with help at dinner time), feeds, dresses himself and goes for long walks on his own.

My point is that " you never know " and that the experts aren't always right. I'd hate to short-change my life based on what the experts tell me is going to happen.
 
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Midpack said:
From what I can tell so far, doctors who will help factor in quality of life are rare unfortunately. They will recommend treatment (for legal reasons in part) unless it’s very obvious like a very old frail patient. It’s entirely up to the patient to research quality of life, side effects, efficacy and make a decision to forego treatment.
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When my Grandpa was 95 and in long-term care he developed stomach cancer and the docs wanted to operate. Grandpa had enough brainpower left to tell them No.

There are unicorns, of course- people running marathons in their 80s or the lovely 92-year old woman I met at Dad's Assisted Living facility who'd just come back from a European cruise with her family. I will NOT be running marathons (never have) but will make healthcare decisions on how well I'm functioning otherwise.
 
I have always been a strong proponent of MAID for those who wish it. As with many others here, I would prefer to live a high quality life and then “fall off a cliff” so to speak. But we can’t always get what we want.

On primarily physical illnesses like cancer, we have a number of decent options to have it our way. We can stop aggressive treatment and switch to palliative care, hospice is often an excellent option, and VSED (voluntary cessation of eating and drinking) is an effective and relatively painless exit strategy I have witnessed.

Loss of cognition is the confounder. As they say, man plans, God laughs. We can map out our exit strategy in as much detail as we want but in the face of an illness like Alzheimer’s the choice is to take yourself out before you are really incompetent or miss the window of opportunity. There is no legal or morally justified way I can see to hand that choice over to others. And the “window of opportunity” never even opens for some of us hit with a stroke or trauma leaving us helpless and incompetent but not terminal.

Fun topic for a summer afternoon.
 
Interesting topic. I ask myself "is death something to fear" or are we genetically predisposed to survival? My dad was a medic in WWll. Saw and treated wounded soldiers. After the war, I think he saw a Dr twice during the rest of his life. My mom rarely went to the Dr. To have babies and at the end of her life, that's it. In some ways I think we are over-treated. I do not want to burden my DH or any member of my family with my care, if it's complicated. Don't want to interfere with their quality of life. I'm fine with passing on. I did turn down chemo and radiation for BC, twice. IMO, often the treatment is worse than the disease.

Dr. Emanuel simply meant he would turn down treatment after 75 yrs. old. I saw him express this in an interview. I doesn't mean he wants to die at 75. If his health is good and takes him to 90, I'm sure he'll accept the extra time.
 
When DH and I updated our Advanced Directives, we found and added a Dementia Clause. Mine included no assisted nutrition such as tube feedings, IVs, or even help in feeding, as there comes a time with Alzheimers, if you live long enough with it, that you have difficulty/become unable to swallow.
We have reviewed everything with our kids to let our wishes be known, along with our PCP and it is in our EMR. If something were to happen, and our decision making is taken away from us, such a stroke or accident, I want that information known.
 
My dad has always been "when it's my time, it's my time". Then he had 2 heart attacks, was revived and had 3 bypass surgery. Then he didn't want it to be his time.

He is 10 years post bypass but didn't change his eating and started smoking again. Now one of his 3 bypasses is 100% occluded/blocked. Now he doesn't want it to be his time. He says he stopped smoking again while they try to figure out if there is any options.

No fun as the 9 lives are used up.
 
bloom2708 said:
My dad has always been "when it's my time, it's my time". Then he had 2 heart attacks, was revived and had 3 bypass surgery. Then he didn't want it to be his time.

He is 10 years post bypass but didn't change his eating and started smoking again. Now one of his 3 bypasses is 100% occluded/blocked. Now he doesn't want it to be his time. He says he stopped smoking again while they try to figure out if there is any options.

No fun as the 9 lives are used up.
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My mother always said she thought she would die at age 79 like her father.
She was a smoker and ended up on oxygen. At age 79 she admitted it would be nice to live a few years into her 80's. She died at age 79, fortunately in her sleep. even though her lungs were not healthy, I truly believe years of her mind and body hearing "I am going to die at 79" was at work.
I am a firm believer in how much your brain/mind thinking is behind your will to live. I have seen it both ways in my years of nursing, both the will to live and the will to die.
 
Ha--I actually think we will justify treatments when faced with illness in our later years as "quality of life" decisions. My docs are pushing an expanded thoughtful end-of-life planning in written form that can run the gamut from full treatment for everything to no treatment for anything (and I'm not even sick 🤣). I'm sorry the OP feels "Obviously the medical community would recommend we all seek cures for anything and everything as long as possible"--perhaps new docs are in order for him?

My best friend's father took care of himself like a champ and was never ill. He fell and broke a hip mowing his lawn in his early 90s. In the hospital, he chose to stop eating, which the hospital honored, and died peacefully after a few days. He was a good man. I'd like to go out like that.
 
Bestwifeever said:
Ha--I actually think we will justify treatments when faced with illness in our later years as "quality of life" decisions. My docs are pushing an expanded thoughtful end-of-life planning in written form that can run the gamut from full treatment for everything to no treatment for anything (and I'm not even sick 🤣). I'm sorry the OP feels "Obviously the medical community would recommend we all seek cures for anything and everything as long as possible"--perhaps new docs are in order for him?

My best friend's father took care of himself like a champ and was never ill. He fell and broke a hip mowing his lawn in his early 90s. In the hospital, he chose to stop eating, which the hospital honored, and died peacefully after a few days. He was a good man. I'd like to go out like that.
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My full statement was "Obviously the medical community would recommend we all seek cures for anything and everything as long as possible - understandably, I’m not inferring a sinister motive."


www.nytimes.com

Overtreatment Is Common, Doctors Say (Published 2017)

Doctors surveyed believed that 20.6 percent of all medical care was unnecessary, including 22 percent of prescriptions.
www.nytimes.com www.nytimes.com
 
My mom lived alone until a week before she died at 89 from cancer, my FIL to 91 still hiking up his mountain daily until he died from a heart attack and a woman in my building is 92, lives alone, drives and has a dog sitting business. So you never know how things will turn out.
 
harllee said:
I am struggling with this issue for my mom right now. Age 93, Alzheimers and other health problems, in skilled nursing. Little quality of life, she says she has lived too long. She has signed DNR, Living Will, Health Care Power of attorney. But it is hard to apply all this to specific situations and my sisters and I struggle. We still have her teeth cleaned and she recently had a cavity and I took her to the dentist to get the cavity taken care of--my thinking is that a tooth abscess would be a lot of pain. She sometimes has trouble breathing and we have authorized the nursing home to give her an inhaler. We gave permission for her to have flu shot, Covid shot, RSV shot. We struggle about antibiotics if she gets a kidney infection, etc. Very hard choices.
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Maybe it's just me, but I see a lot of difference between approving the use of an inhaler, vaccine or antibiotics and a DNR from a heart attack or starting treating cancer at 93, etc.
 
harllee said:
I am struggling with this issue for my mom right now. Age 93, Alzheimers and other health problems, in skilled nursing. Little quality of life, she says she has lived too long. She has signed DNR, Living Will, Health Care Power of attorney. But it is hard to apply all this to specific situations and my sisters and I struggle. We still have her teeth cleaned and she recently had a cavity and I took her to the dentist to get the cavity taken care of--my thinking is that a tooth abscess would be a lot of pain. She sometimes has trouble breathing and we have authorized the nursing home to give her an inhaler. We gave permission for her to have flu shot, Covid shot, RSV shot. We struggle about antibiotics if she gets a kidney infection, etc. Very hard choices.
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I told my kids if I get dementia not to treat infections with antibiotics but keep me doped up until I die. Filling cavities is entirely different in my opinion. I was a guardian for a good friend of mine with dementia and when her cancer came back I didn’t treat it.
 
My parents had long and healthy lives well beyond 75, but both developed dementia in their 90s. My dad was still playing tennis regularly until age 85. At age 90, vascular dementia began and he died as he approached his 95th birthday.

My mom was in remarkable shape past her 93rd birthday. She was still driving short distances, cooking, and generally maintaining the household with help from me. (I lived nearby.) Then her dementia began about half a year after my dad died. She gradually worsened and had 3 falls, each resulting in fractures. The 3rd fall and resulting hip fracture came around her 99th birthday. Amazingly, she lived another 2 years & 8 months, but she could never walk on her own again. She required 24/7 home care to remain in the home she had lived in for over 66 years.

I know that neither of my parents wanted to live the way they did in their final years. My mom actually said several times early in her dementia that she wanted to go to sleep and not wake up.

I agree with most of the Atlantic article, but not everything that Emanuel wrote. For example, he wrote:

"Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed." (emphasis mine)

I have read several articles written by family members who were present when their spouse or other family member ended their lives with the aid of a physician. One person flew to Switzerland for euthanasia when his dementia was just beginning. His wife wrote about her husband's experience and reasoning. None of these writers expressed the feeling that they had "somehow failed". Instead, they completely understood why their loved one had made the decision.

I wish the USA had MAID (Medical Assistance In Dying) as exists in several European countries, as well as in Canada and Colombia. A terminal condition is not required so this is different from physician-assisted suicide, which is legal in several US states and DC and requires a 6 months or less terminal diagnosis. I don't see MAID becoming available in the USA anytime soon due to religious oppostion.
 
I think there's a big difference between having a critical ailment at 35 than at 75.

A friend of the family has a brain tumor. He's 32 years old. He's willing to try anything and everything. I don't blame him. Go for it!
 
I was lucky. At 60 or so, shortly after retiring, I had my first physical in 10 years or so.

The physician sat me down and put the fear of God into me. He told me that I was healthy, blood work good, overweight on the way to obese BUT....

The big BUT was if I did not manage my weight, start an exercise regime, change my diet/lifestyle, , etc he expected to waddle into his office in 5 or 7 years looking for a knee or hip replacement and having to tell me that I had diabetes. Or worse. And instead of once in every 10 years my visits to the doctors office would be much more frequent. It would not be a particularly great lifestyle.

His word picture was not what I wanted for myself. So I changed. No idea if I will make it to 75 but at 72 I am now much healthier, and feel better. I would like to get to 87/89 like my parents did. Who really knows?

I am so appreciative that the took the extra ten minute to have this discussion with me. I was lucky.
 
Based on my family experiences, I hope to have a long and healthy life. Just went to a friend's 100th birthday earlier this year, I told him he has to keep living because I wanted to feel like I was still middle aged for as long possible. :p

Having seen the decline and what happened to a family member's MIL who took a fall on her head permanently disabling her and then developed Parkinsons, I'd want to avoid getting "saved" in a situation like that. OTOH, my granddad did great until the last few years of his life, and even then had no major interventions. I'm aiming for my grandmother's death, dying peacefully in her chair in her bedroom after settling down for the night, but if I end up with something nasty when I'm old like an aggressive cancer, yeah, avoiding the QOL disruption of trying to extend things too far makes sense. The question is, how do you know when it is worth it, and I assume it is only a decision you can make at the time. Theoreticals now don't really matter.
 
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