Time to Die

Ezekiel Emanuel is so adamant that he doesn't want to live past the age of 75 that he's written a fairly lengthy article in The Atlantic explaining why. There's lots to say about this piece, and I recommend a column at The Federalist for an amusing critique.

I'd like to focus here on a few specific paragraphs in which he describes precisely what he will do when he turns 75. Emanuel writes:

At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless. And that good reason is not “It will prolong your life.” I will stop getting any regular preventive tests, screenings, or interventions. I will accept only palliative—not curative—treatments if I am suffering pain or other disability. Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either.

This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.)

After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.

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. A big challenge is antibiotics for pneumonia or skin and urinary infections. Antibiotics are cheap and largely effective in curing infections. It is really hard for us to say no.

Indeed, even people who are sure they don’t want life-extending treatments find it hard to refuse antibiotics. But, as Osler reminds us, unlike the decays associated with chronic conditions, death from these infections is quick and relatively painless. So, no to antibiotics.

Obviously, a do-not-resuscitate order and a complete advance directive indicating no ventilators, dialysis, surgery, antibiotics, or any other medication—nothing except palliative care even if I am conscious but not mentally competent—have been written and recorded. In short, no life-sustaining interventions. I will die when whatever comes first takes me.

Here's what disturbs me about this. Emanuel is a doctor, one of the chief architects of the Affordable Care Act (Obamacare), and a close advisor to President Obama (his brother, Rahm, was Mr. Obama's Chief of Staff during his first term). If he were simply making a personal decision about his own future health care that would be unremarkable, but why publish a personal decision in a national magazine unless there was a more far-reaching agenda?

Given Emanuel's status and history there's reason to worry that this is more than just one man's opinion. It sounds ominously like a prelude to something much more sinister. Maybe I'm wrong, but the subtext of Dr. Emanuel's essay seems to be that not only is this what he's decided to do for himself, but it's what you should decide for yourself as well. It's better for you, better for your family, and better for the country if we don't have to spend billions of dollars on keeping you alive once you're no longer productive.

From there it's not much of a leap to imagine that the policy he's advocating for himself will be advocated as national policy for everyone. The government, which, if the left has its way, will eventually become the single payer of health care costs, will simply decide not to cover the expenses associated with the procedures Emanuel lists above.

At that point Sarah Palin and others who predicted that Obamacare will lead to government bureaucrats - she called them "death panels" - deciding what procedures and tests will be covered and what won't be, essentially consigning those over 75 to the trash bin, will become a reality.

If you don't have time to read the original piece in The Atlantic read the shorter critique in The Federalist. It's quite good.