Rolf Zinkernagel, a Swiss immunologist who won the Nobel Prize in Physiology or Medicine in 1996, believes that the lifespan of human beings has far exceeded what it was intended to be: “I would argue that we are basically built to reach 25 years of age. All the rest is luxury.” Wealthy older people spend a lot of time and money maintaining their health and postponing death. Dinner-party conversations center on colonoscopies, statins (drugs which reduce blood cholesterol), and new diets. Many Americans who are not doctors subscribe to the New England Journal of Medicine. I have noticed a similar trend in well-off, older acquaintances of mine: health, and its maintenance, has become their hobby.
All quite laudable, but let’s take this trend to its logical conclusion. What are the consequences for society if average life expectancy rises to 100 years, or even more? We face the prospect of an army of centenarians cared for by poorly paid immigrants. The children of these centenarians can expect to work well into their 70s, or even 80s. The world of work will alter drastically, with diminishing opportunities for the young.
What if powerful new therapies emerge which can slow down the aging process and postpone death? Undoubtedly it will be the rich and powerful who will avail themselves of them. Poor people in Africa, Asia, and South America will continue to struggle for simple necessities, such as food, clean water, and basic healthcare. There will be bitter debates about whether the state should fund such therapies. The old are a powerful lobby group and, compared to the young, are far more likely to vote, and thus hurt politicians at the ballot box. Politicians and policymakers mess with welfare provision for the old at their peril. The baby boomers of rich Western countries are now in their 60s and 70s and are aiming for a different kind of old age than their parents. They demand a retirement that is well-funded, active, and packed with experience. They are unfettered by mortgage debt and are the last generation to receive defined benefit pensions. The economic downturn of the last several years has only strengthened their position. They are passionate believers in the compression of morbidity.
But this vision of aging is wishful thinking. Many now face an old age in which the final years are spent in nursing homes. There are several societal reasons for this: increased longevity, the demise of the multi-generational extended family, and the contemporary obsession with safety. None of us wants to spend the end of our life in a nursing home; they are viewed (correctly) as places which value safety and protocol over independence and living.
What are we to do? We will not see a return of the preindustrial extended family; the future is urban, atomized, and medicalized. The bioethicist Ezekiel Emanuel outraged the baby boomers with his 2014 essay for the Atlantic, “Why I Hope to Die at 75.” He attacked what he called the American immortal: “I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop. Americans may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me.”
Auberon Waugh (who died aged 61), son of Evelyn Waugh (who died aged 62), once remarked, “It is the duty of all good parents to die young.” Montaigne put it like this: “Make room for others, as others have made room for you.”
Charles C. Mann wrote an essay in 2005 for the Atlanticcalled “The Coming Death Shortage,” which envisaged a future “tripartite society” of “the very old and very rich on top, beta-testing each new treatment on themselves; a mass of ordinary old, forced by insurance into supremely healthy habits, kept alive by medical entitlement; and the diminishingly influential young.”
I am broadly in agreement with Mann that ever-increasing longevity is bad for society, but the problem is this: Given the opportunity of a few extra years, would I take them? Of course I would. There is an old joke: “Who wants to live to be 100? A guy who’s 99.”
Medicine has taken much of the credit, but longevity in developed countries has increased owing to a combination of factors, which include not only organized healthcare, but also improved living conditions, disease prevention, and behavioral changes, such as reductions in smoking.
Interestingly, the maximum human lifespan has remained unchanged at about 110–120 years; it is average longevity which has increased so dramatically. Where do we draw the line and call “enough”? We can’t. John Gray has eloquently argued that although scientific knowledge has increased exponentially since the Enlightenment, human irrationality remains stubbornly static. Science is driven by reason and logic, yet our use of it is frequently irrational. Does this phenomenon have any relevance to my daily work as a doctor? Well yes, it does. Irrationality pervades all aspects of medicine, from deluded, internet-addled patients and relatives, to the overuse of scans and other diagnostic procedures, to the widespread use of drugs of dubious benefit and high cost. Cancer care has been described as “a culture of medical excess.” Overuse and futile use is driven by patients, doctors, hospitals, and pharmaceutical companies. The doctor who practices sparingly and judiciously has little to gain either professionally or financially.
Many within medicine view with alarm the direction modern healthcare has taken — that spending on medicine in countries like the U.S. has passed the tipping point where it causes more harm than good. We have seen the rise in the concept of disease “awareness,” promoted, not infrequently, by pharmaceutical companies. Genetics has the potential to turn us all into patients by identifying our predisposition to various diseases. Guidelines from the European Society of Cardiology on treatment of blood pressure and high cholesterol levels identified 76 percent of the entire adult population of Norway as being “at increased risk.” This ruse of “disease mongering” (driven mainly by the pharmaceutical industry) has identified the worried well, rather than the sick, as their market.
We cannot, like misers, hoard health; living uses it up. Nor should we lose it like spendthrifts. Health, like money, is not an end in itself; like money, it is a prerequisite for a decent, fulfilling life. The obsessive pursuit of health is a form of consumerism and impoverishes us not just spiritually, but also financially. Rising spending on healthcare inevitably means that we spend less on other societal needs, such as education, housing, and transport. Medicine should give up the quest to conquer nature, and retreat to a core function of providing comfort and succor.
Editor’s note: Would you agree that the way medicine is practiced in America today favors longevity over quality of life? We’d like to hear your opinions for a follow-up discussion to be published in the next issue. Send your comments to [email protected].
From The Way We Die Now by Seamus O’Mahony. Copyright ©2017 by the author and reprinted by permission of St. Maritin’s Press.
This is article is featured in the May/June 2019 issue of The Saturday Evening Post. Subscribe to the magazine for more art, inspiring stories, fiction, humor, and features from our archives.
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I am the caretaker for my mom. She is 96 with a pacemaker, HBP, dementia and unable to walk. It’s my mom and I do what is necessary to keep her clean, comfortable and cared for. However, it is painful physically and mentally to see her unable to do hardly anything for herself anymore. The constant nonsensical things that she says are difficult to hear and endure. That phrase living until you die sounds cute but this ain’t living.
People are living too long. Mostly it’s the rich, well-to-do people. I have older friends who continually talk about their health and are always running to the doctor. They are costing us too much in medical expenses and the next generation will have to pay. If you are older you should be grateful for the final years, act your age and not be obsessed with every tiny ache and pain. These baby boomers have too many rights
Certain extraneous means besides a respirator shouldn’t be given to people so freely. Why are people at home basically living like vegetables on all kinds of pills. Better to die than live like a turnip. I know doctors can’t deny help, but there should be a limit to help if there is little quality of life.
Completely agree! Those who personally insist on living forever can do so if they are willing to pay for it themselves. The rest of us should be focused on quality of living and funding healthcare during the reasonable lifespan, not forever.
When my special day comes it will be the coolest artsiest deaths of all. I’m thinking about a portal to Valhalla theme with all kinds of Poetic Edda motifs. I may even dress up as Freja or one of the 3 spinners, then it’ll be just seconds to “see what’s on the other side”. I know this ain’t most folks’ cup of tea, but I don’t see death that way, I’m actually not afraid of it at all. I like the idea of a shorter but productive life that doesn’t take up much resources. Death won’t catch me drooling & demented that’s for damned sure.
You’re basing yourselves on the generations born in the past century in a natural environment no no GMOs and hardly any sinthetic products.
Do you actually think that people born in such an artificial and polluted world have that chance? RELAX! Cancer is taking everybody way before they retire.
LET US LIVE
Well said Darlene! I am about to turn 60 next year. Inside I feel like I’m 27 with lots of ambition and passion. Outside my looks are still good but my body now has aches and they are getting worse and for the first time in my life I had help taking a bag up some stairs! Penny dropped. I ain’t as fit as I used to be and my mortality is creeping up! First time in my life I am counting the years ahead and wonder how far I’ll get! My mom is 88 and still independent but I do not think I’ll reach that far! So… next year my life changes in my golden years. Family holiday for 12 of us to Disney florida then more of the same with days out and memories I’ll treasure until my last breath! Still in full time work so again time to slow it down and enjoy what’s important in my life and what I have neglected whilst still running on the treadmill and that’s family. I don’t want to live till I dribble n pee myself or worse still [email protected] myself daily but if I’m going to go please make it a surprise and don’t let me or my family suffer. In that I thank you god! ( but not until I’m over 91) 🙂
We live in an incredibly selfish society in America. It is all too apparent in our policies both foreign and domestic. When one generation “feels itself” more entitled than another and cares nothing for the burden left for future generations, that is a problem. If the shoe fits, then wear it and if not, then disregard it. Are we living too long? I think the answer to that question is rather obvious.
I am 54 and I am preparing to die. I will not eat up my children’s inheritance with care bills and neither will I visit the doctor once I start to fail. I work in the care sector and it is a depressing madness; the torturous and vastly resource intensive prolonging of ‘life’. However, my problem is how to manage my death in a meaningful and spiritual way. I don’t want to commit suicide but I would appreciate an end-of-life plan for the well. To me just the thought of that makes life immediately jollier and richer.
“I suppose that I will live until I die.”
This is a humorous statement, and is all you can say if you don’t rely on medical intervention. But few of us are in that category. As the author points out, our lives become about staying alive. We actively beat the things that used to bring a timely end…even down to pneumonia and flu shots in one’s late 90’s.
Sixty percent of the greatest works in art, music and literature were created by people over sixty years of age.
I am 71 years old and for the last 30 years or so I have been saying that I don’t want to live past 75 because I have seen to many older people with endless aches, pains, and other physical problems that make their lives miserable. What is the point of extending life if you are in constant pain and can no longer do the things that you love?
However, I suppose that I will live until I die.
if given the opportunity to live into my 90’s I will continue to work and give back to society. I worked hard to become an engineer and if God gives me a long life, I will continue to try and raise the standard of living and the quality of life.
In response to your article, “Are we living too long?” may/June 2019
I am a woman veteran, age 82, living with heart disease and diabetes. And thanks to advancing medical technology and the VA, I have a pacemaker and a hearing aid. Also, I’ve had dental and eye surgery. My teeth are gone, my dentures are in. My improved eye-sight is a blessing. In addition, I lost my son, Gary, at age 13 to Cystic Fibrosis. Now children with CF are getting lung transplants, marrying and living well into their 20’s, 30’s and beyond, Is new technology worth it? you bet! Are we living too long? Speak for yourself. As for me, bring it on!
I’m in complete agreement.P