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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