Setting a Deadline on Death

Where Emanuel veers off course, I think, is in his conviction that the capacity to be productive is what makes life worth living. He bemoans the sad decline, from authoring papers to taking up hobbies until, eventually, "life comes to center around sitting in the den reading or listening to books on tape and doing crossword puzzles."

This goes, I know, against the Emanuel family DNA, but there is no sin in slowing down. There is satisfaction in completing the crossword. You don't always have to bike past the roses on your way up the mountain. In high gear.

Where Emanuel makes a powerful point is in condemning the "manic desperation to endlessly extend life." Medical choices should not be dictated by a patient's age, but they should be informed by it. Extreme treatments to save or even minimally extend the life of a young mother are not necessarily appropriate for an 80-year-old grandmother. Physicians fail their patients by automatically defaulting to treatment.

Here I break from Emanuel. He opposes euthanasia and physician-assisted suicide, but this position does not give adequate weight to the dignity with which we would like to live and die.

Why must a terminally ill cancer patient suffer an agonizing decline when there is a more merciful alternative? Why, and this is a harder question, must an Alzheimer's patient be condemned to slowly lose mental and physical capacities? Facing that terrible situation, I would prefer the choice not to be remembered, in Emanuel's words, as "feeble, ineffectual, even pathetic."

Emanuel concludes with an escape clause: At 75, he writes, "I retain the right to change my mind and offer a vigorous and reasoned defense of living as long as possible."

I look forward to that uncharacteristic about-face, and to sitting down to more of Zeke's excellent cooking -- at 76, 80 and beyond.

========

Ruth Marcus' email address is ruthmarcus@washpost.com.