The Life Not Worth Living

None of us asked to be born but once we’re here may of us are fearful of leaving, even when the quality of life no longer allows them the simplest of pleasures.


There seems to have been a firestorm created following Ezekiel J. Emanuel’s article in The Atlantic recently that expresses a personal preference to avoid life after 75 if it is devoid of a quality that keeps him “vibrant and engaged”.  Your first reaction might be one of shock and horror that a person would choose to die at a time when they may still have many more fruitful years left – but this is not what Emmanuel is advocating as his testimonial here asserts:

I’m neither asking for more time than is likely nor foreshortening my life. Today I am, as far as my physician and I know, very healthy, with no chronic illness.  …  Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide.
I am talking about how long I want to live and the kind and amount of health care I will consent to after 75.

Emmanuel makes some cogent points about people as they age and the conditions they endure which makes living not so pleasant, to put it mildly, and would see death as a relief.

There would always by the religious fundamentalists  of course whose pro-life views would object to anyone sanctioning such end-of-life desires since, as they see it, only God can take a life.  Yeah right, God and a misdirected drone or a murder trial jury that failed to get all the facts in a case.  But that’s an argument I have made here and here that supports the right to die and thus I  will move forward on what concerns me here about those who criticize Emmanuel’s take on choosing to die at age 75.

One of the weakest arguments people are inclined to make in my opinion is how “valuable” life is and we should hang on to it with all of the tenacity we can muster.  Tyler Cowen takes this approach in his article, “Should we hope to live to very ripe old ages?”  A careful reading of Cowen’s piece however finds it hard to detect any substantial reason why life is so valuable when our bodies and our minds have deteriorated to a point that mere existence entails little more than breathing and emptying our bowels of nutrients that resembles much of what is fed infants and some toddlers today

Cowen agrees that “the value of an individual life is to be sure somewhat ineffable”  but then assures us that for the “same reason it is difficult for a life to lose so much of its value”.  Really?  How do you measure such value?  By what scale or social denomination do you set values on human life?  If there be one, shouldn’t it entail the quality of life one can expect from living?  And who, prey tell, makes that assessment?  The Church?  The Government/Society?  The medical science?

I am in full support of the notion that life is precious, primarily because it is all that we have.  It is what we can make of it while we can and then ceases to have meaningful value once we are no longer able to live in a way that doesn’t require 24-7 nursing care or services that deplete our financial resources, leaving us nothing but the charity and good intentions of family and friends.

Though the number 75 has created a metric by which Emmanuel has determined when life starts to deteriorate, for some it will be years later before such negative conditions take over but for many it will start years before.  Both my grandmother and great-grandmother lived to be 103 and 106 respectively.  They were both relatively sharp mentally into their 90’s but for the last 10 years of their life they seemed oblivious of where they were and needed constant supervision from medical staff or qualified family members filling that role.  They could not dress themselves or empty their bladders and bowels without someone aiding them.

On the other hand I have seen people in their 60’s rapidly deteriorate from contemporary diseases my grandmother and great-grandmother were largely immune from, like cancers, diabetes and heart attacks.   Their generation avoided cigarettes, processed food and menus absent raw fruits and vegetables.

Independent ambulation for such people is only possible if they have powered wheelchairs or scooters with an oxygen tank attached to them.  Though many vacationing venues are starting to accommodate people who require such mechanical devices it is  more likely that one’s income determines more their ability to visit such places over any period of time.  Those who are on fixed income incomes cannot afford to take long journeys under such health conditions and as a result wound up spending most of their time in close quarters that ultimately feed the depression which further exacerbates their physical condition.

elderly depression

And what of those who are able to afford the means to be kept alive at all costs?  I worked as a hospice aide worker for about a year and several of the people I spent time with were totally bed-ridden, with one gentleman barely conscious at times to allow the nursing aid to clean him up after he had lost continence.  A condition that he endured daily.  Contrary to what Cowen thinks I haven’t remembered this elderly gentleman as “that really old guy who hung on forever because he loved life so much”.  It was more like that old guy who endured daily humiliations and likely had private urges for someone to end it all for him.


Our lives should be full of those things that bring us both joy and sorrow, because one without the other prevents us from appreciating what we have.  As long as our minds and bodies allow us to, we should fill our lives with all that it has to offer as our personal circumstances allow.  If we have planned our lives too cautiously then I can see where people will have regrets when their number is called.  But that is the lesson of life we should have all learned before age 75, or earlier for that matter.

If fate dictates my time is up before I am willing then I have only myself to blame for not making the most of it with the time I had.  But if I have made the most of it and I become reduced to little more than a bag of rocks I hope I have the courage to cancel any and all medicines and procedures that merely extends a life not worth living.

22 responses to “The Life Not Worth Living

  1. You know I have accomplished much in my life and I feel like there is something else I need to do……I am an old fart and do not want to die but Hell that is not my choice……I will keep working on my stuff as long as the body can hold out and will try to deal with the loss of mobility as it comes…….basically, getting old sucks.

    • “You know I have accomplished much in my life and I feel like there is something else I need to do…..”

      And so you should my friend as we all should. Knowing later when that simply can’t be achieved at any reasonable level is the time to say ” no more effort to extend a life that has met its limits”, if you so choose.

      • I try not to think about the limits….I try to focus on one more thing to accomplish….yes, I am avoiding the reality….I will continue to push until that desire has left this body….I know it will come but I choose to ignore the thought for now….

  2. I think this is one of the most important conversations we’ll have in the first half of this century.

    This simple message was produced by a UK group, Campaign for Dignity in Dying:

    “An assisted dying law would not result in more people dying, but in fewer people suffering.”

    • “An assisted dying law would not result in more people dying, but in fewer people suffering.”


      I share too Emmanuel’s view, to some degree, that points out that there are those who want to die not out of suffering 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. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority.”

      This is a noble idea though that requires great efforts from the entirety of society and I just don’t see this happening in our expanding, more complex cultural malaise. But getting old and losing your mental and physical skills takes its toll on people unlike young depressed people where hope for them is more likely than the elderly.

      As I mentioned at the top of this post,we didn’t choose to be here but we should be able to choose when and how we leave, considering of course we have taken every opportunity life has put before us and we no longer are content in just being a cause for someone else’s view about the value of life.

  3. Fill out a Five Wishes form, my friend and distribute it to all of your close family (possibly with the threat of disinheritance if anyone violates your wishes (all depends on how trust worthy your family is). I mention the latter remembering one of my two best friends from high school whose father died and by the time he had gotten home, his elder sister had thrown out his father’s Neptune Society card and planned an elaborate Catholic funeral.

    • We’ve already had our will written up with a DNR order attached. We have paid to have our bodies cremated so that issue has also been addressed.

      We plan on retiring in an independent elder community where we can still plant fruits and veggies and travel as long as the money is there. But this place will also accommodate our needs as our independent capabilities wane where we can move next door to an assisted living facility. This way the kids won’t have to worry as I did with my parents about placing us in a facility where our needs will be met until we draw our last breath.

      Planning this all out, making those choices in advance, takes the worry out of our lives and our children’s lives, allowing us all to focus more on enjoying what time we have left.

  4. It is to me a totally personal decision and should not be the subject of judgment by anyone else. One knows what one wishes to endure in old age, and what one does not. One’s choice is simply a human given…to me at least.

  5. Difficult subject. It’s just such a hard thing to call. You have to factor in greedy relatives and medical expediency, and also, some people just want to hang on, like grim death, when they get to the end; whatever they said when they were younger. Absorbing piece, though, thanks.

    • Np doubt that the day the grim reaper arrives at our doors we will tell him they guy they’re looking for moved or is living next door, especially if he or she is not our favorite person.

      But it would be nice to know that society doesn’t put obstacles in our way by allowing death to expire by our standards and on our call, not theirs

  6. Thought provoking LB. In Asia, people are living to almost hundred years but dependent on others for basic needs for years. Their children too are elderly and they have to depend on others too! One lady friend told me – I take more medicines than food to remain alive and there is no quality to life. It is a tough call but the reality is people are kept alive by modern medicine and technology and they suffer and their loved are likewise seeing their elderly suffer. It is no fun if the younger generation have to look after many layers of elderly- sadly no easy solutions – siva

    • ” It is a tough call but the reality is people are kept alive by modern medicine and technology and they suffer and their loved are likewise seeing their elderly suffer.”

      Exactly shiva and this is what Emmanuel is talking about when he says he will refuse medical help to simply keep him alive with no quality of life rather than being a burden to his children.

  7. Hey, Woodgate. It’s great to see an old duffer like you can still, with a little help, get up and go for a walk walker. (Shit, I’m an asshole!)

    After my early twenties, my desire to carry on plummeted almost to the level of that 75 year old incontinent man. And it’s been getting lower ever since. I can only imagine how miserable I’d be if my health and mobility went downhill.

    Yet again, this is another issue that will be entirely decided by what I call The Worst Generation (aka The Baby Boomers). These spoiled rotten shits will, once again, conform society to fit their selfish desires. They are large in number and are aging. Because both the birth rate and voting rates have fallen off since they came of age, by the time they hit the age where these issues will directly affect them, they’ll be even more powerful politically than they are now. And because of a combination of medical advances and the short term thinking that’s dominated their lives, Boomers will live longer but with many more years in the “just holding on” category.

    So, this could break in 2 directions, or a combo of both:

    1) Quantity: “More! More! More! And damn the consequences!” has been the motto of their lives. Why wouldn’t it be the motto of their deaths? It’s also the attitude the Medical Industry already has. Extending life, no matter how miserable, is the only goal. And in America’s for-profit system, the medical system will keep them alive like (Warning: Dr Who reference!) Lady Cassandra O’Brien …as long as they can pay the bills.

    Being the 1st generation to live their lives in crushing debt to keep their overspending addiction in overdrive, they don’t have money. But they will have Medicare. Nobody younger than them will have it, but they will. The system will be re-written to keep them alive until America collapses.

    2) Quality: You’d think this would be about balancing “quality of life” issues. Nope. No Death Panels will be making rational, balanced, decisions for the well being of individuals and all of society. Not in America! It will be all up to the customer.

    Since the entire world revolves around them, the Boomer’s decision is all that matters. They will morph the system to fit whatever they personally want. Folks will be able to get the kind of high price, customized, sendoffs Sol Roth got in the visionary movie, Soylent Green.

    “If ever in doubt about what the future holds, always go with the Science Fiction nightmare.” – Sedate Me

    • “And in America’s for-profit system, the medical system will keep them alive like Lady Cassandra O’Brien as long as they can pay the bills.”

      This is one of the points of Emmanuel’s piece. Keeping alive just to continue to live with very little if any quality of life is simply not worth it to him and people like you and me. Toss the pills and cancel the treatments and let the end commence. Just give me plenty of pain killers if necessary.

      Love the quote about the future and science fiction

  8. Well, it’s amazing how often the sci-fi nightmares come true (See: 1984)

    I think Lady Cassandra is an excellent metaphor for the sheer vanity and self-importance of our “skin deep” society. After so many surgeries, the woman was just skin stretched tight as a drum. She also attempted to download herself into a computer/robot, so her greatness could live forever. This is the goal of so many of uber-rich these days.

    Soylent Green (1973) was simply visionary: The world’s population is 7 billion and Earth is suffering from overpopulation, diminishing natural resources, pollution, crumbling infrastructure, rampant poverty, dying oceans, food shortages, Climate Change, police brutality, and the dominance of mega-corporations. Yet a tiny elite tried to act as if nothing was happening while the world collapsed around them. All of society’s institutions were corrupted to serve the desires of the privileged elites at the expense of everyone else. There was a flotilla of lies, a dismissive attitude toward knowledge and burying of the science. Anything sound familiar yet?

    Although the clip I posted was edited to display the workings of the Madison Square Euthanasia Gardens, the full scene between Heston and the dying (in real-life too) Robinson was sad on several levels and somewhat reminiscent of the final scene of another of Heston’s 70’s classics, Planet Of The Apes.

  9. before age 75, “or earlier for that matter”……….and therein lies the problem.
    Life is precious.
    “Life IS pain, Princess, and anybody who says differently is trying to sell you something.” (Wesley, in “Princess Bride”.
    Good for you for having thoughts and expressing them so eloquently. Keep thinking. Keep learning. The final page has not been written.

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