Noted oncologist tells why he will refuse most medical procedures and tests when he turns 75

Jan 23, 2023 | 38 comments

By Advisory Board staff

In 2014, Ezekiel Emanuel — a prominent health policy expert, medical ethicist, and oncologist — wrote an infamous article in The Atlantic called “Why I Hope to Die at 75.” Now, just 10 years from his 75th birthday, Emanuel speaks with The Sunday Times’ Helen Rumbelow to explain why he will likely maintain his position to stop accepting most medical treatments at age 75.

He clarified, however, that it was not his intention to die at 75. “The headline of the article was written by an editor for the purpose of selling magazines. I never said that,” he said.

In the Atlantic article, Emanuel wrote that he would refuse medical interventions — including antibiotics and vaccinations — after he turned 75 years old, saying he believes most older Americans live too long in a deteriorating state. He also said he would refuse chemo and radiation treatments if he contracted cancer and such routine screening procedures as blood tests, endoscopies and colonoscopies.

“Doubtless, death is a loss,” he wrote. “But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived . . . We are no longer remembered as vibrant and engaged, but as feeble, ineffectual, even pathetic.”

Dr. Ezekiel Emanuel

Emanuel insists he will not avoid all medical treatment when he’s 75, just those intended to prolong a life in irreversible decline. “Obviously, if I break my arm or have a deep cut I would have these things taken care of. And, if I were in serious pain I would take pain medication.”

At age 65, Emanuel now has just 10 years before he he needs to make major health decisions.

In the interview with Rumbelow, Emanuel said society focuses too much on the short period leading up to death instead of the years of deterioration. “While modern medicine has increased lifespan dramatically, it has barely increased healthspan,” Rumbelow quotes Emanuel as saying.

A study by the United Kingdom’s Office of National Statistics found that English individuals aged 65 in 2018 had an average of 20 years left to live, but the second decade would be filled with chronic “illness or disability.” “Aged 75, in other words, is where the suffering begins,” Emanuel tells Rumbelow.

According to Emanuel, every time he mentions his plan to refuse treatment at 75, almost everyone says 75 is too young, citing “super-agers” ranging from 90-year-old grandmothers who surfs, U.S. President Joe Biden, who is 80, not to mention former president Donald Trump, 76. “We can’t all be outliers and some of the so-called outliers are a little more batty than we care to acknowldege,” Emanuel said.

When asked if he wants a quick illness to decide his end since it would take bravery to withstand a long treatment or take his own life, Emanuel responded, “Well, I think it’s bravery to say no to interventions where the majority of people would say yes.”

Emanuel did not hesitate when Rumbelow asked him which illness he fears most — dementia. “There’s no doubt about it,” he said, adding that the rates ‘boom’ after age 75. “Living too long places real emotional weights on our progeny,” he wrote in his original essay, even when people won’t admit it. “Consider the waste of good years by people who are just beginning their retirement who are stuck taking care of 90-year-old parents who no longer recognize them?”

Emanuel also said he is skeptical of the “immortals” investing so much energy into the dream of living forever.

“You see this in the tech gurus who are investing in longevity [he cites Sergey Brin and Larry Page, the Google founders who have made investments in labs working to extend life]. These people think the world will collapse if they’re not here. It won’t collapse . . . They tend to be men. I think many men haven’t figured out what their life’s about. They get on to the conventional treadmill and they haven’t thought through, ‘do I really wanna be a tech tycoon or an investment banker? What’s the social utility here? Is it a meaningful life?’ Part of wanting to live to 100 is to get more time to make that contribution. But by the end it’s too late,” Emanuel said.

In particular, Emanuel said he wants to be realistic about when his own “consumption” exceeds his “contribution.”

When asked if anything has changed for him since he wrote the infamous 2014 article, Emanuel said, “I wouldn’t say nothing.” Emanuel’s partner does not agree with his plan, and “she would like me to consider preventative measures like a flu vaccine”.

“A lot will depend on whether I really am a rare outlier at 75, and I’m not deceiving myself. That will be the biggest challenge . . . We are in discussions,” Emanuel said. However, Emanuel said he believes he will likely stick to his plan.
____________________

Credit: Healthcare Advisory Board