Pure trolling by Zeke (another Trevian; one "m" in the last name). He's the same guy who suggested raising the retirement age (for the rich, granted). Like all trolling, there's a seed of sensibility, just like you say, but to put a hard limit on desirable age is all about clicks.
He's also Ari's brother, of Entourage depiction fame. Their father was in the Irgun. They certainly have vitality, as a family, but it's not clear they've done much good in the world.
It seems especially odd to me because of this --
Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide.
How the fuck does he expect refusing medical treatment except palliative care is going to stop him from living with Alzheimer's is what I wonder.
I saw that article. So stupid. Bioethicists are the worst.
4: Presumably by stopping him from living.
The problem with bioethics is it has no biocognitive biocontent.
4 is an excellent question. I would never wish Alzheimer's on a 76-year-old, either, but...
6: Well, sure. But it isn't as if you will die from untreated Alzheimer's. You're still waiting around for something else to kill you. Life expectancy at 75 is 11 years for a male and 13 for a female.
I mean, you will eventually from Alzheimer's, treated or not, but certainly not before people notice you have it.
People may be slower to notice if you've been spouting shit this stupid at age 57.
I figured that's what you meant. Zeke's just crossing his fingers and waiting for a fatal stroke.
In a perfect world, a gang of hale 90-year-olds will beat Zeke to death on his 75th birthday. Could we do a Kickstarter campaign to make that happen?
I think he may be right in the sense that a majority of treatment at that age ends up counterproductive, but the heuristic is definitely overbroad and possibly clickbait. And as TIE points out, he talks like he values life only if it's allowing him to do memorable deeds.
Is this a test balloon for proposing the lapsing of curative Medicare benefits past a certain age?
he talks like he values life only if it's allowing him to do memorable deeds
He does at least bring up mentorship and being a store of wisdom, but turns it around to the risks of being a burden on family.
What bothered me is the same thing Heebie brings up: how many informed patients who share his views on end-of-life wind up as miserable invalids? Just file your DNR, forego the chemo, and take your chances. Of course, if you read the last sentence, he all but admits he doesn't really mean it.
My parents have independently come to views very like Zeke's and I pretty much expect them to take stronger action than refusing treatment. I believe this because I am the executor on both their estates and when they sit me down to tell me what to do, they say things like, 'I'll take care of the end of me.' Do not go to law school, folks, or you'll end up as executor for your parents, although oldest child and daughter might have qualified me without that. (My parents are divorced and live with their new partners, but are of similar minds on this.)
Thing is, I do think people of that mindset get channeled into medical treatment and invalidism. I think it is extremely hard to refuse treatment. Once that train gets rolling, the momentum is fierce and takes fierce will to counteract. A rule like 'no more after 75' at least puts some weight on the counterbalance.
This is reasonable to me:
http://www.nytimes.com/2013/11/20/your-money/how-doctors-die.html?pagewanted=all&_r=0
Being executor of an estate doesn't usually come with medical power of attorney, does it?
How could it? You only execute after the person's already dead, right?
I don't like to leave jobs hanging around on my to do list.
16.last is very true. I also suspect that 75 feels better than people expect it to when they're actually living it. My grandfather was healthy and very independent until he was a little past 90. He had been spared most major illnesses until then and enjoyed his life.
It's different when you have something terminal and untreatable, but slow. I hope I don't have to make decisions about whether to give my mother treatments which aren't palliative for the non-Alzheimer's ailments or let her die of pneumonia or a bladder infection. She broke her wrist a few months ago. It was casted, and she was miserable. Decisions will probably only get harder. Fingers crossed Dad doesn't get hit by a bus.
Being executor of an estate doesn't usually come with medical power of attorney, does it?
When it does it's called executioner instead.
That was a stupid article. And I'm all for assisted suicide and people going when they want to.
I don't think 70's the new 50, but it might be the new 60. For some people. We recently celebrated both of C's parents 70ths. His dad is a bit overweight, very active, cycles miles each week. His mum is a bit overweight, has a drinking problem, doesn't go out much and walks veeeeeerrrrry slowly. You'd think she was ten years older than his dad. We hope she'll die quickly when she does, because life for an alcoholic in a care home doesn't sound very appealing.
It's not uncommon to do a durable power of attorney, and a living will, at the same time one does one's will. Same lawyer will happily draft the whole packet.
The thing about taking matters into your own hands is that you only get one chance, so you really have to make it work. One of my parents' friends messed it up, and then ended up with care he didn't want in a severely restrained environment.
I thought the statistic near the end here was interesting - despite the picture EE paints, the expected number of disability-free years for someone at 65 actually grew, and years with limitations shrank, between 1993 and 2003.
I think it's pretty well established by psychologists that "how worth it will life be to me if (x) happens" is one of the things that we're incredibly bad at judging. It's true for almost all the potentially nasty stuff that can happen to people: disability, aging, etc. We automatically assume that we'll be really badly off and unhappy when, generally speaking, we won't be.
The reason is that as far as we can tell people just have a set "general happiness/satisfaction with life" point, and we default back to it relatively quickly after almost everything.* So, someone who loses their legs will feel really bad about it and that their life is less good for a while, and then that'll wear off and they'll go back to feeling exactly the same as they did before it happened. I've never been sure if that's a reassuring thing to know or a kind of depressing one, because it applies to awesome things as much as it does to bad ones.
*Odd exception: plastic surgery.
My lawyer sister (first child) has durable power of attorney for my mother, and my doctor sister (third) has medical power of attorney. It fell to me not long ago to do the actual moving of my mother from her home to a memory care facility near them, and it ranks possibly second among my most miserable experiences, so fuck you, EE, and fuck The Atlantic for trying to outdo Slate by publishing trolling bullshit like this.
26 is pretty depressing because I've been counting on being happier when certain things start happening. I guess "sleeping through the night on a regular basis" might be in the plastic surgery exception, right?
Really? People are fundamentally happier after getting plastic surgery?
24.1 is very true, having gone through the process recently. If you are having both documents drawn up by the same person, there's a decent chance that the same person might be named as both executor and medical power-of-attorney person.
One thing that I'm not entirely happy with is that on our attorney's advice, I named my brother-in-law as my medical POA person after my wife, rather than one of my sisters. Attorney was strongly recommending that BIL would be the better choice because he lives in-state, rather than my sisters on the opposite coast. On the other hand, my sisters would probably have a better idea what my specific wishes are in a particular case, though I generally trust BIL's judgement (and he and his wife did provide their home for hospice care when her sister was dying, so he has some experience with some of the decisions that might come up). So not a bad choice, but I'm not totally happy with letting geography trump intimacy. Hopefully it won't matter for years.
26: Since people are generally more badness-adverse than awesomeness seeking, I'd say that's a good thing. Now let's all go get plastic surgery.
28: My understanding is that MPHP is right, relative to people's happiness baselines - but that most people's baselines get happier and happier throughout their life, (with a dip around parenthood, all joy, no fun etc). Return to your regularly scheduled optimism.
It's all about quality of life. In a lot of cases prolonging life reduces the quality. "Heroic" treatment that ends up with you in great pain or insensible from pain-killers and only prolongs your life a bit: bad. Treatments entered into with full understanding of the risks and possible benefits; i.e., you are of sound mind: much better.
The hard part is when the patient isn't of sound mind any longer, and hasn't left clear instructions or appointed a healthcare proxy. Then the family (or friends) are in agony when a decision about treatment is made.
Still, EE is a moron. I've known people who lived to over 100, still had sharp minds, had manageable health problems, and were a joy to be around. They were more of net plus than EE will ever be. As a society we can obviously do better than "put them on an ice floe if they get ill at 75."
TL;DR: Where do I sign up for that Kickstarter?
"You gotta tell me doc, after this procedure, will I have any kind of meaningful quality of life?"
"Why, sure you will. I imagine you'll have a pretty good quality of life for years to come."
"Gee, that's terrific, doc! I never have before!"
I liked that joke better when it had a piano.
"You gotta tell me doc, after this procedure, will I have any kind of meaningful quality of life?"
"Why, sure you will. I imagine you'll have a pretty good quality of life for years to come."
"I'm a piano!"
I think that whether or not one has dealt with a relative with dementia probably has a big effect on one's attitude toward the whole "how to handle getting older and frailer" bit. I have relative chugging on into their tenth year of early-onset dementia (that is, even now my relative is younger than the typical onset age for regular dementia) , and it's absolutely brutal - and my relative's condition isn't even one of the really bad dementias, since it is relatively sparing of personality and language. It's brutal for my relative, who is labile, frightened and miserable much of the time and who has been very depressed since diagnosis; it's brutal for my relative's carer; and it's not very nice for anyone else in the family either. This isn't some kind of "well, actually living as an invalid isn't that bad and has its own quiet compensations" - there are no compensations, it's not okay, it's a brutal and nightmarish way to go. Things have happened in the past couple of years that are really, really deeply not-good.
And the issue is that even if you have the guts and the ability to kill yourself, you have to pray that the timing is right and that you don't slide into full-on dementia before you realize that it's time to take care of matters.
Having seen this all shake out over the past decade and having realized that I have one near and several semi-near relatively with various forms of dementia and thus my risk is pretty high, I don't plan to stick around to get diagnosed. I'm terribly afraid of living out my last five or ten years in physical agony and mental confusion in some charity ward nursing home hell, bedsores full of maggots, etc.
I no longer worry about any other illnesses, though, because I figure that even dying young beats the hell out of living into a demented old age. I'm kind of hoping that I don't get cancer (or some other fatal condition) in my forties, because it would be the devil's choice - refuse treatment so that you are sure to be dead before anything worse can happen, thus missing out on ten or fifteen years before you could reasonably expect even early-onset dementia, or try to get cured and then run the risk that you won't be able to kill yourself?
Given my particular family history, I'd be incredibly foolish to seek palliative care for anything after fifty or so.
As a point of contrast, my going-on-97-year-old grandma is totally senile, but happy and less stressed and anxious than she's ever been.
She actually, uh, found God recently, which is a bit bizarre to the family, but no one feels the need to attack it or anything. Seems to make her happy.
(And in fact, all three grandparents that I've watched get senile were relatively happy senile patients, (although one was on anti-depressants for the first time in her life, but she's not biologically related), and none were close enough that I saw them daily. This has given my the fantasy that if such things are inheritable, I might have the happier kind of senility.)
I present an exchange that has stuck with me from "Passed Away", a movie in which Bob Hoskins starred. Hoskins and a brother are shopping for a casket for their father and the undertaker is trying to upsell them. Showing them a much fancier casket than they have indicated they want, the undertaker says, "Mrs. XX's family bought one of these for her just last week." Hoskin and his brother look at each other, and one asks, "Mrs. XX? How old was she?" The Undertaker: "94". The brothers together: "Who would want to live to be 94?" The Undertaker: "A 93 year old!"
I seem much more favorably inclined toward EE's column than the multitude here. I think he's saying that one should take the opportunity to get out while the getting is good. He's saying that if one is presented with an opportunity for a good death after age 74, take it. I've had too many elderly relatives where the medical system has launcehd into overdrive to save/extend a life, with months to years of misery as the result. Anyway, it seems like a reasonable way to open a conversation about the topic of how people should approach end of life decisions.
She actually, uh, found God recently
This is the outspoken one, right? Wow. Any God in particular? Hebrew edition?
40.2 One more for this, though I'd hate for my folks, both right around that age, to give up, I want them both enjoying every day.
But it's not really a public topic. Maybe the advice in 74 is OK to broadcast, to think about it and have papers competently drawn up.
Seems to be the nondenominational American version of God. Nothing in there was exactly Christian, but bright warm lights and He Will Take Care of Me didn't feel exactly Jewish, either.
It occurs to me I've never seen a grandparent get senile. Unhappy, cranky, distant, yes, but no actual dementia. And I've had five of the seven die so far, one past 95.
Two of them were able to get pretty good deaths - one probably by virtue of being a doctor and knowing when to stop treatment and go home, the other one by the very good graces of Kaiser who were forthright about what further treatment would likely mean and helped his wife make the decision.
43 to 41, and yep, that's the right grandma.
Plastic surgery! (Tracking that down again through google took forever, because of stupid plastic surgery clinics and wellness websites.)
I think the actual effect is mainly that a lot of people who get plastic surgery do it because there's something specific about their physical appearance that makes them unhappy and then after the surgery it isn't there. And more importantly that that was specifically their motive - they didn't have excess expectations of what would happen as a result of it. So if someone thought that it would transform their life in a wonderful one then they got disappointed. But if they thought "when I see my reflection I won't do that little internal wince about the way my nose looks" or whatever then, yeah, that's true.
I think it just fits under one of the more common lessons of psychological research into happiness, namely that what you think is important to your happiness (or unhappiness) is big changes in your life, but actually it's small ones.
The reason I think is mainly that we default to a baseline. So a sudden positive change (winning the lottery, say) makes you feel good for a while but then your happiness drops back down to its norm. A whole bunch of really little positive things kick your happiness up a little and then each time it drops back down a bit later on too. But you can have a lot of small things happening pretty steadily, and feeling good a lot makes other things in your life better in general (lower stress, etc.) so you get a much bigger effect. So if you have to choose between shortening your commute, or changing it from a moderately stressful one (sitting in traffic) to a less stressful one (sitting on the subway), and a really awesome car it's better to go with the former. The car will make you feel great for a while but eventually it'll just be your car, and every day you'll be moderately annoyed for an hour and be more stressed out as a result (and so on). Or you can spend that hour every day listening to music or reading a book or daydreaming and not feel as stressed out, which has a generally good impact on you for a bit instead.
38.1: I'm sorry you're in that situation. My mother has been noticeably ill for about 7 years now, I think, and she'll be Medicare eligible next year. She spent the first many years more agreeable and less anxious than she'd been since I can remember, but she's reverted back to irritability, anxiety, and passive aggressive muttering. The boyfriend was shocked by what he thought was new behavior, but it was more a return to (more confused) form.
I reach the point pretty quickly of wishing for "good deaths" for people. The boyfriend's family this part year has had some awful diagnoses and health crises, and he thinks I'm awful for sort of hoping they go quickly and peacefully. I don't think he really knows what the alternative looks like, and I hope he never has to see for himself.
38: Dementia can cut both ways though. My dad has dementia (possible complications from a brain injury about 18 years ago, plus aging), but he's generally pretty happy as long as my mom is around to help care for him. She's survived a number of close calls through some fairly heroic measures (cancer, stroke, recurrent pneumonia plus major surgery to correct the cause of same), but she has a decent quality of life now, aside from the demands of caregiving. But he would be absolutely miserable without her, as we've seen when either she or he was hospitalized, plus there would be no way for him to live safely at home without another family member there full time. Her survival supports not just her quality of life, but also his.
Also, diagnoses of upcoming dementia aren't foolproof. A few years after his accident, my dad's then neurologist diagnosed him with Alzheimer's. But his subsequent neurologist disagreed, and was able to reverse many of the symptoms doctor 1 had noticed by switching up the anti-seizure medicine he was taking. He got a number of good years in before the latest turn.
In the fine tradition of this place, I have not read the linked article. Nevertheless: the nub of an interesting point here is that the US medical merry-go-round is easy to get on and hard to stop.
My experience is that it often take forceful, sustained, repeated efforts to get doctors/hospitals NOT to treat you. It doesn't matter what you have expressed in a living will,* they will default to interventions because that's how they're trained, and they will keep doing interventions until you get formally better or die.
*Also, your living will is only as powerful as your most wavering next-of-kin.
Well, my Mom died when she was 87 and had good quality of life, oer her, until the last two weeks. And her ex bpyfriend before my father, Mohr Keet, is still alive at 100 and was bungy jumping until he was 96.
Yeah, anecdotes. So sue me.
My dad's dementia apparently wasn't Alzheimer's either. He probably had a stroke at the same time he had a heart attack, when he was in his late seventies. It was immediately apparent he couldn't do math anymore, my sister looked at a tax return he had done and it was preposterous. He retained long-term memory for the 10 years he lived after that, and his personality never changed much. But he often didn't know where he was, and we'd watch him find his room by reading the names on the doors. He was so smart even then that he could cover some incapacities so that a stranger wouldn't know there was anything wrong. And there'd be a surprising presentness, or he'd notice a change in one of my children.
In many states the language for Durable Power of Attorney for Health Care and Living Will are set out in the statute, so that it's simply a matter of downloading and printing, with attention to proper execution and witnessing. You can go a long way even without a lawyer, if you don't have one.
I've had five of the seven
One of your grandparents was a Tribble?
The total roster includes three subsequent spouses.
You know, I was thinking you should have had eight. I'm just that smart.
50: Additionally, there's a reason it's a cascade of interventions; often each step is reasonable, on its face. 80-year-old Grandma shatters her leg in a car crash; emergency surgery repairs the leg. Infection sets into the wound; second surgery cleans out the infection. Lots of drugs to treat the infection. Drugs to treat the effects of the drugs. Etc., etc. -- very easy to wind up in a lingering bad place, but not always an obvious point to say "no more."
51: Old Scandinavians are robust.
Also, long time, no see.
MPHP
Sorry, MHPH, looks like you're the Member of Parliament for Hyde Park now.
Not only that, but dementia treatment is advancing in leaps and bounds. You'd feel a bit of a charlie if you decided to die after diagnosis at 75 and then medical science developed to give you another ten years. Look at what happened with Aids therapy - life expectancy went from a few years to a decade to, basically, almost a full lifetime now.
Old Scandinavians are robust.
Quite. Spouse's grandfather (97), who lives at home with his wife (86), broke his hip & collarbone this summer. 2 weeks in hospital, 3 weeks in rehab, and he was back home using a walker. He's now using canes. It was scary for the family, but his resilience is incredible.
59L I would love a cite about how dementia treatment is advancing in leaps and bounds - that's nothing I've heard from doctors or seen on PubMed. There's, as far as I know, one marginally effective drug - which doesn't do anything for most forms of dementia. There are a few types of adjustment/occupational therapy to help you communicate effectively as long as you can and improve your quality of life. But there's - as far as I know - nothing that has been shown to slow the progress of dementia, not even off-label stuff or meaningful clinical trials. Certainly, there's some understanding that co-existing conditions can exacerbate dementia - infections, stomach problems, etc can all increase confusion and anxiety and once those are cleared up the patient can regain some ground. But if we're really talking about dementia - Alzheimer's, progressive aphasia, all the frontotemporal dementias - I just haven't seen anything suggesting that there's meaningful treatment.
Perhaps a patient might have something which caused dementia-like symptoms in the short term - bipolar disorder, for example - for which there is treatment.
61 is right as far as I know also For reasons of personal interest, I've gone to a talk on the latest research and heard of nothing but what you mention either. As near as I can tell, my mom is a success story for the one marginally effective medication. She got put on it very early and doesn't seem to have had much progression.
Is there progress being made on stroke-related dementia (that is, better treatment of strokes immediately so they don't cause the same kind of brain damage)? I don't know how common that is in comparison to Alzheimers, but it's what I'm more familiar with, as what seems to have put my grandmother in a nursing home for her last couple of decades.
It depends on the type of stroke. If you have the leaky kind, I don't think things have changed that much.
46: People with very large breast who get breast reductions are often quite happy about it. The back pain goes away, and it's easier to find clothes that fit.
61/62: Might be a US/UK difference in terms of press coverage. You two are right, but Cameron is making a push for a cure by 2025, calling summits, doubling funding, etc.
Current best is two marginally effective drugs that buy about three months of greater independence (like dressing oneself) in about half of patients treated. Study endpoints like that strike me as BS, but I guess it means something for caregivers.
I have many thoughts about the state of Alzheimer's research, but they're dull and sort of inside baseball.
I read that piece of crap. For an allegedly smart guy it was a remarkably fucked-up effort. I'm 73 but that number isn't relevant as long as I can live independently. Absent that, I'm out of here.
Given the life at any cost mentality and the profit motives, the answer to not getting caught in the medical-industrial machinery is to bring a gun with you in the ambulance. Or have some hard-headed and realistic children.
68: I think that some hospitals have metal detectors. Option 2 is hard for the childless. (Hell, everythign about aging is hard for the childless.)
You could substitute an isolated house plus big, hungry dogs.
63: If you are talking about the clot-related type of stroke (ischemic), then I would expect tPA to be just as effective with respect to stroke-caused dementia as it is with respect to the other symptoms, if administered promptly (within 3-4.5 hours). That's what saved my mom - she was very fortunate to be at a church meeting when she had her stroke, and the church organist (who was just finishing up practicing) recognized what was going on and got my mom to the hospital immediately. If she had been at home alone with my dad, it would have been very bad for both of them. That stuff is a fricking miracle drug - she was able to start moving the paralyzed side again almost immediately after the drug was administered. It still took her weeks in rehab to recover, but she told us she appreciated how much better off she was than most of the other stroke patients there.
As Moby said, treatment of the leaky/hemorrhagic kind of stroke hasn't had the same kind of radical breakthrough.
69: Start a service company. For a reasonable fee and whatever paperwork it takes, someone comes in and gets the docs to pull your plug(s) or yanks you out whatever shithole storage place they've stashed you.
70: Dogs? I thought the consensus here was hogs. Or was that just an Emersonian fantasy?
73: Are Kosher and Halal symmetrical? I'd bet there are some guys (would have to be guys) sitting around arguing this.
Can people infect pigs with trichinosis? That seems fair. It's always bothered me that they can give us diseases and we don't do hardly anything at all bad to them.
76: Um... bacon? prosciutto? jamon iberico?
Just back from 2 weeks in Spain, and I sure wouldn't want to be a pig there. Esp. since, as the priest admitted to the rabbi, it's not as good as sex (2nd entry here)