{"id":5672,"date":"2019-08-27T07:09:39","date_gmt":"2019-08-27T11:09:39","guid":{"rendered":"http:\/\/www.silvercentury.org\/?p=5672"},"modified":"2019-12-04T13:18:37","modified_gmt":"2019-12-04T18:18:37","slug":"not-old-enough-to-die-old-enough-to-choose-wisely","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2019\/08\/not-old-enough-to-die-old-enough-to-choose-wisely\/","title":{"rendered":"Not ‘Old Enough to Die,’ Old Enough to Choose Wisely"},"content":{"rendered":"

Author and activist Barbara Ehrenreich has long been one of my heroes, and I imagine an affinity in our fondness for myth-busting. In her new book, <\/span>Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer <\/span><\/i>(2018), she describes herself as an \u201camateur sociologist,\u201d and I thought, \u201cAha, me too!\u201d <\/span><\/p>\n

But although I was a staff writer for a science museum for 20 years, Ehrenreich\u2019s PhD in cellular immunology leaves me in the dust. She brings deep medical expertise to her latest subject: the American delusion that we can evade aging, even death itself, via right doctoring, right acting and right thinking. (Her previous book, <\/span>Bright-sided: How Positive Thinking Is Undermining America<\/span><\/i> (2010),<\/span> skewered Americans\u2019 outsized faith in positive thinking<\/a>.)<\/span><\/p>\n

I couldn\u2019t agree more with <\/span>Natural Causes\u2019<\/span><\/i> exposition of the damage done by our reluctance to acknowledge aging and mortality. Age denial is where ageism takes root, and it\u2019s fed at every turn by a culture that frames aging as failure and natural transitions as disease. Shame and fear create markets, capitalism always needs new markets, and health care is big business. <\/span><\/p>\n

Age denial not only fosters ageism, it makes a good death less likely. Pretending we\u2019re not getting older, that we\u2019re not mortal, makes it harder to embark on <\/span>the necessary conversations about what we think we\u2019ll want when the time comes<\/a>.<\/span> It also leads us to squander resources on costly but ineffective tests and treatments, especially towards the end. <\/span><\/p>\n

Most of <\/span>Natural Causes<\/span><\/i> is a detailed takedown of those tests and treatments, from mammograms to mindfulness: \u201cpreventive medicine\u201d that Ehrenreich, the biologist, exposes as medically useless and ethically problematic. Fitness nuts live no longer than the rest of us. Most medical screenings\u2014for breast, colon and prostate cancer, for example, along with annual physicals\u2014also fail the evidence-based test.<\/span><\/p>\n

\u201cOnce I realized I was old enough to die, I decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life,\u201d writes Ehrenreich. <\/span><\/p>\n

I\u2019d tweak her credo: replace \u201cold enough to die\u201d with \u201cold enough to choose wisely.\u201d It\u2019s not that she\u2019s eager to call it quits, which very few of us do, but that she\u2019s wise enough to spend her days doing what she likes: \u201cAs the time that remains to me shrinks, each month and day becomes too precious to spend in windowless waiting rooms and under the cold scrutiny of machines.\u201d<\/span><\/p>\n

At 76, Ehrenreich is calling it quits on all that. She declines longevity for its own sake and demands that we forsake the illusion that we\u2019re in charge of our biological destinies.  <\/span><\/p>\n

\u201cIf anything, I hope this book will encourage you to rethink the project of personal control over your body and mind. We would all like to live longer and healthier lives; the question is how much of our lives should be devoted to this project, when we all, or at least most of us, have other, often more consequential things to do,\u201d she writes.  <\/span><\/p>\n

I concur. The way we grow old is governed by a whole range of variables\u2014including environment, personality and genes, compounded by class, gender, race, luck and the churnings of the global economy\u2014over which we have varying degrees of control. Available only to the well-off, the illusion of control dumps all responsibility onto the individual, conflates luck with virtue, demands optimism without end and shames us when we inevitably fall short.<\/span><\/p>\n

I do, however, take serious issue with the ageist way in which Ehrenreich frames her central argument. The title of her book comes from a phrase used in obituaries when the deceased is over 70: a death from \u201cnatural causes.\u201d This raises no eyebrows, as she points out, and it shouldn\u2019t. The death of a young person is indeed harder to bear than that of an octogenarian, because youngers have experienced less of what life has to offer and because the rest of us are robbed of the chance to witness and share those experiences.<\/span><\/p>\n

But that doesn\u2019t make it okay to reduce aging to illness. \u201cEven the most ebullient of the elderly eventually comes to realize aging is above all an accumulation of disabilities,\u201d writes Ehrenreich.<\/span><\/p>\n

Above all? Hardly! Growing old also brings self-knowledge, better mental health, even liberation, and is a period of ongoing growth and development, especially for those with meaningful roles and social supports. Even the most frightened and unenlightened know that despite the loss of cartilage and comrades, aging is different\u2014and way better\u2014than the way it\u2019s portrayed in the culture.<\/span><\/p>\n

Nor is it acceptable to suggest that olders are useless and disposable. Noting that the hallmark diseases of aging (atherosclerosis, arthritis, Alzheimer\u2019s disease, diabetes, and osteoporosis) are all autoimmune disorders, Ehrenreich proposes that instead of asking why the body attacks itself, a better question might be:<\/span><\/p>\n

Why shouldn\u2019t it happen? <\/span><\/p>\n

The survival of an older person is of no evolutionary consequence, since that person can no longer reproduce, unless one wants to argue for the role of grandparents in prolonging the lives of their descendants. It might even, in a Darwinian sense, be better to remove the elderly before they can use up any more resources that might otherwise go to the young\u2026 And this perspective may be particularly attractive at a time, like now, when the dominant discourse on aging focuses on the deleterious economic effects of largely aging populations. If we didn\u2019t have inflammatory diseases to get the job done, we might have to turn to euthanasia. <\/span><\/p>\n

Yikes! <\/span>The idea that population aging will bankrupt society<\/a><\/span> is economically and ethically flawed. Ehrenreich has been a lifelong activist on behalf of the less visible and privileged, yet here she buttresses ageism\u2019s ugliest premise: as people move through life, they lose value as human beings.<\/span><\/p>\n

The fact that the \u201cdominant discourse\u201d on aging is so negative and one-sided\u2014so ageist, in other words\u2014is what makes it so urgent and important to challenge age bias. The conversation is anything but neutral, especially around \u201cliving too long.\u201d An ageist culture casts the \u201cend of life problem\u201d in terms of increasing numbers of old people who inconveniently refuse to die, when the underlying issue is the changing nature of health care: the plethora of profitable, often legally mandated, high-tech, medical interventions the book decries. <\/span><\/p>\n

Whose interests are in play besides those of the patient, and who is her advocate if she needs one? It\u2019s not a particularly radical leap to conceive of assisted suicide and euthanasia as forms of discrimination against the old, the ill, the disabled and those who are no longer economically productive, cloaked in the rhetoric of compassion. In an ageist and capitalist society, the line between \u201cright to die\u201d and \u201cduty to die\u201d can get blurry alarmingly fast.<\/span><\/p>\n

\u201cIdeally, the determination of when one is old enough to die should be a personal decision, based on a judgment of the likely benefits, if any, of medical care and\u2014just as important at a certain age\u2014how we choose to spend the time that remains to us,\u201d writes Ehrenreich. <\/span><\/p>\n

But the right to self-determination is important at <\/span>any<\/span><\/i> age. It\u2019s ageism and ableism that make the old and ill seem less entitled to it, and cutthroat capitalism that sanctions their abandonment. Small wonder that it\u2019s become commonplace to hear even healthy, middle-aged people wondering whether the ethical alternative to \u201cliving too long\u201d will be to commit suicide\u2014not because they\u2019re sick, or broke, or have no one to take care of them, but simply because they\u2019ve grown old. That is internalized ageism of the deadliest sort. At any age and in any condition, a person has the right to <\/span>want to stay alive<\/span><\/i>.<\/span><\/p>\n

Ehrenreich opts for quality of life, which for her means a life as free of doctors and hospitals as possible. For the record, much of the care doctors offer patients with terminal conditions is futile, and most doctors would themselves decline it. But also for the record, an ageist society grossly underestimates the quality of life of the very old.  <\/span><\/p>\n

The medicalization of aging does make what Ehrenreich calls \u201cthe truly sinister possibility\u201d more likely: that \u201cfor many of us, all the little measures we take to remain fit\u2014all the deprivations and exertions\u2014will only lead to a longer chance to live with crippling and humiliating disabilities.\u201d But it\u2019s stigma\u2014ageism and ableism again\u2014that makes disability humiliating. And there\u2019s a big difference between taking reasonably good care of yourself and giving yourself over to a life defined by doctoring.<\/span><\/p>\n

Each of us will have to decide when to abstain or indulge, whether to be scanned or scoped and how to cope with the consequences. I had every inch of me examined last summer when I turned 65 and went on Medicare. That was before I\u2019d read <\/span>Natural Causes<\/span><\/i>. When the next decision point arises, will I have the courage and clarity to forego tests or treatment? Will I break with my privileged demographic, buck my doctor\u2019s advice, brave my family\u2019s disapproval? Will I be not \u201cold enough\u201d but wise enough? I don\u2019t know yet.<\/span><\/p>\n

Not all of us will make the same choices, and none of us know what we will want at the end. But postponing those reckonings\u2014not dealing with aging and its inevitable end\u2014robs us of calm and contentment all the way along. I\u2019m glad that growing hospice and palliative care movements are making it easier for more of us to forsake <\/span>the futile pursuit of immortality<\/a><\/span> and hope the trend signals a growing cultural willingness to come to terms with the transitions ahead. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Author and activist Barbara Ehrenreich has long been one of my heroes, and I imagine an affinity in our fondness for myth-busting. In her new book, <\/span>she describes herself as an \u201camateur sociologist,\u201d and I thought, \u201cAha, me too!\u201d <\/span><\/p>\n

Read more Not ‘Old Enough to Die,’ Old Enough to Choose Wisely<\/span> ›<\/span><\/a><\/div>\n

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