September 19, 2018

How I plan to die

One Sunday last November, 86-year-old Joy Johnson laced her running shoes and ran the New York marathon for the 25th year in a row.  At mile 20, she tripped and fell, but quickly got up and finished the race. After celebratory hugs from her family and a quick interview with Al Roker, she returned to her hotel room, took a nap and died.

She is my idol.  

Who wouldn’t want to go out that way?  And yet, for many elderly people, the reality of life at 86 doesn’t involve marathons, but frailty, physical disability or Alzheimer’s, straining the resources of the grown children who care for them. At 55, I’ve already made my children promise that if I become demented, they will not write a heartbreaking memoir about how they bravely fed me prunes while I stared dully into space with food all over my shirt or, as Karl Ove Knausgaard vividly recounts in the international best-seller “My Struggle,” hauled my week-old festering corpse out of the home I’d trashed in my senility.   As human beings live longer and longer, extreme elderliness is a likelihood for many of us. But if we can’t choose to be elderly like Joy Johnson, do we want to live like Knausgaard’s father? Is there an opt-out clause?

Yes, says Dr. Ezekiel Emanuel, whose recent article in The Atlantic, “Why I Hope to Die at 75,” went viral immediately, racking up thousands of comments. Emanuel objects to what he calls the “American immortal” ideal of prolonging life as long as possible. Life after 80, Emanuel contends, is likely to involve physical or mental diminishment. Over the objections of his family, Emanuel has decided that he will accept no medical care after he is 75, and if diagnosed in his late 60s with a terminal illness, he will choose not to be treated. Ideally, he hopes to die of an infection like pneumonia, which will kill him swiftly and relatively painlessly.  

I’m fascinated with Emanuel’s argument. What’s most appealing to me is the idea that if I chose it, I might avoid what horrifies me most: that I would become a burden to my children, a shell of the full human being I believe myself to be. I am a control freak. I fear indignity more than death, and if the passionate public response to Emanuel’s article is any indication, I’m not alone.

But the more I think about his argument, the more dubious I become. One of his central arguments is that as people age, they experience a slowdown in memory and problem-solving ability. For him, this slowdown represents a dire and unequivocal loss of humanity. The average age of Nobel Prize winners, he argues, is 45. For the majority of elderly people, “Creativity, originality and productivity are pretty much gone.” Because they often feel happy anyway, they are oblivious to the fact that they are “aspiring to and doing less and less.” 

I think of my mother, a very lively 80, who retired several years ago from her career as a psychologist; though she remains extremely active and takes many classes at Northwestern University, she’s often content to take life a little more slowly than she once did. On a recent trip to Laguna Beach, she was happy to walk into town and sit on a bench for much of the afternoon, watching the ocean. But really, why in the world should she aspire to do more? What’s wrong with taking time to breathe the fresh air and watch the gulls swoop over the waves? Couldn’t that be called wisdom? Or even enlightenment? Three years ago, she caught a bacterial infection that nearly killed her; after a brief course of antibiotics, she was back on her feet. If she’d refused antibiotics and died by choice, how would that have been different from suicide? For the rest of my life, I would have felt personally responsible, guilty and even angry. And how would her beloved grandchildren have felt, knowing that a quick death was more important to her than being at their college graduations? Is that really how she would want to be remembered?  

I don’t want to sentimentalize the reality of aging. Too many of my friends know the pain of caring for an elderly parent who is suffering from dementia. We roll the dice when we choose an uncertain future. But our lives belong to the people we love as much as to ourselves, and making a unilateral, radical decision in the midst of a healthy life may cause more pain than it prevents.  Our legacies are as complex as the lives we have lived. And old age, for all its losses, is not only loss.  

I respect Emanuel’s choice, but to me, making a proclamation like his in the midst of a healthy life feels like a defensive crouch, a way of denying uncertainty. It also feels deeply unfair to the rest of the family — and does an injustice to how much our elderly relatives and friends often give to us. The same medical system that gives some people the illusion of immortality also gives us the illusion that we can control when we die without causing suffering to others. Instead of focusing on how Joy Johnson died, I’ve decided to focus on how she ran her race: full-throttle, joyous, undaunted by pain. I can’t promise to live that way when I’m 86, or when I’m 76, or even, let’s face it, tomorrow. But I can try to live that way today.  And maybe that’s enough.

Ellie Herman is a writer, teacher and life coach.  She blogs at gatsbyinLA.wordpress.com