“Live too long” or “cost too much?” And who makes the call?

 

In a New York Times op-ed titled “On Dying After Your Time”, prominent bioethicist Daniel Callahan concludes that we should help young people become old, but that when it comes to the old “our duty may be just the reverse: to let death have its day.” It provoked these rebuttals from me and from my colleague Elizabeth Schneewind:

 

When it comes to the value of longer lives, Daniel Callahan’s skepticism about Google’s new Calico “anti-aging” initiative is on point. Far better to wrestle with mortality than to postpone that reckoning in pursuit of biomedical bonanzas. But how could the ethicist get one thing so right and allow ageism and misinformation to derail the rest of his reasoning?

“Modern medicine is very good at keeping elderly people with chronic diseases expensively alive,” he writes. Why the “elderly” in that sentence? Because old people are selfish enough to contract diseases instead of getting hit by buses or committing suicide! People have to die of something, and serious diseases do indeed tend to pile up towards the end of life. This is called the compression of morbidity, and it’s why healthcare costs are highest in our final months or years. It’s also a basic index of progress, because it means people are staying healthy longer. The population to which Callahan refers is the best-educated, healthiest group of older adults in history. Furthermore, the overtechnologized and highly fragmented nature of our healthcare system—not an aging population—is responsible for rising costs.

Callahan next blames older people—“a society where the aged stay in place for many more years”—for impeding upward social and economic mobility by staying in the workforce. In fact the notion that older workers compete with younger ones is a fallacy known as the fixed lump of labor. The problem in a weak economy is not enough jobs, period. If the job market is strong, workers of all ages benefit. According to a 2012 Pew Charitable Trust report, “greater employment of older persons leads to better outcomes for the young.” Furthermore, for better and worse, people are going to have to work longer to pay for longer lives. That’s why “greedy geezers” are also castigated for leaving the labor force.

“And exactly what are the potential social benefits? Is there any evidence that more old people will make special contributions?” asks Callahan, himself an octogenarian. For starters, they write opinion pieces like his. True, most older people aren’t as well positioned, but perhaps they care for a neighbor or grandchild, or mentor a younger person, or otherwise contribute to the public good—or simply look after themselves. Perhaps, unable to manage even that, they belong to the 3% (a mere three percent, down from 4.6% in 2000 according to the U.S. Census) of the 65+ population in nursing homes. Perhaps, even then, their friends and families simply like having them around, as Callahan’s surely does. 

Most significantly, he likes being around. Why else would Callahan have chosen to benefit so greatly from the healthcare system he disparages: “At 83, I’m a good example. I’m on oxygen at night for emphysema, and three years ago I needed a seven-hour emergency heart operation to save my life.” We already invest in the extension of healthy life in young people; where’s the justification for withholding it from the old?  Why should a long future have value but not a rich past? At what point does this ethicist think people should abdicate not just their value as human beings but the very right to want to stay alive?

 

By Elizabeth Hughes Schneewind:

    Daniel Callahan, a distinguished writer on ethical issues concerning old people, published an op-ed (NYT, 12/1/13) criticizing the goal of a new company, Calico:  tackling the “challenge of aging.” 

    Long life per se is not necessarily a good, says Callahan, while a meaningful, fulfilled life is a good, presumably at any age.  Most people these days will agree that some people, old or otherwise, are now kept alive when their life has lost its meaning and is so painful that they would prefer to be dead.  That is the reason for the assisted suicide movement.

    But Callahan’s main argument for limiting life is economic.  Where would the age cutoff fall, and who would make this decision?  He seems to think it would fall at the point at which a person is no longer likely to make a “special contribution” to humanity and at which his/her care has become “too expensive.”  But why should this apply only to the old?  Some societies have considered, e. g., developmentally disabled children of no value and too expensive to maintain.  We know what the terrible results have been, and we do not consider them morally acceptable.

    Callahan thinks that the increasing number of old people and their expanding needs are upsetting the “upward social and economic mobility”  that has been a fine characteristic of modern American life.  Certainly, there is a great deal wrong with our socio-economic system, which is increasingly dividing the rich from the poor.  Thanks to mechanization and other developments, there are fewer and fewer jobs while there are more and more people.  The old notion that every responsible able-bodied adult should be able to find and hold a full-time job capable of supporting a family is as out-dated as the idea that old people should be able to be self-sufficient because they have Social Security.  Why blame the old for a system gone awry?  Better to blame, among others, Silicone Valley for inventing more and more products that replace people with machines.

    It is one thing to think as a social planner and decide that the world might be better off if certain people were eliminated.  It is quite another to consider whether, at a particular point in our own lives or in that of those we care for or respect, we  would think it would be best for life to end.  In the event, almost no one wants to die, absent intractable physical or psychic pain or the fear of something considered even worse than death, such as torture or public shame.  While the life of a frail old person in a nursing home may not appear worthwhile to a young healthy person, he or she may nonetheless feel quite differently at that stage of life.

    Decisions about the value of a life are profoundly personal and individual.  They should not be made on the basis of impersonal social policy. 

The author is a geriatric social worker and the author of “Of Ageism. Suicide, and Limiting Life,” J. Gerontological Social Work, Vol. 23 (1/2, 1994. and other articles on aging.

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