That snowy mountain beckons after 75

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On the needless prolongation of life

Dr Ezekiel J. Emanuel is an American oncologist, bioethicist, and public intellectual who came to prominence through his work on medical ethics and health policy. A professor at the University of Pennsylvania, he served as a senior health adviser in the Obama administration and has long been a sharp critic of what he calls the American obsession with longevity.

In a widely discussed essay, Why I Hope to Die at 75, published in The Atlantic, Emanuel argued that medical progress has become a kind of trap. By continually extending life through ever more invasive and expensive treatments, he said, modern medicine too often condemns people to long periods of physical decline and cognitive decay.

His proposal was not about suicide or euthanasia, but about choosing to stop aggressive medical intervention once life’s natural arc has passed its peak of creativity, productivity, and vitality. Beyond that point, we are merely adding years without adding life.

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I’m now in my mid-seventies, just the age Dr Emanuel was talking about. Over the last decade or so I have visited many care homes housing the old, the very weak and sick, and the demented - often all three. Some recalled Hieronymus Bosch’s vision of hell, with lounges lined with warehoused old dears nodding and drooling to some rhythm only they could discern. The best ones resembled hotels, with at least some of the residents alert enough to resent the bored and patronising young staff, playing infantile memory games - always in the lounge - to 'stave off dementia'.

I remember my mother in her mid-eighties, a widow living alone in an empty council house north of Bristol, miles from her nearest relatives, confiding to me that she had stashed some of her medication away: she would never, ever go into a home.

Five years later, of course, she was in the home where many months later she died, barely aware that the house she had cried copious tears to be returned to had been handed back to the council and now housed other people.

Let me just state for the record that I feel equally her horror, and would hope that I would choose to ascend that snowy mountain, to watch that last, solitary sunset, and not hasten to descend.

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