The Boomers in the Twilight Zone

Following-up, "Three-Quarters of Generation Z 'Not Interested In Sports'."

From Andrew Sullivan, "How exactly are they going to die? And how much choice should they have in it?":

I’m not particularly afraid of death. But I’m afraid of dying.

And dying can now take a very, very long time. In the past, with poorer diets, fewer medicines, and many more hazards, your life could be over a few months after being born or moments after giving birth or just as you were contemplating retirement. Now, by your sixties, you may well have close to a quarter of your life ahead of you. In 1860, life expectancy was 39.4 years. By 2060, it’s predicted to be 85.6 years. This is another deep paradigm shift in modernity we have not come close to adapting to.

For some, with their bodies intact and minds sharp, it’s a wonderful thing. But for many, perhaps most others, those final decades can be physically and mentally tough. Increasingly living alone, or in assisted living or nursing homes, the lonely elderly persist in a twilight zone of extended, pain-free — but not exactly better — life.

We don’t like to focus on this quality-of-life question because it calls into question the huge success we have had increasing the quantity of it. But it’s a big deal, it seems to me, altering our entire perspective on our lives and futures. Ricky Gervais has a great bit when he tells how he’s often told to stop smoking, or eat better, or exercise more — because leaving these vices behind will add a decade to his life. And his response is: sure, but the wrong decade! If he could get a decade in his thirties or forties again, he’d take it in an instant. But to live a crepuscular experience in your nineties? Not so much. “Remember, being healthy is basically just dying as slowly as possible,” he quipped. Not entirely wrong.

Anyone who has spent time caring for aging parents knows the drill: the physical and then the mental deterioration; the humiliations of helplessness; the often punitive absorption of drug after drug, treatment after treatment; multiple medicinal protocols of ever-increasing complexity and side effects. Staying in a family home becomes impossible for those who need 24-hour care, and for adult children to handle when they’re already overwhelmed by work and kids. Home-care workers — increasingly low-paid immigrants — can alleviate only so much.

All this is going to get much worse in the next couple of decades as the Boomers age further: “The population aged 45 to 64 years, the peak caregiving age, will increase by 1% between 2010 and 2030 while the population older than 80 years will increase by 79%.” I’ll be among them — on the edge of Gen X and Boomerville.

I mention all this as critical background for debating policies around euthanasia or “assisted dying” (a phrase that feels morbidly destined to become “death-care.”) Oregon pioneered the practice in the US with the Death with Dignity Act in 1997. At the heart of its requirements is a diagnosis of six months to live. Following Oregon’s framework, nine other states and DC now have laws for assisted suicide. Public support for euthanasia has remained strong — 72 percent in the latest Gallup.

But this balance could easily get destabilized in the demographic traffic-jam to come. In 2016, euthanasia came to Canada — but it’s gone much, much further than the US. The Medical Assistance in Dying (or MAID) program is now booming and raising all kinds of red flags: there were “10,000 deaths by euthanasia last year, an increase of about a third from the previous year.” (That’s five times the rate of Oregon, which actually saw a drop in deaths last year.) To help bump yourself off in Canada, under the initial guidelines, there had to be “unbearable physical or mental suffering that cannot be relieved under conditions that patients consider acceptable,” and death had to be “reasonably foreseeable” — not a strict timeline as in Oregon. The law was later amended to allow for assisted suicide even if you are not terminally ill.

More safeguards are now being stripped away:

Gone is the “reasonably foreseeable” death requirement, thus clearing the path of eligibility for disabled individuals who otherwise might have a lifetime to live. Gone, too, is the ten-day waiting requirement and the obligation to provide information on palliative-care options to all applicants. … [O]nly one [independent witness] is necessary now. Unlike in other countries where euthanasia is lawful, Canada does not even require an independent review of the applicant’s request for death to make sure coercion was not involved.

This is less a slippery slope than a full-on, well-polished ice-rink. Several disturbing cases have cropped up — of muddled individuals signing papers they really shouldn’t have with no close relatives consulted; others who simply could not afford the costs of survival with a challenging disease, or housing, and so chose death; people with severe illness being subtly encouraged to die in order to save money:

In one recording obtained by the AP, the hospital’s director of ethics told [patient Roger Foley] that for him to remain in the hospital, it would cost “north of $1,500 a day.” Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care. “Roger, this is not my show,” the ethicist responded. “My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”

It’s hard to imagine a greater power-dynamic than that of a hospital doctor and a patient with a degenerative brain disorder. For any doctor to initiate a discussion of costs and euthanasia in this context should, in my view, be a firing offense.

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Then this: in March, a Canadian will be able to request assistance in dying solely for mental health reasons. And the law will also be available to minors under the age of 18. Where to begin? How do we know that the request for suicide isn’t a function of the mental illness? And when the number of assisted suicides jumps by a third in one year, as it just did in Canada, it’s obviously not a hypothetical matter.

Ross Douthat had a moving piece on this — and I largely agree with his insistence on the absolute inviolable dignity of every human being and the unquantifiable moral value of every second of his or her life. I’m a Catholic, after all. At the same time, we have to assess what this moral absolutism means in practice. It can entail a huge amount of personal suffering; it deprives anyone of a right to determine how she or he will die; and it hasn’t been adapted to our unprecedented scientific achievements, which have turned so many medical fates into choices we simply cannot avoid.

Does the person who lives the longest win the race? So much of our medical logic suggests this, but it’s an absurd way to think of life. I’m changed forever by losing some of my closest friends when they were in their twenties and thirties from AIDS a couple decades ago. They died; I didn’t. Wrapping my head around that has taken a while, but it became a burning conviction inside me that their lives were not worth less than mine for being cut so short; that life is less a race than a performance, less about how many years you can rack up, but how much love and passion and friendship a life can express, however brief or interrupted.

I still think this. Which is why I do not want to force terminally sick people to live as their bodies and minds disintegrate so badly that they would really rather die. Dignity goes both ways. My suggestion would be simply not aggressively treating the conditions and illnesses that old age naturally brings, accepting the decline of the body and mind rather than fighting like hell against it, and finding far better ways to simply alleviate pain and distress.

And at some point, go gentle. Treating those at the end of life with psilocybin, or ketamine, or other psychedelics should become routine, as we care for the soul in the days nearer our deaths. (Congress should pass this bipartisan bill to waive Schedule 1 status when it comes to the terminally ill.) We can let people die with dignity, in other words, by inaction as much as action, and by setting sane, humane limits on our medicinal power — with the obvious exception of pain meds.

Even Ross allows that “it is not barbaric for the law to acknowledge hard choices in end-of-life care, about when to withdraw life support or how aggressively to manage agonizing pain.” But that should be less of an aside than a strong proposal. What kind of support for how long? In my view, not much and not for too long. What rights does a dying patient have in refusing treatment? Total. What depths of indignity does she have to endure? Not so much. I’m sure Dish readers have their own views and unique experiences — so let’s air them as frankly as we can in the weeks ahead (dish@andrewsullivan.com). There has to be a line. Maybe we can collectively try to find it

I think of Pope John Paul II’s extremism on the matter of life — even as his body and mind twisted into a contortion of pain and sickness due to Parkinson’s and old age. His example did the opposite of what he intended: he persuaded me of the insanity of clinging to life as if death were the ultimate enemy. There’s little heroism in that — just agony and proof that we humans have once again become victims of our own intelligence, creating worlds we are not equipped or designed to live in, achieving medical successes that, if pursued to their logical conclusion, become grotesque human failures.

Moderation please, especially in our dotage. And mercy.