Response to Ezekiel Emanuel's "Atlantic" essay

I started thinking about this development around the time I turned 70 and realized I was still living the kind of life I had lived through most of my adulthood. Most of the 70-year-olds I knew, furthermore, seemed to be having the same experience. I mentioned this little discovery to a few other people and discovered I wasn’t the only person who’d had that thought. Margaret Mead’s daughter, Mary Catherine Bateson, has even written a book about it, Composing a Further Life: The Age of Active Wisdom.

“Biomedicine has once again created a profound change in the human condition,” Bateson writes. “We have inserted a new developmental stage into the life cycle, a second stage of adulthood, not an extension tacked on to old age.”

A second stage

This new stage of life is one of the great triumphs of medical science, and we are still learning what it means. There have always been a few people who lived into old age in good shape. Today, most of the Americans now alive will probably enjoy that happy fate. Modern medicine can cure or alleviate many of the conditions that blighted old age in the past.

People who would have been blinded by cataracts can go on seeing. People who would have been crippled by arthritis can receive hip and knee transplants. Problems like diabetes and high blood pressure can be turned into conditions most people can live with without major disruptions in their lives.

I’ve been under treatment for glaucoma for almost 30 years. If nature had taken its course, I would have gone blind about 15 years ago. Today, ophthalmologists claim most glaucoma patients will die with most of the vision they had when they started treatment.

Ezekiel Emanuel has decided he will stop having certain kinds of tests, such as colonoscopies, when he turns 75. As it happens, I had a colonoscopy just after I turned 75, thanks to a primary care physician who noticed something suspicious and had me take it two years early. The probe located a tumor, and a surgeon removed the tumor three weeks later.

If I hadn’t had the colonoscopy, I would probably be dead or dying right now. Instead, in the last three years I’ve attended over 200 concerts, read about 150 books, and continued to enjoy an active social life and miscellaneous pleasures like Thanksgiving get-togethers and the first three seasons of Homeland on DVD.

I could also note that I’ve continued to live a productive life, since I’ve written about 150 BSR pieces during those three years, along with a few well-received science fiction stories. But I don’t think that’s relevant. I chose my words with some care when I said millions of people were living satisfying lives.

Beyond utilitarianism

My personal political and social philosophy rests on the idea that human beings are ends, not means. We do not exist to serve society. Societies exist to serve us. If the members of a society feel they are living satisfactory lives, then that society has achieved its highest aim.

Obviously, we all have social obligations. But those obligations are essentially a payment for services rendered.

The real social issue isn’t the value of extra life — that’s up to the individual. The real social issue is the cost. Those extra years are a form of wealth, and like all wealth, they come with a price tag. All those doctors, nurses, technicians, machines, and drugs have to be paid for, along with the research that makes them effective.

Who will pay?

How should we distribute this new form of wealth? Should individuals pay for it themselves? Should we distribute it to everybody in equal measure, via the tax system?

The first option places the distribution at the mercy of the marketplace. Bankers and hedge fund operators would get more years than schoolteachers and social workers (to cite the most popular examples of economic villains and underpaid worthies). The second option takes money from frugal and productive citizens and makes them subsidize spendthrifts and ne’er-do-wells (to cite the examples popular in other segments of our great democracy).

My guess is we’ll do what we’ve always done and produce a mishmash that incorporates both options. The greedy plutocrats will buy all the years they can while they try to keep their taxes to a minimum. The upright public servants will get the best health care and pension plans their unions can wring from the politicians. The freelancers and risk-takers will take their chances. Everyone will feel there must be a better way.

Even though I have now reached the advanced age of 78 and seem to be in full command of my mental faculties, I’m afraid I can’t offer you a solution to this social dilemma. I’m not a pundit or a moralist. I can only advise you my experience indicates you should take advantage of this new stage of life. Make the most of it. Go until you stop. You won’t regret it.

To read Dan Rottenberg’s reaction to Emanuel’s article, click here.