Most people want to live as long possible.

But realistically, what will your later years look like?

• Will you be able to get around or will you need the assistance of a cane, a walker, or a wheelchair?

• Will you be dragging an oxygen tank behind you just to get a normal dose of breath?

• Will you have forgotten your address, how to add two and two, and the most important people in your life?

We may live longer than our grandparents did, but in those extra years, we’ll likely have more disabilities too.

How long do you really want to live? Have you thought about it?

I have. Around the age of seventy I decided, in a vague sort of way, not to receive treatment should I develop a serious condition. 

My decision was predicated on my desire to avoid invasive procedures and caustic medicines that would likely destroy the quality of my life and exacerbate my suffering all the more.

I didn’t write a treatise on my new resolution. I didn’t detail every possible scenario and what I would do in every single case. And I didn’t tell a single soul.

About a year later, I finally realized the unrelenting red area on my nose might be skin cancer. When a dermatologist eventually deemed the spot pre-cancerous, I didn’t stop to think about my big “no treatment” decision made the previous year. 

I applied two treatment creams to the spots twice a day for a week. It did the trick. When new spots appeared on my left temple a few months later, I thought: “That’s a little too close to the brain.” I quickly got out my tubes of anti-cancer cream again.

This was not cancer, right? It didn’t require an invasive procedure. It made sense to me to treat the spots. 

But where would I draw the line in the future?

Recently, I’ve also wondered, “What about the pain that might come from an undiagnosed consequential illness? Will a doctor even prescribe comfort medicine without a diagnosis or will she want to shoot me off directly into an MRI machine?” 

I also reflected on whether I would even have a choice about my own treatment. I don’t plan to commit suicide or request euthanasia—both illegal in most countries. But some illnesses rip away your control altogether.

For example, my vegan CalTech PhD brother didn’t have a choice when he develop dementia during the COVID-19 era. He did crash his car once before his keys were taken away by his girlfriend. But we’ll never know whether the crash resulted from a brain error or a moment of intentionality.

This question was answered, as best it can be, when I heard about the deaths of two men in their late seventies, who departed a few months apart. 

Both individuals lost their appetite and became as thin as a flag pole many months before the rush to an emergency room. In my estimation, loss of appetite and significant weight loss late in life are likely signs of serious illness.

These strong-willed men didn’t want to be told to eat more. “Leave me alone,” they would say. They also refused to see their physicians for regular medical check-ups. Their wives relented to their stubbornness.

Unsurprisingly, each man was suddenly hospitalized due to the onset of urgent symptoms. Both were diagnosed with cancer a few days later. Both died within a few short weeks of their diagnosis—one at home and the other in the hospital.

Did these obstinate guys refuse medical check-ups because they sensed they were dying? Maybe they didn’t want to endure invasive procedures and torturous treatments at this late stage of their life. Perhaps they silently thought, “Why not go without all the painful procedures and unnecessary fuss?”

Their end-of-life experience showed me that as long as I’m of sound mind, at least to some degree, I may indeed have the choice to refuse treatment.

In a controversial 2014 Atlantic article entitled “Why I Hope to Die at 75” and written at the age of 57, oncologist Ezekiel J. Emanuel lays out his reasons for hoping for a shorter rather than a longer life.

Emanuel says the scientific data indicates a progressive loss of physical functioning as we age. Although we may live longer than our grandparents, we’ll likely have more years with some form of disease.

“As Crimmins puts it, over the last 50 years, health care hasn’t slowed the aging process as much as it’s slowed the dying process.”

Emanuel uses data on strokes and dementia to support his position. The idea of living longer, but more incapacitated doesn’t appeal to him.

Even if we don’t fall prey to these limiting and heart-wrenching conditions, most older adults experience some degree of mental decline and research shows, lose their creativity as well.

I know my early seventies feel far different than my sixties did. I almost had a panic attack when it took me quite a long time to remember the word “sarong” even though one covers my couch. And my left knee has started to ache more often than not.

You might cite opposing examples, like your Aunt Mable who remains sharp-witted at the age of 96. But remember, human capabilities are typically subject to the infamous bell curve. You’ll find brilliant exceptions to the decline rule. Emanuel calls them “outliers.”

But it’s a mistake to assume you’ll be a physically healthy and mentally fit outlier when you’re older no matter how much celery juice you drink or puzzles you solve. Sorry, but the bell curve has it in for you.

Emanuel believes he’ll have lived a rich and complete life by the age of 75. It’s the number he’s chosen to refuse medical treatments of all kinds. He wants his children to remember him as vital rather than frail and mentally compromised—but that’s one aspect of his thinking on the matter.

And unlike me, Emanuel has a detailed plan.

Emanuel didn’t choose the title for his initial article. He won’t commit suicide or request someone else to end his life. In fact, he advocates against these practice. And he won’t necessarily die exactly at 75.

But Emanuel has made a commitment to refuse medical treatment after 75. Unlike my vague decision, he’s spelled out his intentions with precision.

For example, Emanuel says:

“At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless. And that good reason is not ‘It will prolong your life.’ I will stop getting any regular preventive tests, screenings, or interventions. I will accept only palliative — not curative — treatments if I am suffering pain or other disability.”

He goes on to flesh out the details, which include in part:

• No colonoscopies after 65

• No heart surgeries or implantable heart devices after 75

• No flu shots or antibiotics after that dividing year

Emanuel says he doesn’t judge others who want to live as long as possible. This is a decision he’s made only for himself. Although he reserves the right to change his mind, he stood by his decision in an interview he gave five years after his initial article.

However, Emanuel favors productivity over slowing down or having fun in your later years. Naturally, this has influenced his no more treatment plan. Emanuel doesn’t consider playful activities you might engage in as an elder like riding motorcycles or hiking constitute a meaningful life. 

I would heartily disagree with him on value of slow living and the health-enhancing importance of play. I also believe connection to be one of the most important gifts we can give one another, whatever our age. 

Surely, life has value apart from productivity.

Does his no treatment after 75 years of age position mean he has no fear of death? In a 2019 interview Emanuel says no:

“I do fear death. But I think I fear being sort of decrepit and falling apart more.”

Emanuel’s refusal of treatment after 75 plan has turned my vague decision into a more confrontational reality. 

But still, Emanuel’s plan makes sense to me. I may in fact skip my 2015 colonoscopy. Do you think I’m crazy? Do you think Emanuel is insane?

Or does this kind of end-of-life approach make sense to you too?

I think we all have a responsibility to think about the end of our life and convey our wishes to those around us. But honestly, I don’t spend hours in rumination about the future.

Once we have a will in place and have considered and expressed our end-of-life wishes, I feel our time is best spent in the present moment—right here, right now. I’ll be doing just that in my remaining years, while also repeating the word “sarong” at least 75 times a day.

Thank you for your presence, I know your time is precious!  Don’t forget to  sign up for Wild Arisings, my twice monthly letters from the heart filled with insights, inspiration, and ideas to help you connect with and live from your truest self. 

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