The oncologist who will refuse all medical treatment after 75 (even for cancer)

A bit extreme! I am in my 80th year so this has some relevance for me. I am glad that I don't agree with him. I have just had a very good year.

I did however have a lot of medical support in recent years so I see that he does have a point. The support I had was not very onerous and has left me in very good health but others will be less fortunate than that

“Zeke”, as he is known, is influential in many ways, but his work that starts the most arguments is an essay titled “Why I want to die at 75”. It’s not just that he hopes “to die before I get old”, in the immortal lyrics of the Who. Rather, Emanuel pledges that at 75 he will stop trying to cheat death. He will act as though the breakthroughs made in medicine since the 19th century have never existed, seeking no cure for any encroaching ailments - no chemotherapy, certainly, but also no antibiotics, operations, statins, stents, screening, tests or vaccines. Avoid all contact with doctors, in other words.

He would like to be carried off the old-fashioned way, by nature’s mercifully swift brutality, rather than endure the decade of medically extended multiple illnesses that on average awaits us in the final furlong.

“Doubtless, death is a loss,” Emanuel wrote in that essay, which went viral in the US. “But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us if not disabled then faltering and declining, a state that may not be worse than death, but is nonetheless deprived . . . We are no longer remembered as vibrant and engaged, but as feeble, ineffectual, even pathetic.”

The essay goes on to enumerate the burdens that an over-75 typically places on the world, and how lonely and tired the growing tribe of ninety-somethings are as their lives become constricted to a single chair.

Emanuel’s solution to the problem of dying is not desperate denial, as it is for so many Californian tech bros in search of immortality. Nor is it the legalised euthanasia that is gradually spreading across the western world and that Emanuel actively opposes. Instead, he promises to pioneer a radical, retro survival of the fittest.

Some people write “living wills” to curb resuscitation efforts when already very frail. This takes that to a new extreme. He first set it forth at the relatively sprightly age of 57. On reading it I thought: “All very well to say this when you have a long lease left, but will his resolve to reject medical care falter when his 75th birthday draws closer? Will he find himself thinking, maybe a sneaky little Covid booster won’t hurt?”

Now Emanuel is 65, with ten years before the great doctor goes premedical, and I have a lot of questions. His brothers do too. Emanuel says that they call him on his birthday and ask, “How many more years is it again that I have to put up with you?”

So I tell him I’d rather see how old age pans out then be offered an exit if I felt I couldn’t go on - something akin to what the novelist Martin Amis (now 73) proposed when he talked half-seriously of euthanasia booths, where you would be greeted with a “martini and a medal”. Emanuel hates this. Euthanasia is riddled with moral and practical problems, he tells me, and even where legalised is considered only by a tiny minority. “If you think you’re going to legalise euthanasia, and it’s going to solve end-of-life care, you are deluded,” he says with the force of a putdown at a dinner with Ari and Rahm.

He says that we focus too much on the acute months before death and not on the long years of degradation. While modern medicine has increased lifespan dramatically, it has barely increased healthspan. A study by the Office of National Statistics is typical - it showed that if you were alive in England aged 65 in 2018, you have on average 20 years left to live, but the second decade would be consumed by chronic “illness or disability”. Aged 75, in other words, is where the suffering begins.

And it’s not just me who is deluded, Emanuel says. Every time he talks about his plan, almost everyone’s first reaction is to say that 75 is too young and to super-agers they know - these range from their 90-year-old surfing granny to President Biden (80) and Anthony Fauci, chief medical adviser to the US president (82), or indeed the oldest practising doctor, the 100-year-old Howard Tucker, who began working as a neurologist in Ohio in 1947 and still treats patients. We secretly believe that we will be these outliers, but “we can’t all be outliers”.

I wonder if he wants a quick illness to decide his end, as it would take bravery to either withstand a long medical treatment or take his own life. “Well, I think it’s bravery to say no to interventions where the majority of people would say yes,” he says. When I ask him the illness he fears most, he doesn’t hesitate: dementia. “There’s no doubt about it.” And after 75 the rates go “boom”, he says - even if we are not demented we lose self-sufficiency. “Living too long places real emotional weights on our progeny,” he wrote in his essay, even though they “won’t admit it”.

He is scornful of the new breed of (mostly male) “immortals” putting so much energy into the dream of living for ever. An Ipsos survey in November found that only a third of Britons want to live to 100, with more men than women wanting to live that long.

Emanuel wants to be clear-eyed about when his own “consumption” exceeds his “contribution”. Here he edges closer to what ethicists call the “duty to die” argument, the harsh utilitarian idea that the non-useful need to sling their hook. For someone as energetic and ambitious as him, passivity is clearly terrifying.

I say that perhaps “contribution” isn’t a good metric. There is value in the simple pleasures of old age. A large study by the esteemed psychologist Daniel Kahneman (now 88) in 2010 found that while happiness and enjoyment tailed off in one’s seventies, “emotional wellbeing” peaked at 82. Emanuel isn’t convinced, saying that people instinctively want to work to “leave the world better”, whether it’s as simple as being fit enough to manage a garden.


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