The Boomers In The Twilight Zone
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.
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.
(Note to readers: This is an excerpt of The Weekly Dish. If you’re already a subscriber, click here to read the full version. Subscribe for the whole Dish experience!)
A reader writes:
I had not watched this clip of you talking about coming out to your parents until you linked it at the bottom of your podcast discussion last week:
The reaction of your dad to you coming out brought a tear to my eye. I am sitting on the sofa with my 4- and 2-year-old sons watching Peppa Pig. Before they were born, I could not have identified with your father’s reaction, but now I know exactly how he felt. It was an amazing powerful reaction. I aspire to be as strong a support to my sons as your father was for you.
New On The Dishcast: Carl Trueman
Carl is a Christian theologian and ecclesiastical historian. He’s currently a professor of biblical and religious studies at Grove City College, as well as an ordained minister in the Orthodox Presbyterian Church. He’s the author of many books, but here we discuss The Rise and Triumph of the Modern Self (a condensed version of which just came out: Strange New World: How Thinkers and Activists Redefined Identity and Sparked the Sexual Revolution). It’s been a hit on the paleocon right.
Listen to the episode here. There you can find two clips of our convo — on our disagreement over the nature of gayness, and whether gay marriages adversely affect straight marriages. That link also takes you to commentary over last week’s episode with Alyssa Rosenberg, with listeners dissenting against both of us on the topic of social justice in children’s books. And readers continue the discussion on gay rights, sex changes for kid, and a changing England. We also talk cinema more. Here’s a clip from last week of Alyssa and me talking Tár:
Browse the entire Dishcast archive for an episode you might enjoy.
And Our Ukraine Strategy Is … ?
I hope to explore the entire Ukraine issue some more in the new year — but a simple observation. Putin’s strategy is evolving and as brutal as ever. The goal remains the long-term occupation of all of Ukraine; the means is another batch of 200,000 conscripts and a punishing air war that is fast destroying the core of Ukraine’s energy infrastructure. The air raids continue and are merciless. In this week’s barrage, 50 percent of Ukraine’s energy needs went unmet. And it’s only December:
Key pillars of the economy — coal mining, industrial manufacturing, information technology — cannot function without electricity or internet service. The World Bank has warned that poverty could explode tenfold. Unemployment, already close to 30 percent, is likely to climb further.
Just to keep Ukraine barely functioning is going to take $55 billion next year. And we have yet to see how ordinary Europeans will respond to an enduring recession caused in part by the Russian invasion.
My point here is not to whine. It is to ask: what is our strategy? The current adaptation to Russia’s bombardment seems to be to send sophisticated Patriot missiles into an active war-zone to defend Ukraine’s airspace. And that is designed to do what exactly? Help Ukrainians survive the winter … and then what? Right now, the US is deferring entirely to Kyiv on war aims, even as we add risk after risk to a confrontation with a nuclear power.
It is extremely hard to see how Ukraine can compromise with a power that has effectively raped their sovereignty, murdered their civilians and committed war crimes in their occupation. But if the choice is between compromise and economic and human devastation — turning Kyiv into Grozny — something will have to give. Solidarity to all those Ukrainians enduring this nightmare this Christmas. But a viable strategy toward some kind of settlement would be nice too.
Dissents Of The Week
A reader wants to change the headline of my latest column:
“He Is What He Always Was” should be “He Is Worse Than He Ever Has Been.” Yes, it is a matter of degree, but degree matters. I count myself as someone who always saw Trump as personally odious but allowed that the Trump administration did some actual good things: judicial appointments, Abraham Accords, Title IX reform, Operation Warp Speed, etc. People with “TDS” had trouble seeing acknowledging such important achievements. At one point, I would have said that — net, net — the Trump presidency was somewhere around neutral.
But, he just couldn’t handle losing fair and square to Sleepy Joe, and he went off the rails — even by the standards he previously set — with his behavior that led to January 6th. He exchanged a dog whistle for an actual whistle.
From the beginning, I’ve seen his arc as a classic one of a tyrant’s psyche. Yes, it intensifies as it gains power — but the psychological underpinnings are the same now as ever.
Read more dissents here, including a reader who ventures, “It seems to me that you, and the gay community in general, refuse to accept that this promiscuity played a major role in the early spread of HIV.” Keep the dissents coming: dish@andrewsullivan.com.
Cool Ad Watch
From Copyranter’s top picks of 2022 — an ad that Cartman would approve:
In The ‘Stacks
This is a feature in the paid version of the Dish spotlighting more than a dozen of our favorite pieces from other Substackers every week. This week’s selection covers subjects such as the AI power of ChatGPT, abortion pills, and the woke semantics of “unhoused.” Below is one example, followed by a new substack we’re following:
Yassine Meskhout takes a sexy look at his home country of Morocco and “how the government can have its cake (enforce religious mores) and eat it too (don’t scare the tourists).”
The Distance is “a politically homeless shelter from woke and left-right discourse” on trans issues.
You can also browse all the substacks we follow and read on a regular basis here — a combination of our favorite writers and new ones we’re checking out. It’s a blogroll of sorts. If you have any recommendations for “In the ‘Stacks,” especially ones from emerging writers, please let us know: dish@andrewsullivan.com.
The View From Your Window Contest
Where do you think it’s located? Email your guess to contest@andrewsullivan.com. Please put the location — city and/or state first, then country — in the subject line. Proximity counts if no one gets the exact spot. Bonus points for fun facts and stories. The winner gets the choice of a VFYW book or two annual Dish subscriptions. If you are not a subscriber, please indicate that status in your entry and we will give you a free month subscription if we select your entry for the contest results (example here if you’re new to the contest). Happy sleuthing!
The results for last week’s window are coming in a separate email to paid subscribers later today. Returning this week is A. Dishhead — the moniker for the creative sleuth who has made custom postcards for most of the VFYW locations. Below he gets in the Christmas spirit and sends us off for the holiday break — see you in 2023!
