The Elderly not Resting on their Laurels

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On the morning of Wednesday, November 20th, 2013, I was beginning to peruse the article by Dan Gorenstein in the New York Times, “How Doctors Die: In Coming to Grips With Their Own Mortality, They Are Showing the Way for Others”. CNN was on the TV in the background. On came the presentation of the 2013 Presidential Medals of Freedom to 16 people, a few of them posthumously. This is the highest civilian honor one can receive. This was the 50th       anniversary of the award, established by President Kennedy not long before the 50th anniversary of his assassination. It has become one of his clear-cut legacies.

Quickly my attention was refocused on this presentation, which I soon found to be absorbing and inspiring. President Obama said the “The Presidential Medal of Freedom goes to men and women who have dedicated their own lives to enriching ours”. Given that broad definition, it was not surprising that the awards recognized those in fields ranging from sports to sexuality, from jazz to journalism, and from religion to human rights. The ethnic backgrounds and countries of origin of the recipients were similarly diverse.

The ones that were the most impressive to me were the ones who not only did such important things earlier in their lives, but who are continuing to do so as they age. It would have been easy and understandable if they just had retired and rested on their laurels. But, no, they did not and, as such, they are models for what all of the elderly potentially can do, in our own ways and with our own skills.
 
Here are those elderly recipients who, as far as I can tell, are still living and in good health, and clearly not resting on their laurels:
 
Ernie Banks. Now 82 years old, he was known as “Mr. Cub”. He was one of the pioneer Black-American baseball players, a star shortstop who played for the Chicago Cubs, a team that always seemed to fall short. But he always seemed positive and eternally optimistic, purveyor of positive psychology well before that became a field of study and interest. However, that attitude drew criticism from those who wanted him to be more outspoken about racism. His response to that was: “I kept my mouth shut but tried to make a difference. My whole life, I just wanted to make people better.”

In his life over 65, he exemplified that goal, becoming an ordained minister and establishing the charity Live Above and Beyond Foundation, which tries to increase the self-esteem, healthcare, and other opportunities of the young and old. At the ceremony, he concretely and symbolically answered those old critics by giving President Obama an official Jackie Robinson bat. Robinson broke the color barrier in baseball and was more outspoken, just as Obama broke the Presidential color barrier in the USA.

Bill Clinton. Now only two years over 65, one could conclude that he is doing as much or more to improve the world as when he served as President Clinton. The way President Obama put it, maybe Bill Clinton is just getting started as President. Especially with the establishment of the Clinton Foundation, he has made major contributions not only to strengthen global economies, just as he improved the economy in the USA when President, but to the health of people and the health of the environment. It’s as if he took his failed healthcare reform initiative in a global direction that politics couldn’t sabotage.

Daniel Kahneman. Now 79, Daniel Kahneman continues his pioneering work in combining economics and psychology at Princeton University, where he is now a professor emeritus. His research on making decisions in uncertain circumstances won him the Nobel Prize for Economics in 2002. In 2011, his book Thinking, Fast and Slow, summarized his work and became a best seller.  He must have learned the basics of making such decisions when he and his family were on the run for years from the Nazis.

Richard Lugar. Senator Lugar, now 81 years old, continued to serve in the Senate until just this year. In contrast to the current state of the parties, he was known for his bipartisan leadership in the past. He continues to be a strong voice on foreign policy, especially nuclear disarmament.

Mario Molina. Now 70, Mario Molina was raised in Mexico City. After coming to the USA for education, he studied how chlorofluorocarbons depleted the ozone layer, for which he later shared the Nobel Prize in Chemistry. He continues to study the climate and environmental changes that affect us all.

Gloria Steinem. Now 79, Ms. Steinem continues her well-known pioneering activism for women’s equality and rights. Her essential message to women was to not solely rely on listening to her advice, but to one’s own voice, as Ms. Steinem modeled in such an exemplary way. She continues to listen to her own voice in co-founding the Women’s Media Center, as well as marrying later in life.

Cordy Tindell “CT” Vivian Now almost 90 years old, in 2012 he served as interim President of the Southern Christian Leadership Conference, continuing his leadership in the civil rights movement. In a variation of President Obama’s slogan, “Yes, We Can”, Reverend Vivian has been exclaiming, “Yes, We Care”.
 
Patricia Wald. Now 85, for the last 20 years, Judge Wald became a leader in the International Criminal Tribunal in the Hague, hearing human rights cases related to the former Yugoslavia. Other human rights projects include a Task Force on Guantanamo.

Oprah Winfrey. Probably most can’t help but know of Oprah’s continuing national presence as she passes the age of 65. Her essential message was “you can”, and through various media, encouraged people to find the best in themselves, as she found the best in herself. Akin to Ernie Banks, another African-American, she seemed to be an informal positive psychologist well before the field of positive psychology emerged.

Loretta Lynn and Arturo Sandoval. Not to diminish their individual contributions, but their common denominator was to continue making moving music past the age of 65. More than that, they were stars in the two fields where it can be said that the USA contributed unique art forms to the world: Loretta Lynn, now 81, for country music and Arturo Sandoval, now 68, for jazz.

After the presentations, I returned to finish the article on “How Doctors Die”. Both the article and the award presentations reinforce how important it is for the elderly to contribute to the welfare of the country and future generations. The challenges they continue to work on are major challenges for the world: human rights, cultural conflict, climate change, nuclear war, and gender disparities, among them. Not only that, but they contribute to fields that are so important to our individual well-being: music, non-violent sports, entertainment, decision making, and positive psychology.
 
President Kennedy tragically could not get close to the age of 65, and we can only imagine what more he could have accomplished if he lived a long life. However, to honor his early death, we elders, to paraphrase the beginning of his most famous quote, need to be reminded to “ask not what your country can do for you” in terms of Medicare and Social Security, at least not to solely ask that. Rather, we need to continue to “ask what you can do for your country”. These awardees provide plenty of answers, even for when we are known to have a terminal illness.

H. Steve Moffic, M.D., 67, retired from clinical practice at 66. He was fondly deemed a “psychiatric gadfly” by the Chair of the Department of Psychiatry where he first trained. His book The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare, published in 1997, was the first extended discussion of the ethics of managed mental health care.

6 Responses to “The Elderly not Resting on their Laurels”

  1. Carol Eblen

    Yes! It is wonderful to recognize that there is still life and achievement after 65 and I applaud you for bringing this to the attention of those who read this Hastings Center blog.

    I am delighted to be able to converse with you again. You were so kind to respond to me in your blog article “Suicide Among the Elderly” which has 34 comments. I intend to buy your book about the “ethics of Managed Care” because I am happy to know that you recognized that “Managed Care” might not always be ethical.

    As you know, I have been on a mission to expose the fact that covert and overt unilateral(default) DNR code status is being misused by hospitals to limit life-saving and life-extending treatments that the hospitals KNOW will not be reimbursed by Medicare and the private insurers.

    Medicare and Private Insurers have not been reimbursing hospitals/physicians for non beneficial over treatment, mistakes, errors, complications, and for exceeding the diagnosis related group cap for over ten years now. Have the hospitals been misusing DNR code status for ten years and hastening death without the informed consent of patients?

    I believe these covert/overt unilateral DNRs are epidemic in our acute care hospitals and that the hospitals feel that they are quite safe in hastening the death of elderly/disabled Medicare/Medicaid patients for fiscal expediency without the informed consent of the patients. Why do the hospitals feel so safe?

    In researching the law since the 1991 Patient Self Determination Act was passed, I couldn’t understand why the hospitals would feel so safe since most state law and federal law deem unilateral DNRs (especially for financial gain) to be crimes and it is implied in the law and ethics that DNRs are only moral and legal when they are consented to by the competent patient or the patient’s surrogate and only legal without the informed consent of the patient when “medical futility” is invoked under some due-process procedure approved in state law.

    However, yesterday, after reading he Article “Uncertainty and Futility” A Case Study by Thomas P. Duffy, a founding member of the Hastings Center, I am beginning to understand that we can blame the bioethicists for hiding behind “futility discussions” for 22 years and pushing with their great influence to treat unilateral DNR code status as merely an ethics lapse, that is not really immoral, and NOT a tort or a crime as long as the treating physicians’ motives were honorable. There has been no case law developed about unilateral DNRs and no prosecutions of the discrimination prohibited in the 1991 Patient Self Determination Act.

    I was shocked to read about the cruel OVER TREATMENT of a patient and the lie by omission that started it all in this article written by Dr. Duffy. Yet, I had to realize hat Dr. Duffy is a fine man and an excellent physician and thought he was standing on hallowed ground!

    I was shocked again to read some of the commentaries on this Article, such as the “First Commentary” entitled “Medicine and Moral Balance: The Art of Disclosure” by Robert A. Burt, which appeared contradictory to me. Mr. Burt claims that disclosure to patients suffering from imminently life-threatening diseases –“is almost an art.” He says later in the commentary when talking about the recommended treatment that “The failure of the prior courses (of treatment) and Joseph’s terrible suffering as a result of the second round had, as Duffy described it, “withered Joseph both in body and in spirit.”…….Yet, Dr. Duffy approved a third round of radiation because the patient’s wife wanted it! —-and justified this –but how?

    Of course, CMS and the private insurers came to a point after the 1991 Patient Self Determination Act was passed by the Congress where they were not going to reimburse physicians for cruel over treatment of incurable diseases. While I’m sure Dr. Duffy did not cruelly over treat this patient for profit, he did profit, and he spared himself the emotional burden of telling this patient that the prognosis indicated he was going to die and that he couldn’t help him. But, isn’t this ego?

    How can the Hastings Center represent that their goal is “Self Determination” for those over 65 when they have created a situation where Hospitals are hastening the death of the elderly/disabled on Medicare/Medicaid without their informed consent because they aren’t being reimbursed for non beneficial over treatment, mistakes, errors, and the complications thereof made by physicians in the outpatient setting.

    Of course, The Department of Justice and HHS joined together to prosecute over treatment of patients for profit using the federal false claims act and I’m sure that this will put an end to non beneficial over treatment of elderly/disabled Medicare/Medicaid patients.

    It appears also that the autonomy of the individual physicians will be removed as Hospitals across the United States by out physicians’ practices and the physicians now work for the hospitals. It appears that the hospitals and the insurance companies will decide who lives and who dies and that the hospitals will buy Hospice and Home Care organizations as well and put them under one umbrella.

    But who is watching out for the patients and protecting the Medicare Purse from Big Hospital and Big Insurance.

    I blame the bioethicists for making cruel over treatment of patients possible for the last 22 years and for not exposing that the Hospitals are hastening the death of the elderly/disabled without their informed consent when “medical futility” isn’t a factor.

    Am I wrong?

  2. Steve Moffic

    I don’t know the answer, but perhaps, per the awards, the more important issue is how we are living, not how we are dying.

    Steve Moffic

  3. Carol Eblen

    Of course! This is why I pursue this matter and why I have tried to warn my brothers and sisters and why I try to engage bioethicists in conversation about the matter of immoral, unethical, and illegal DNRs made possible by the Bioethicists that are extrapolated into the charts of the elderly/disabled for fiscal expediency —to preserve the profits of the for-profit medical system and CAP unreimbursed hospital costs. .

    I can do this —I can try to warn and try to stop this ugly passive euthanasia of the elderly for $$$$$ because I am NOT DEAD YET.

    I recognize your “grace” in responding to me at all and thank you for this.

    When does “medical futility” become “medical murder” for profits? Think about this!

  4. Herb

    Thank you for shining the spotlight on the award winner’s lives. They are an inspiration to all of us over 65 to not give up on our dreams for a better world especially the world from which our careers were built.

  5. Carl Hammerschlag

    Thanks for reminding us that productivity, and participation in life are not limited by age. Indeed, we are obligated to continue to share whatever our gifts and experiences with others because what gives meaning and purpose to our lives is not measured by what we’ve accumulated, but what we have left behind.

  6. Steve Moffic

    I very much appreciate the recent comments of Carol, Herb, and Carl. Having “grace”, “dreams”, and “purpose” is not age dependent. They also remind me that continuing to contribute is not only with the major contributions of a legacy, but in the everyday way we lead our lives, in the kindness and respect we show to others.

    Steve Moffic