When is a Good, or Tolerable, Time to Die?

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As someone who has spent many years writing about end-of-life care, there is one question that has long intrigued me, but it is rarely posed in that context. When is a good, or tolerable, time to die? I do not mean when one is in pain or suffering, which is the way that question usually comes up. Like most others, I don’t want useless and painful care or needless suffering. My question is more speculative: even if one is in good health, medically and physically, when might one consider that one’s life has been sufficiently long? By “sufficiently” here I mean when death would not be judged an evil in my eyes or that of others.

I took a crack at that question in a 1987 book on the likely need some day to ration care for the elderly. I was then 57. My answer was when one had lived long enough to enjoy most, but not necessarily all, of the benefits of life: work, education, family, travel, and the like. I thought above 80 was a reasonable place to draw that line. I would hope, to be sure, that my family and friends would grieve my death, but might also express a consoling phrase I have often heard about the death of an elderly person–that he “lived a full life.”

I don’t believe our own or any society has grieved about the death of an elderly person as somehow a blow to human life itself. The fact that the oldest part of most cemeteries, where the graves of those who died two or more generations ago, display no flowers or flags tells that story; they get no visitors any more. Now, of course, the graves of Washington, Jefferson, Kennedy, and other notables do get visited and decorated. But I have never heard anyone say that it is a tragedy that Washington is not still alive. Other presidents came along, and that has worked out well enough.

When I first started talking that way in middle age, I got taunted: “Well, let’s see what you’ll say when you’re 80.” I now say exactly the same thing, although I am living a happy, productive life, well past 80 and likely to have a few more years in that good shape. Needless to say, I have gotten a lot of resistance to my way of thinking. A thoughtful theologian, Paul Ramsey, once pointed out to me that not everyone wants to write books or see the world. “Some people,” he said, “just like to sit on the porch every evening and watch the sun set.” My youngish wife of 81 has noted that she could be happy just reading new books indefinitely and re-reading good ones.

In a much-cited article, the philosopher Thomas Nagel clearly characterizes what I believe to be at the core of those who resist death: “death, no matter however inevitable, is the abrupt cancellation of indefinitely extensive possible goods. . . . that we will inevitably die in a few years can not by itself imply that it would not be good to live longer. . . . if the normal lifespan were a thousand years, death at 80 would be a tragedy.”

I find it an odd argument for two reasons. One of them is that much human experience in others spheres of human life says otherwise. Childhood is a wonderful stage of life, but would anyone want to have it extended for indeterminate decades? When good plays, movies, novels, and even athletic events come to an end, we usually don’t wish that they could have gone on longer and never end. Beginnings and endings belong to much of our lives and make them interesting.

The second reason is social and evolutionary. Indefinitely longer life would change the fact and experience not only of aging but also of life itself. We have not a clue about whether that would be good or bad and will probably never find out. But evolution and the biological development of human life display a passing of the generations, the young becoming old and eventually dying, replaced by a new generation of the young, and with them renewed vigor of our species. At my age I don’t hang out much with 2-to-4 year olds, but it is always a joy to watch them cavort about smiling and laughing at trivial delights we would ignore (jumping over cracks in a sidewalk is one of them). But then we also like to watch them grow up.

Not long ago I had a kind of out-of-body experience of death. It was not of the type that got much attention a few decades ago, with some people mistakenly pronounced dead reporting lovely and mystical experiences. That bemusement did not last long. By definition, if you come back from a supposed death, you were not dead. My experience was different. I had a life-threatening heart problem, the major symptom of which was an instant blackout, and I fell to the floor. It did not last long, but the experience was memorable. Or, put more precisely, the non-experience of a total blackout, the pure nothingness of it all, was striking in retrospect. I concluded, on no better personal evidence, that death must be like that. But would that not be committing the same fallacy that the aforementioned mystical experience committed? Not quite, for nothingness seemed to me more plausible than lovely mystical experiences. I will find out one of these days. Or I won’t.

Daniel Callahan, 83, is co-founder and President Emeritus of The Hastings Center and an editor of Over 65.

7 Responses to “When is a Good, or Tolerable, Time to Die?”

  1. Eric Reines

    Dear Dan: I’d like to live long enough to see my children established in life and to be there for my wife. I’d rather live a year too short than a minute too long. I don’t want to be greedy about getting more life. Thank you. Eric

  2. Carol Eblen

    Eric makes a point! But what is wrong with being greedy about more time if the qualify of one’s life is such that there is still joy or purpose in staying alive as long as possible —a month, six months or a year?

    Why should hospitals/physicians be allowed to extrapolate covert/overt unilateral DNR code status into the hospital charts of the elderly/disabled on Medicare/Medicaid for the purpose of shortening their lives to CAP costs that will not be reimbursed by CMS and Big Insurance, the Advantage and GAP insurers.

    You must know that covert rationing of end-of-life care has been going on for many years in the United States and yet you do not speak against it? I heard your speech on the Internet where you explained covert rationing as “just not paying for the treatment” and hasn’t this been going on under both political parties for a long time — Perhaps, since President Bush signed the “Pay for Performance” Initiative in 2005/6?

    Don’t you feel any responsibility for allowing the Big Insurers to raid the Medicare Purse. How do you feel about the “obscene” compensation paid to some of the executives in Big Insurance who profit from the Medicare Purse as recently reported by Wendell Potter of The Center for Public Integrity?

  3. Daniel Callahan

    My comments have nothing to do with being “greedy,” a word I did not use. No, I do not feel responsible for allowing Big Insurers to raid the Medicare purse. What am I a private citizen supposed to do about that? I think what they are doing is lousy, and I wrote a whole book about the noxious power of the market in health care, so I have done what I can in that area.

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