Monthly Archives: December 2014

Christmas Wishes

For those who celebrate Christmas:

May you be surrounded by people you love, or at the very least, may you be awash in happy thoughts of those you love.

If it is (or has been) raining rather than snowing where you are, may the water serve as a symbol of birth and life.

May the children in your life be smiling today.

May you feel hopeful.

May you feel content.

May you feel comfort in your old traditions and excitement in the new.

For those who do not celebrate Chrismas:

May you enjoy the beauty of the lights on and in your friends’ and neighbors’ homes.

May you enjoy and embrace the sentiments of peace on Earth and good will toward men (and may the term “men” apply to all humanity).

May you enjoy a brief break from the normal hustle and bustle of daily life.

For those who are working today:

May you feel satisfied in knowing that you are helping others to enjoy their holiday by covering for them.

Healthcare workers, police officers, firefighters, and others whose work does not respect the calendar in any way – may you know deep down that your work both saves and touches the lives of not only those you serve directly, but of everyone whose lives are touched by those you serve.

Merry Christmas.

An Appalling and Alarming Devaluation of Life

I received an email earlier this fall from someone very close to me – a psychiatrist, in her mid-60s, extremely intelligent, level-headed, non-reactionary, balanced, rational, and even. She tends to be somewhat progressive and mildly left-of-center on social issues. She sent me the link to Ezekiel Emanuel’s article in the Atlantic, “Why I Hope to Die at 75”, and she expressed significant concern.

I also tend to be somewhat progressive and left-of-center on social matters, reasonably level-headed, and non-reactionary. I found the article to be chilling.

I provide the brief background on our personalities and social-issue political leanings very deliberately. You need to know who is alarmed here, because my article is about to sound like it was written by a right-wing pundit with paranoid tendencies. It was not.

The piece in The Atlantic invokes fears far beyond those of death panels (which, as unacceptable as such a concept is, at least imply that there are some decisions to be made as far as who might merit the resources to have life-saving treatment). Dr. Emanuel’s article sets the stage for an expectation that people’s health is not something for which society should pay at all once they have reached a specified age (the specific age he chose is 75). No need for a death panel – you just need access to a person’s date of birth. He repeatedly uses the term, “American Immortal,” to imply that the idea of living healthily into old age is unrealistic, selfish, and greedy. He steps so far over the line with his stated “personal” preferences that the rest of us won’t be able to help but view the government as magnanimous when it generously allows Medicare to cover an antibiotic for a 76-year-old. I am afraid that Dr. Emanuel aims to be so outrageous in his arguments that a slight step back will be viewed as reasonable.

His points of persuasion reminded me of an Onion article from the late 1990s, when Dr. Kevorkian was frequently making headlines (“‘Vehicular Manslaughter Doctor’ Assists in 23rd Doctor-Assisted Vehicular Manslaughter”). The Onion writers are able to make anything funny – even a subject such as assisted suicide. Their satire in this particular article goes over the top in its farcical quotes depicting the suffering of people (for example, having to put on a special pair of glasses just to read) whom they are putting out of their misery by running over with a car. Dr. Emanuel’s depictions of the infirmities of those 75 and older are frequently as preposterous as those of The Onion (for example, one of his instances of something horrible to be enshrined in the memories of someone’s children or grandchildren is that person’s having to ask what someone else said – seriously, he implies that it’s better for a person not to have a memory of a grandparent who has some hearing loss). To be fair, Dr. Emanuel does not advocate direct homicide of those 75 and older, but he most certainly promotes shoving them out of the healthcare world onto a proverbial ice floe. And rather than being funny, the seriousness of his dissertation is simply horrifying.

His position is coldly utilitarian. He establishes any loss of functionality, productivity, or creativity as making the world smaller, of being no way to live or to be remembered. So he recommends that people die first, before losing any functionality, productivity, or creativity. I certainly would not want to be the in-any-way-less-than-perfect family member of this guy.

Dr. Emanuel puts forth that those 75 and older already have grandkids or even great-grandkids, and their continued existence overshadows the next generation down. I would put forth that a little therapy would go a long way towards resolving such psychological issues for someone who feels he is not able to achieve his rightful position as patriarch, and I would put forth that such therapy would be significantly preferable to killing off one’s parents.

Speaking of killing people off, it also shocked me that a physician would take the medically unsound (from a population/public health standpoint) stance that after a certain age he would refuse a flu vaccine. Is this so he can pass influenza along to infants, other elderly people, and those with weakened immune systems, so as to efficiently thin the herd and more quickly reduce their financial burden on society? There are creepy parallels to both The Giver and Children of the Corn.

On Ezekiel Emanuel’s website, there is a big quote screaming from the homepage ( “Zeke Emanuel is a force of nature. Author, ethicist, cook, medic, policymaker: he makes other over-achievers look lazy and inadequate. There are very few policy experts – in health care or any other field – with Zeke’s smarts, political antenna and persuasive powers.” This man is a member of the academic and political elite. One of the architects of the Affordable Care Act (ACA or “Obamacare”), he is in the healthcare policy inner circle. His words do not die on the page. People in positions of power are listening to this man.

He sets up a false choice of being a sickly immortal-wannabe or forgoing all medical care at a predetermined age. He puts forth what is either his own fear of not being at his peak or what is his politically calculated and expedient depiction of old age as a universal “succumbing to that slow constriction of activities and aspirations,” and thereby devalues any life that is not at his defined “peak.”

This man is an ethicist. His ethics are unnerving.

I asked my youngest son to read the article and tell me what he thought about it. He is still two months shy of turning 14. I’ll stipulate that he is a smart 13-year-old (he has two smart older brothers to learn from), but still – he’s 13. Here’s his response:

“There’s a lot of wrong stuff in that article. He makes it sound like getting old is bad and that life is less worth living when you’re old. He’s wrong. As you get older, you know more and more about life, so you live it more clearly. You’re wiser. So what if you slow down a little? And what’s wrong with listening to books and doing puzzles? He said it was bad for people to have memories of someone older or weaker. He sounds like he just wants to shove old people out on an ice floe.” So I wasn’t the only one who had that ice floe image. “And that thing he said about older people overshadowing younger ones – that’s just messed up.”

I then asked my son if it sounded like the author was just stating his own personal opinion. He answered, “Actually, it sounds like he’s trying to convince other people of what he’s saying under the guise of it’s being his own opinion.” Out of the mouths of babes. He’s a high school freshman and he wasn’t fooled.

My son asked who this author is. I told him that he’s a very influential doctor involved in healthcare policy. He replied, “that’s scary.”

Listen to the kid.

Because Ezekiel Emanuel is a member of the political elite, he will have the prerogative to “change his mind” and access healthcare when he’s older than 75. But when his words have been enacted into policy, the rest of us won’t have that option. This man’s words and his position of influence combine to seriously threaten our right to life, liberty, and pursuit of happiness. Do not let him force anyone to go gentle into that good night before they’re damn good and ready.

I cannot dismiss his article as the musings of a madman. His words appear to be the cold, calculated attempt at the social engineering required to decrease our country’s medical bills in a deeply disturbing manner. They are a set-up to “well, if Ezekiel Emanuel is totally healthy and strong and climbing mountains in his late 50’s and declares that he should be dead in less than 20 years and not using up money for healthcare, then who is someone with (arthritis, diabetes, any ailment of any kind) to demand care? Why should we give a new hip to a 70-year-old? Why should we treat cancer in someone in their 60s?” I hope every member of the AARP (and every one of their family members, and anyone who is in or someday plans to be in that demographic) reads Dr. Ezekiel’s article. And I hope they read mine.

Do not let this man have the last word. Do not let him smile sweetly and innocently as he sets the stage for a “there will be no coverage for chemotherapy (or dialysis, or ICU care, or hip-replacement surgery, or medications other than painkillers…) after age (whatever seems like a number likely not to cause a huge outcry)” policy enactment. Let the outcry be heard now. Let it be huge. Keep your eyes and ears open. Follow what policy makers and policy influencers are saying and know who your elected officials are listening to. Keep reading what Ezekiel Emanuel writes. Keep up the outcry as necessary and keep it loud. Do not underestimate the power and influence of his words, or the power and influence of your own.


Fighting Preconceptions

We all have prejudices. We have racial prejudices. Religious prejudices. Gender prejudices. Occupational prejudices. Age prejudices. Weight prejudices. Height prejudices. We prejudge based on hair style. Language. Accent. Clothing. Shoes. Attractiveness. Tattoos. Names. Jewelry. Family. Hobbies. Cars. Schools. Type of home. Music. Where a person lives. What type of work a person does. What a person reads. Talents. Disabilities. Physique. Medical history. Injuries. Opinions or assessments by others.

No one is immune to prejudice. We have evolved to formulate split decisions. Malcolm Gladwell’s bestseller, Blink, focuses on the quickness of our decisions, on our prejudices, and on some ways to work around the prejudices. Our hard-wired tendency to prejudge is unavoidable, so we need to recognize it in order for it not to control us.

We need to get beyond our first thought and continue thinking. We need to figure out where the first reaction came from and check ourselves. We need to listen and to keep listening. We need to constantly reassess. Especially when we are in positions of power.

Police officers are in positions of power. Doctors and nurses are in positions of power. The prejudices of all of us have the potential to cost a person his or her life.

Defend and protect. First do no harm. We take these oaths and are bound to do what we can to uphold them. But sometimes we need to fight ourselves to do so.

A prejudice may cause a police officer to see a threat when there in actuality is no danger. A prejudice may cause a doctor to dismiss cries of pain as histrionics. A prejudice may cause a nurse to dismiss a family member’s report of a problem as whining. And once any one of us makes this initial presumption, we can kill someone if we don’t catch ourselves.

Those of us with people’s lives in our hands cannot stop at that first impression, Yes, a first reaction may very well be correct, but we must be diligent in our thought processes so that we don’t stop with that first thought. We cannot be too proud or stubborn to admit when our first thought is wrong. We have to keep listening.

When someone says “I’m in pain,” we need to listen. When someone says “I can’t breathe,” we need to listen. Maybe the person at first glance appears to be able to breathe, or not to be in so much pain, but we cannot risk ignoring those statements. Ever.

We cannot let our our desire to be respected get in the way of our oaths. We cannot let our drive to be seen as the one in-the-right to get in the way of true righteousness. We need to be bigger than that.

We need to remember that to save a life is to save the world, even if it means we might look like we lost or have to admit that we were wrong. We’ll win in the long run when we maintain our oaths.

First do no harm. Serve and protect. Command respect by showing it. Always remember that because we are human, we must go beyond the first thought. We owe it to humanity.