Owing God a death

     Talk of “owing” God a death after 70 and living on “ borrowed time” was common when I was a child . Dying was not seen as the worst thing that might happen and was openly discussed. I am now well over  70 but  come from long-lived stock.  Currently I have a very active life (ranging from windsurfing to trying to learn Turkish) and no wish to die .  There is room for  compromise but there are limits beyond which mere survival seems unacceptable.  Illnesses causing incapacity are  far more threatening than  illnesses likely to result in death .  Besides the more one has been exposed to the illnesses of old age , the more death is not without its attraction. The obvious question is whether there will come a time when the mere probability of incapacitating disease will reach a point when one should make a pre-emptive strike . Recently , a well-known and thoughtful 67 year old ( John Simpson ) stated that he would take “the early out” if faced with debilitating illness in his later years but waiting for the illness can remove the opportunity for action. Equally the suicide of the 60 year old – to avoid growing old - described in the opening pages of “Love in the Time of Cholera” is a bit extreme.  Opportunism can be relevant if one has thought the matter through beforehand.  One very elderly relative accidentally severed an artery during a fall in the kitchen. For some time she wandered her home (blood spraying on the walls and furniture) before deciding to seek help. Her life went downhill thereafter and she always referred to that night as the time God gave her a  chance but she failed to take it. Another previously  very active relative in her nineties just refused to see a doctor when she developed severe dysphagia and  she died within a few days at home.  

   We have become antagonistic towards those who do not see life as everything –  perhaps we find them too much of a threat and reject them as “control freaks” . Medical intervention is seen in terms of life expectancy not quality. This , and the pressures to see old age as a glorious experience,  leaves some of us feeling alienated from Society.  Medically , the need to give hope seems to outweigh the need for honesty. Quite rightly , life insurance does not offer the same rates at 70 as it would at 30 and private health insurance becomes very costly.  So many of our patients cope by ignoring the fact that age increases the chance of death and disease  : just think of those times when “bad news” comes as a shock to the older patients or their  families .  We make it hard for people to refuse potentially life- saving interventions  but these can be a disaster for the older (and occasionally the younger) patient  , whilst  still being seen as a medical success.  

    Of course there are those who have a very different view of life and survival is their first and foremost concern and we need to try to help them achieve this . but perhaps for this one final event in life we should see people as individuals.   Meanwhile , those of us who see life differently have to make our option appraisal as best we can , taking others into account as well .   Perhaps those with a well-thought  through  personal philosophy should be accorded the same respect as those with religious belief.  We should aim to live as long as we should , not as long as we can .