Living large, living long and just getting by
Let's jump to the punch line. Emanuel's conclusion is that he does want to live beyond the age of 75 and, when he reaches that age, he will forgo all medical interventions that aim to prolong his life. Transposing the conclusion to policy, Emanuel concludes that raising life expectancy in a society beyond the age of 75 is not an appropriate public health goal. More attention should be spent on ensuring that sub-groups (like African American males) attain a life-expectancy of 75 years or improving the statistics on infant and adolescent mortality.
These are his conclusions, but how does he get there? What reasons are offered for the 'hope to die at 75' on personal and policy levels? The main reasons are that as people age beyond 75, they experience various degrees and types of physical and mental disability. We all know this, of course, but Emanuel has an especially self-revealing way of mapping this out. A noteworthy fact: the average of Nobel Prize winners is 48. Other noteworthy fact: studies on creativity have shown that classical composers write their first major works in their twenties, peak in their 40's, and then go into irreversible decline. Except for a few outliers, creativity, originality and productivity go downhill after the age of 75. Our thoughts either run along the same well-worn neutral pathways, or the pathways themselves start to fray and fall apart. Sure, one can take other roles, like mentorship, and yet doesn't this too simply reflect (as Emanuel puts it) the "constricting of our ambitions and expectations"? But not only do we progressively become dull as dishwater and daft as brushes. We become burdensome to others, particularly our children, who increasingly have to care for us as we edge further and further into decrepitude. How can they win the Nobel if they have to deal with our shit (pun intended)? And to top it all off, those around us have to bear painful witness to our descent, which (according to Emanuel) has the effect of erasing memories of what we were like when we still had the juice. Because that is the underlying philosophy of life here: don't live long, live large, and get out before you embarrass yourself and burden others.
Yes, this is the philosophy of life of a white male, driven, affluent and privileged, whose career has been marked by important achievements and prestigious positions in academia and government. It is understandable to be concerned about decline when you are so high up in the socio-economic-cultural-political stratosphere. And probably you do not get to that position unless you have always been very strongly convinced that thinking, creativity, productivity, achievement, making social contributions (rather than friendship, love, dancing, hanging out, laughing, skinny dipping, eating pudding) are what is to be most valued in a human life. But what about the rest of us, whose life achievements are unlikely to even get close to the composers, the Nobel Laureates or Emanuel himself? Probably Emanuel at age 75 will be scoring better on all the indices (creativity, productivity, etc.) of the reasons for living than a lot of (younger) people globally, particularly those without the same opportunities, whose capacities have been stunted by oppression. If he does not have a reason to prolong his life then, neither do we.