Turning 70 seems to have created a change in my thinking about life and death, and especially life until death. Maybe this is because I seem to be more aware of my mortality. My faith in the Christian message of the birth and death of Jesus has made death just another exciting part of my life’s journey, one I anticipate within the next 10 to 15 years. What scares me is that my body is wearing out in ways that can’t be fixed. I don’t want to face a debilitating, painful illness where I have lost control. I don’t want medicine to extend my life when there is no longer meaning or quality. This really scares me.

I have studied and taught the biological aspects of aging but until now they were about someone else. I am now realizing that my body is aging – wearing out. Isn’t it funny that we can know something intellectually, but then know it at a different level when we experience it. I am beginning to think about what it means that my aging body is going to fail in ways that could result in increasing dependency and, sometime soon, total failure.

This probably sounds morbid to anyone under age 60 and you may not want to read any further – unless you have aging parents and then you should stick with me. If you are somewhere around 70 you should definitely read on because what I am experiencing is universal and inevitable. If you are having a hard time reading this, rest assured I am having a hard time writing about it. I want to be like Scarlet O’Hara and think about it tomorrow. But another part says I need to think (and write) about it now so that I may be able to impact how I choose to use health care and how I live until the end, before I get caught in the health care web and it is too late to decide for myself.

I have been thinking and reading about this for a few months. The first pressure to think about it came from health care providers asking if I had a health care directive. I finally forced myself to create one a couple of years ago when we updated our wills. I thought about it, and we talked about it, and it was much easier than I thought it would be. The reason it was easier was because the decision I made was for right now – this year. I know what kind of medical intervention I want now but I also know I will want to make changes to it as my body wears out in ways that are irreversible. As my body changes, I know my desires for health care and living will also change so I will repeatedly update my health care directive. Maybe we need to update our health care directives when we change the batteries in our smoke detectors.

I received another nudge to think about how I want to die from a post by Brian on his travel blog Everywhere Once titled “To Go Gently Into That Good Night?”  Brian doesn’t leave his life to chance – and I always enjoy reading his very well written essays on making good choices for traveling and life in general. In this essay he is thinking about the choices we can make about how we want to die.

Brian introduced me to the thinking of Ezekiel J. Emanuel who is an oncologist, a bioethicist, and a vice provost of the University of Pennsylvania. Brian talks about Dr. Emanuel’s decision to decline all medical treatment at age 75, electing to die of whatever ailment come first. I later read Emanuel’s article in the October, 2014 issue of The Atlantic and think that his decision is too extreme for me. He is now 57 and has decided that he will decline all medical treatment when he reaches age 75, including flu vaccines and penicillin. In the cost/benefit analysis that takes place when we make good decisions, it doesn’t seem logical to decline a treatment that doesn’t decrease quality of life but can protect and heal us for a while longer. But his arguments extended my thinking beyond my health care directive to thinking about under what conditions I would want to decline medical treatment when I am sitting in my doctor’s office instead of looking up at first responders or in an emergency room.

My thinking was further stimulated when we were with friends last summer talking about what all 70-somethings get around to talking about eventually – health issues. One friend is an ovarian cancer survivor. As she talked about her experience I started thinking about what I would do if I got that dreaded diagnosis of cancer. Her description of her response to chemotherapy sounded very similar to what I experienced before I got my Fibromyalgia symptoms under control.

I realized how difficult chemotherapy would be for me. I would have to stop all the medications that are working so well for me. My starting point would be similar to her response to treatment – and then I would add the discomfort of treatment as another layer. I don’t think I want to do that. I have mentioned this to many friends and family members. A few seem to get it, but most look away. Choosing to die instead of taking on the medical fight doesn’t seem to sit well with people and I understand, especially when love is involved.

I probably can’t prepare a response for when I am told I have cancer or some other potentially fatal condition because my decisions will need to be based on the costs (emotional, physical, and monetary) and potential benefits at that time. But I think I will have a better chance of making the right choices for me and those I love if I have thought through what I value beforehand.

That is why I am writing about aging and death. I want to sort it out in my own mind while sharing with others so we can maybe have a dialogue. I don’t have more posts written and waiting to be posted because this is a process – of reading, thinking, and writing. But there will be more because I know it is a conversation we need to have. Feel free to leave a link if you have written on this topic.