When is your personal "best by" date? - (1/31/2023)

By Dr. Ron Gasbarro 

Rudy was in the pharmacy waiting for his prescription when he blurted out to the pharmacist, “Hey, Doc! Did you ever think at what age you would like to die?” “That’s a bit morbid,” replied the pharmacist. “But I guess everyone has a ‘best by’ number in mind. Oh, you know, an age that he would like to live up to. Sort of like the ‘best by’ dates you see on a carton of milk.” “My uncle Adam lived to be 99,” Rudy told the pharmacist. “He would complain because he was not in good health. ‘Why is God making me live so long?’ Uncle Adam would lament. And after all that, he missed his 100th birthday by 8 days!” 

“That was a shame that he couldn’t hang on until his centenary,” the pharmacist said. But why was that considered a failure? What would be the point of hitting the 100 mark? After that achievement, would everyone wait around and wait for him to kick the bucket? Quality, not quantity, as the saying goes. And from the sounds of it, Uncle Adam did not have a high quality of life. Ezekiel Emanuel, MD, a leading US oncologist and bioethicist, who, at age 55, authored an article for The Atlantic in which he stated that after age 75, he would no longer receive any medical interventions should he develop cancer. That means no screenings, no chemotherapy, no cardiac stress tests or valve replacements, no antibiotics, and no vaccinations. This year, at age 65, he is willfully sticking to his vow.     

In a 2023 interview of Dr. Emanuel by The (London) Times, journalist Helen Dumbelow cites a 2018 study by the United Kingdom's Office of National Statistics which revealed that Brits aged 65 had an average of 20 years left to live. However, the following decade would be replete with chronic "illness or disability." Dr. Emanuel admits that even he, as a medical practitioner, would always be willing to keep a patient alive and filled with drugs, and tubes, and orders for more medical tests, even if no quality of life is guaranteed. Despite all these interventions, length of life is extended even though quality of life is not enhanced. All the while, the body is decaying bone by organ by muscle by cell. You can always drink the milk a few days after its “best by” date. After that, it gets sour and distasteful.

When asked which condition he fears most, he quickly says, “dementia.” He states that cases of cognitive decline surge throughout the eighth decade of life. He feels strongly about investing in longevity – that one could break the boundaries of life expectancy if one has something to contribute to life, to society, to himself. Emanuel said he is resolutely realistic about when his own "consumption" exceeds his "contribution."   

Sure, we all know the 92-year-old who water skis. Or the 103-year-old Australian who skydived on her birthday each year. Just recently, the world’s oldest person, Sister André, a nun from France, died at age 118. Congratz! But someone’s got to be the most ancient. Yet, is being the Queen of the Antediluvians the best way to depart from this glorious planet? You can hear it from one of the most powerful minds ever created. Considered the most influential physicist of all time, Albert Einstein had undergone treatment to repair a ruptured aortic aneurysm. But after that, he said, “Nicht mehr!” Einstein refused further surgery, stating, "I want to go when I want. It is tasteless to prolong life artificially. I have done my share. It is time to go. I will do it elegantly." He died the next morning at age 76, having continued to work until the end. And as the pharmacist said to Rudy, “Once more with feeling: Quality, not quantity. Contribution, not consumption.” 

Ron Gasbarro, PharmD, is a recovering pharmacist and writer-in-residence at Rx-Press.


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