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President-Elect Joe Biden's announced COVID-19 task force includes a doctor who penned an article in The Atlantic in 2014 titled "Why I hope to die at 75."
Dr. Ezekiel Emanuel, 63, is an oncologist and Vice Provost for Global Initiatives at the University of Pennsylvania, as well as the brother of former Chicago Mayor and Barack Obama's former Chief of Staff Rahm Emanuel.
In the article, Emanuel details his reasoning for not wanting to live past 75 due to concerns over quality of life. He laments the decline associated with old age, pointing to physical ailments such as arthritis and paralyzing strokes, and particularly highlights the mental ailments associated with Alzheimer's disease, which affects one in three Americans over 85 as medical advancements in the field remain stalled.
Emanuel also worries about the effects old age has on children. "Living parents also occupy the role of head of the family," explained Emanuel. "They make it hard for grown children to become the patriarch or matriarch. When parents routinely live to 95, children must caretake into their own retirement. That doesn’t leave them much time on their own—and it is all old age. When parents live to 75, children have had the joys of a rich relationship with their parents, but also have enough time for their own lives, out of their parents’ shadows."
Acknowledging that few children want their own parents to die, he writes "while children can never fully escape this weight even after a parent dies, there is much less pressure to conform to parental expectations and demands after they are gone."
Dr. Emanuel continues by suggesting that the elderly would be diminishing their own legacy by living past 75. "We wish our children to remember us in our prime. Active, vigorous, engaged, animated, astute, enthusiastic, funny, warm, loving. Not stooped and sluggish, forgetful and repetitive, constantly asking “What did she say?” We want to be remembered as independent, not experienced as burdens."
The oncologist aligns his views on death with policy goals. Dr. Emanuel suggests that life expectancy should not be the primary indicator to determine how successful a healthcare system is and we should instead focus more on "the growing disabilities of old age, and chronic conditions—not on prolonging the dying process."
Such statements are particularly concerning given the nature of COVID-19. While initial research focused on the effects the virus has on the lungs, doctors are now more knowledgeable of the wider and long-lasting effects of COVID-19. According to the World Health Organization, symptoms such as fatigue, loss of taste and smell, shortness of breath, heart damage, confusion, and more can persist for weeks or months after the patient has recovered from the virus. A study on survivors of SARS, a related illness, showed that up to 40 percent of patients still suffered from long-term effects more than three years after recovery.
In other words, survivors of COVID-19, especially elderly survivors, are likely to have a diminished quality of life and the long-term effects may remain burdensome on their caretakers, whether they be doctors or family members.
Beyond this fact, many people who die of COVID-19 have one or more co-morbidities which already have a negative impact on quality of life such as obesity, and in some of these cases treating COVID-19 could, in effect, just be "prolonging the dying process."
This is not to suggest that Dr. Emanuel would simply allow the elderly to die. Indeed, Dr. Emanuel "often [advises] people in this age group on how to get the best medical care available in the United States for their ailments. That is their choice, and [he wants] to support them." Beyond that, Dr. Emanuel has been a staunch opponent of euthanasia and assisted suicide, let alone doctors allowing the elderly die against their wills. Questions remain, however, about how such attitudes towards elderliness may affect his work.
Biden's COVID-19 task force has also sparked controversy for the appointment of Dr. Marcella Nunez-Smith, Director of the Equity Research and Innovation Center at Yale University. Critics of the concept of health equity suggest that it shifts focus away from failures within the system which disproportionately harm certain groups. Instead, it focuses more on delegitimizing the healthcare system itself due to the existence of health disparities, whether or not those disparities are actually caused by the healthcare system itself, in order to push for revolutionary change.