Tuesday, 23 September 2014

Living and dying well.

This morning’s straits times' article carried this title, “Too young to die, too old to worry.” It was written by Jason Kari Awish, a professor of medicine, medical ethics and health policy at University of Pennsylvania. It was a fun read with a smackaroo of humor and practical advice about living and dying. The article started with the famed song-writer Leonard Cohen who planned to celebrate his 80th birthday with a cigarette. He said, “It’s the right
age to recommence.” How cool is that for an octogenarian. But first, here is a little background.

If the article has a theme, it is this (as posed by the writer): When should we set aside a life lived for the future and instead, embrace the pleasures of the present? This is in fact a clarion call for us to live now (the quality of life, that is, its depth) and stop worrying about our mortality (the quantity of life, that is, its length). I think living a long life has become an obsession for us; especially the well-off. We want to age gracefully and 
live long but in doing so, “more than half of adults aged 65 or older are taking five or more prescription medications, over-the-counter medications or dietary supplements, many of them designed not to treat suffering but to reduce the chances of future suffering” (so writes Prof Awish).

This obsession to control our future by preventing illnesses may have extended our life somehow but it is done so at the expense of our enjoying the present. Now, I do not want to be irresponsible here and I
 know that we have to strive to live healthy and for our beloved dependents. In fact, the article made passing mention of this quote, “One fitness product tagline captures the zeitgeist: “Your health account is your wealth account! Long live living long!” But like all good things, living long ought to come with some moderation and balance. Here is what I mean.

I was having a conversation with my wife this morning about the tagline "Long live living long" and I asked her, “Is there a right time for one to start living more for quality rather than for quantity?” She echoed
 my sentiments when she replied that it is an infuriating trade-off between excessive worrying about the future and truly enjoying the present. She told me that some time ago she read about a senior cancer surgeon who admitted that if he had terminal cancer, he would retire into a beach house – somewhere private and scenic - and enjoy the remaining balance of his life there.

He confessed that he did not want to go through what his own patients had gone through, that is, all that chemotherapy, medication and invasive
treatments. I guess that surgeon didn’t want to live his life being monitored, scrutinized and studied like a lab-rat. Now the pertinent question would be this, “What if such early medical detection and timely intervention could save your life?” Well, if that’s the case, I would think that the trade-off is well worth the effort and time.

But what if living long requires one to turn himself into a human depository of medicine, pills and supplements, and be subjected to regular checkups and 
surgeries with little certainty of its effectiveness? Doesn't that just complicate matters a tad bit? How about the unpreventable cognitive diseases that comes with old age like Alzheimer, Parkinson and Stroke? If one were to receive such a diagnosis, what is the next course of action then? Aren’t we just holding off a certain almost unbearable form of eventual death and not preventing it from coming to pass? Somehow, that word “preventing” death doesn’t go down well with us because nothing is more certain than 
death, taxes and PAP winning a majority seat at the next election. And in holding off eventual death, is there a limit as to how far we should go about doing it? Should we turn our life on its head by extending it while being deprived of the pleasure of enjoying it?

The Catholic theologian Hans Kung (at 85 years old) recently discovered that he has Parkinson and is fast losing his sight. He wrote that he is considering committing suicide.I don’t want to continue to exist as a shadow of myself,” wrote the man. "I also don't want to be sent off to a nursing home…I’m not tired of life, but tired of living.” Here is a man
 who has lived his life to a ripe old age by today’s standard. He has caused more than a theological dent in the Catholic Church and its doctrines and is ready to go at a time of his own design and choosing. "No person is obligated to suffer the unbearable as something sent from God," he further wrote. "People can decide this for themselves and no priest, doctor or judge can stop them." I guess there is no greater empowerment in living than to have the final say over how and when one dies.  

But let's return to Cohen's birthday resolution to start smoking again. The Hallelujah singer said, "Quite seriously, does anyone know where you can buy a Turkish or Greek cigarette? I'm looking forward to that first smoke. I've been thinking about that for 30 years. It's one of the few consistent strings of thoughts I've been able to locate." Maybe, the tongue-in-cheek comment has a ring of truth in it. Maybe, Cohen is trying to tell us that we owe it to ourselves to live fully in the present and leave worrying about the future to, well, the future.

In fact, the article
 made this observation about prevention, "When it comes to prevention, there can be too much of a good thing. Groups such as the US Preventive Services Task Force regularly review the evidence that support prevention guidelines and find that after certain ages, the benefits of prevention are not worth the risks and hassles of testing, surgery and medications."

Mm...I think for Cohen - having lived to a good old age of 80 - some things are just unpreventable like cognitive decay. They will come regardless
 of all our overcautious preventive measures. Equally, I guess some things are not worth being deprived of and for Cohen it is a good smoke. And for most of us, I guess it would be something less frivolous than that.

So let me end with this thought. This morning my wife and I also talked about how long we wish to live for. However, we did not specify the number, that is, we avoided offering a figure. We told ourselves that we are prepared to leave this world after our responsibilities to our children are duly discharged, that is, to ensure that they have all grown up and are reasonably independent.
 Although we do not know what the future has in store for us, we consciously measure our living years with such meaningful engagement as raising our children and enjoying the journey along the way (among other mutually enriching diversions of course).

I guess when it comes to dying, the number of years wished for is not as important as how a life is lived. And a life that lives to the fullest is one that actively engages with the present and not one that anxiously strives to extend it at whatever the costs. Cheerz.

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