The unintended consequence of promoting longevity

Charles Cowling



Michael Wolff describes caring for his eldery, dementing mother in New York magazine. It’s a long piece and it will concentrate your mind. You’ll brood on it.  Warning: once you start, you won’t be able to put it down. 

…what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering—who can so conscientiously facilitate it? 

“Why do we want to cure cancer? Why do we want everybody to stop smoking? For this?” wailed a friend of mine with two long-ailing and yet tenacious in-laws. 

Age is one of the great modern adventures, a technological marvel—we’re given several more youthful-ish decades if we take care of ourselves. Almost nobody, at least openly, sees this for its ultimate, dismaying, unintended consequence: By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources. 

This is not anomalous; this is the norm. 

The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese, and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment—though far, far, far from healthy.

Read it all here

14 thoughts on “The unintended consequence of promoting longevity

  1. Charles Cowling

    We have lost the understanding? the compassion? the intelligence? the mercy? to allow people to die. We are very good at keeping people alive – which I think is different from ‘saving’ life. I attended an end of life conference and heard that the NHS spends more money on keeping you alive in the last 2 years of your existence than all the rest of your healthcare budget put together.

    I hear several times a month families who tell me that an aged Mum or Dad had ‘stopped eating’. My father chose this method to hasten his own end. I’m not sure I would have been able to administer a fatal dose of morphine…. but if he’d been in a position to ask me… who knows?

    In the event of loss of mental faculties, Mrs Jed and I have a pact that we will help each other, taking the decision if necessary ….and the consequences. The thinking being that the survivor would probably get better treatment in a prison than in a nursing home.

    But the scenario we haven’t figured out is if one of us dies in the cabbage patch with our boots on, and the survivor loses the plot – then the burden falls on one of our children to make decisions. Perhaps that’s a conversation we need to have. DNR tattoos?

    Charles Cowling
  2. Charles Cowling
    Chris the trainee

    Charles thank you. I agree completely.
    As to polls, I would happily fill out a poll. Usually. But not this one. Because it ain’t that easy. Would I kill my mother ? After 30 years as a police officer the answer is a no. But would I let her slip away quietly without a fuss ? without question yes.
    But that requires a degree of cooperation between the state and the individual that is quite unimaginable at this time. I’d like to think my children or my wife could have that sort of choice about my life, but it just isn’t that close.

    Kitty, my heart goes out to you. It must have been so difficult measuring out that exact amount every day. Thank goodness I never had those kinds of dilemmas.

    And on a different note, can I say how happy I am to have found this blog. Even were I not set on the path that I am, I would still enjoy contributing and reading the thought provoking posts on here. Thank you.

    Charles Cowling
  3. Charles Cowling

    Chris, it was brave of you to write that — and salutary. Thank you. Your experience is unimaginable, yet all too common. I think it’s perfectly understandable that you should have felt helpless, and I think that’s how society still feels. There are huge decisions to be made at the ethical level, and the problem is only going to get worse. The history of medicine is one of triumph over death. Perhaps one way to start is to substitute ‘live saving’ with ‘death postponing’, and for medicine to adapt to the problem it has created along with the blessings it has brought.

    Charles Cowling
  4. Charles Cowling

    My mum died six weeks after being diagnosed with cancer. She was a young 65 and up until her diagnosis she had been working full-time. When I was looking after her and even though I didn’t want to prolong her suffering, I wasn’t brave enough to give her an over-dose morphine. Looking back I can’t believe how anxious I was to measure out the exact dose. Mercifully she died two days after going into a hospice.

    Charles Cowling
  5. Charles Cowling
    Kathryn Edwards

    This article is a gift. Time and again, the report comes back from the front line that medics emphasise the wrong bit of the dilemma: the smart thing to consider is how one (or one’s elderly kin) will be placed AFTER the life-saving surgical intervention.

    In our rush to avoid trouble we confuse quantity of life with the quality of it. What happened to quitting while ahead or dying with one’s boots on? If we weren’t so insulated from the realities of dying and death, we might be more inclined to prepare and take responsibility for our own outcomes.

    Charles Cowling
  6. Charles Cowling
    Poppy Mardall

    I LOVE the polls! Poll us Charles. POLL US!!!

    Charles Cowling
    1. Charles Cowling

      Poppy, I could post a poll to find out whether people want polls – and no one would fill it in. The problem with this blog is that its readers are stealth readers, overwhelmingly. It can be very dispiriting.

      Charles Cowling
      1. Charles Cowling

        Is not a poll of 2 ( say Poppy and me) as valid (maybe more valid) as a poll of 200?

        Charles Cowling
        1. Charles Cowling
          Charles Cowling

          Well, yes, Jed, it is. It’s too late to add a poll to this post, but I shall use them oftener to enable the two of you to exercise your democratic rights.

          You must promise to vote, though!!

          Charles Cowling
  7. Charles Cowling
    Chris the trainee

    I debated long and hard before blogging this piece. Like the author, I had the dilemma: do you make it public ? And who am I doing it for ? But there are so many people out there in the same situation, that the word needs to be spread and people need to know that theirs is not an isolated case.
    It’s an interesting article, and on the face of it, quite cold hearted. That is unless you have lived with a relative with dementia or similar diseases.
    This piece brought back so many memories. It’s not just the states, it’s the UK and probably most of Europe as well (though I have no evidence of that). The piece he has written, mirrors my mother’s decline and the fight we had with doctor’s and the careful shared language that each party used.
    My mother had vascular dementia which left her with no short term and no long term memory. Add to this the progressive effect of the condition and quite a long way before the end, she was not aware of who she was, let alone the rest of the family. It started with a series of falls and ended (thank goodness !) in a very caring nursing home.
    She spent the last ten years before her death in a care home. They were lovely people. They dressed, bathed, fed and gave meds to my mother that kept her alive. Whether she was aware of this is a very moot point and you certainly would not have said that she did had you spent any time with her.
    It’s a strange existence when you get lost walking 20 feet away from your usual chair (and that was 7 years ago) and in the end she went into hospital with the inevitable UTI and went downhill from there.
    In hospital they were lovely. She was in there for over a month. She barely ate and they gave her nourishment intravenously. Why ? In the end they gave it up, discussing with us in hushed, diplomatic terms their reasons for doing so, preaching to the converted who wanted to see her go quietly.
    I can associate with the gallows humour. We got to know most of the residents in my mum’s home and used to rib mum when she was well enough to understand. You quickly develop the humour or you sink without trace.
    “The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going.”
    How true this is. 50 years ago, my mother would have been looked after at home and drifted away peacefully long before the protracted end that befell her. (Not that we could have coped with her dementia at home) Now, with the miracle of modern pharmaceuticals, her life was prolonged extraordinarily longer than it needed to be.
    “Down this rabbit hole, we all become ineffective and pitiful.”
    My mum was a bit of a cantankerous old woman, but she was proud enough not to have wanted what happened to her in any way shape or form. And me ? I was only allowed by the state to go with the flow of keeping her in a state of suspended animation. I ask myself the question from time to time: shame on me, or shame on society ?

    Charles Cowling
  8. Charles Cowling
    Manasa Majumdar

    My aunt gave me the link to this website, and she was totally right
    in every way, Keep up the great work!

    Charles Cowling
    1. Charles Cowling
      Charles Cowling

      Very nice of you to leave a comment, Manasa. Makes it all worthwhile!

      Charles Cowling
  9. Charles Cowling
    Charles Cowling

    No one ever responds to a poll, Jonathan. I don’t know why not. GFG readers just aren’t into plebiscites, darn them.

    There’s always self-deliverance. Okay, killing oneself.

    Charles Cowling
  10. Charles Cowling

    “The unintended consequence of promoting longevity.” What an utter, utter understatement.

    Thank you, Michael Wolff, for dissecting yourself and pinning your ripped open, screaming soul to the inspection table for all the world to see. You made me howl with your matter-of-fact description of this death by slow torture of your mother, compounded by the obligatory complicity of her family in this crime. It is indeed a holocaust. We live in a world where we are so scared of surrendering to death that a nightmarish living death takes precedence, with the law not so much protecting the living as threatening their carers.

    And what will happen when the vast majority of us are too demented to function? How on earth do we think the others will cope with us? “Nuts?”? If only we were as sane as lunatics.

    Charles, how about one of those blogpolls like you had for the word ‘casket’: “would you help your mother die?”
    No, come to think of it, that too is a euphemism – “would you be prepared to kill your mother?”

    I believe I would.

    Charles Cowling

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