Shouldn't We Just Stop Fighting Death?

Clifton K. Meador, MD

Disclosures

September 23, 2013

Life Expectancy vs Human Life Span

As part of the current discussions about defining death, it is important to back off a bit and look at the larger scene. There is great confusion regarding the differences between the definition of life expectancy and the definition of the human life span.

Clifton K. Meador, MD

Life expectancy from birth is a kind of calculated average age at death of a cohort of people born in a certain year. In 1900, the US life expectancy from birth was around 48 years. In 2000, it was nearly 79 years. This doesn't mean that in 1900 most people died in their 40s, never achieving old age. Many reached old age; just not as many as now.

It's important to understand the calculation of life expectancy from birth. As an extreme hypothetical example, assume only 2 people were born in a year; one died at age 1 year and the other died at age 80 years. The average age of death would be 40 years, so the life expectancy for that year would be 40 years.

More people are living to older ages because they did not die in infancy or childhood. I hear people say that, in the old days, one was old at 45 years. Wrong again. People lived to old age -- just not as many as now. They failed to reach old age because they died in childhood.

Nortin Hadler, MD, Professor of Medicine and Microbiology/Immunology at the University of North Carolina at Chapel Hill, has written extensively on aging, lifespan, and life expectancy. He makes the case that little of the sharp declines in childhood and adult mortality since 1900 came from medical care. Likewise, little of the increase in life expectancy since birth can be attributed to medical care.[1]

Our national attitudes about death are affected by these confusions about the differences in a fixed life span and life expectancy. Some of us seem unable to accept death as natural and oppose any effort to deal with end-of-life issues. In recent elections, pejorative terms such as "death squads" appeared whenever anyone tried to deal with rational medical care at the end of life.

If one believes that life goes on nearly forever and that medical care is always essential, then those people will demand a strict and absolute definition of death. For those people, rigor mortis might be demanded as a sign of death and cardiopulmonary resuscitation (CPR) should go on forever. No ventilator will ever be turned off no matter how brain-dead the patient.

Recall the national debacle on a Sunday in 2005, when the entire US Congress met to consider terminating life support for Terri Schiavo, a single patient in a chronic vegetative state. Someone was asked whether medical care should continue forever. What if the patient under discussion developed gangrene in one or both legs? Should amputation be done? The answer was a strong and immediate "yes." Hang on to life no matter what!

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