Emanuel Easily Avoids AMA Rebuke Over 'Die-at-75' Stance

November 12, 2014

UPDATED November 12, 2014 // Ezekiel "Zeke" Emanuel, MD, a former White House advisor on healthcare reform, easily avoided a rebuke from the American Medical Association's (AMA's) House of Delegates November 10 over a recent Atlantic Monthly article titled "Why I Hope to Die at 75."

The House of Delegates rejected a resolution that would have put the AMA on record as disagreeing with the views Dr Emanuel expressed in the article and stripped him of an AMA Foundation award.

In his article, Dr Emanuel contended that although death is a loss, "living too long is also a loss," particularly as personal productivity wanes. The 75-year mark "forces each of us to ask whether our consumption is worth our contribution," said Dr Emanuel, who chairs the Department of Medical Ethics and Health Policy at the University of Pennsylvania in Philadelphia. He said that once he reached the age of 75 years, he would not try to actively end his life, but neither would he try to prolong it. Accordingly, he would refuse antibiotics, heart-valve replacement, and cancer treatment, should the need arise. Flu shots, too.

Although attempting to persuade readers to embrace his views, Dr Emanuel said he was not criticizing those who wish to live as long as possible, nor was he advocating physician-assisted suicide or euthanasia. Nevertheless, his article drew fire in many quarters, including the medical profession, as devaluing the lives of the elderly and confirming fears of a "death panel" agenda in the Affordable Care Act, which Dr Emanuel helped design.

One physician rubbed the wrong way by Dr Emanuel's positions was AMA delegate Gregory Pinto, MD, an ophthalmologist in Saratoga Springs, New York, who proposed the defeated resolution. According to the resolution, the Atlantic Monthly piece opined "that life is less valuable with advancing age," even though physicians are trained "to value human life in all its forms, regardless of age or physical or mental infirmity."

In addition to proposing that the AMA publicly repudiate Dr Emanuel's views, Dr Pinto also said that the AMA Foundation should rescind a leadership honor bestowed on him last year. Dr Emanuel received the Isaac Hays, MD, and James Bell, MD, Award for Leadership in Medical Ethics and Professionalism, named after the coauthors of the original AMA Code of Medical Ethics.

A committee on amendments to the AMA constitution and bylaws recommended rejecting Dr Pinto's resolution. The committee's report to the House of Delegates said that stripping Dr Emanuel of the leadership award "would cause undue controversy" because the award did not relate to his magazine article. Furthermore, many physicians who testified before the committee noted that Dr Emanuel was speaking about himself, and not about all patients, according to the committee report.

Ezekiel Emanuel, MD

An observer at Monday's House of Delegates meeting told Medscape Medical News that the committee recommendation passed in a voice vote, with no opposing votes heard.

Efforts to reach Dr Pinto for a comment were unsuccessful.

Dr Emanuel is the brother of Rahm Emanuel, the mayor of Chicago and the first White House Chief of Staff in the Obama administration.

Dr Emanuel Answers His Critics

In an interview with Medscape Medical News, Dr Emanuel said that Dr Pinto and other critics have misrepresented his Atlantic Monthly article.

Dr Emanuel asserted that he never said that "life is less valuable with advancing age," contrary to what Dr Pinto's resolution stated.

"I just want people to think through their lives," he said. "Is it the quantity of their life that is most important, or the quality? Everybody I talk to says quality of life.

"Ninety-five percent of the doctors and nurses who've written me [about the article] agree with my view. They have a lot of experience doing lots of things for adults who think their life is not meaningful."

He also said that he was not advocating, as some have suggested based on his consumption–contribution remark, that Americans should receive less healthcare as their productivity decreases in old age. He stressed that he was speaking for himself.

"That is just a total misreading of the article," he said. "It's about my consumption and my contribution. It's not about social policy."

His article, he noted, described a variety of contributions that older people can make to society. Mentoring younger adults was one, he said. "A lot of people say that spending time with grandchildren is valuable."

Again, the article was about his personal preferences.

"I lay it out for myself," he said. "I cannot imagine being content bird watching. That's not my life."

Dr Emanuel said he appreciated the AMA House of Delegates rejecting Dr Pinto's resolution. At the same time, he evinced the equanimity of a public figure who has developed a thick skin.

"A lot worse has been said about me," he told Medscape Medical News. "I learned in the White House not to take too much of this seriously."

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