The Corner

Health Care

Biden’s Coronavirus Adviser Wants to Die at 75

Dr. Ezekiel Emanuel, professor of Health Care Management at the Wharton School of the University of Pennsylvania, in Washington, D.C., April 1, 2014 (Jim Bourg/Reuters)

Joe Biden has announced the creation of a “Public Health Advisory Committee,” consisting of Democratic experts to advise him about how to best grapple with the coronavirus during the campaign. Okay. Good public-health practices are worthy goals for any candidate.

But I don’t think receiving such information requires the naming of a big-name board and a major press announcement. Rather, it seems to me that the committee’s true purpose is to be a “shadow” task force that will second guess the Trump administration’s actions to the media and strive to make Biden appear presidential in the face of the threat. If so, this is politics at its most cynical and could inhibit effective public response to the ongoing panic by creating a competing center of information and communication. The unnecessary speech Biden made about not shaking hands or hugging anymore — and the press response thereto — backs up my suspicion.

The bioethicist Ezekiel Emanuel — a prime architect of Obamacare — is the most famous person on the committee. Why is that important? Emanuel made headlines a few years ago by writing in The Atlantic that he wants to die at age 75 — younger than Joe Biden is today — and he thinks we should want that too. From his piece:

Here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

That’s a terrible attitude about the elderly, a denigrating “quality of life” judgmentalism that deems the value of the old as having less importance than that of younger people.

And here’s the irony. Who are most at risk of death or serious illness from the coronavirus? The very elderly Emanuel sees as having lives that are “feeble, ineffectual, even pathetic.”

Emanuel’s advice, written in the hope that the rest of us will also “think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging,” is particularly relevant to this particular moment in time in which the elderly are mortally threatened by a viral epidemic:

What about simple stuff? Flu shots are out. Certainly if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs.

A big challenge is antibiotics for pneumonia or skin and urinary infections. Antibiotics are cheap and largely effective in curing infections. It is really hard for us to say no. Indeed, even people who are sure they don’t want life-extending treatments find it hard to refuse antibiotics. But, as Osler reminds us, unlike the decays associated with chronic conditions, death from these infections is quick and relatively painless. So, no to antibiotics.

That isn’t all:

Obviously, a do-not-resuscitate order and a complete advance directive indicating no ventilators, dialysis, surgery, antibiotics, or any other medication—nothing except palliative care even if I am conscious but not mentally competent—have been written and recorded. In short, no life-sustaining interventions. I will die when whatever comes first takes me.

Is that the kind of advice Emanuel is giving to Joe Biden?

Finally, illustrating why Emanuel is an odd choice for being on Biden’s advisory committee, here’s what he wrote about the cognitive abilities of people his candidate’s age:

Even if we aren’t demented, our mental functioning deteriorates as we grow older. Age-associated declines in mental-processing speed, working and long-term memory, and problem-solving are well established. Conversely, distractibility increases. We cannot focus and stay with a project as well as we could when we were young. As we move slower with age, we also think slower.

That seems painfully apt, given Biden’s recent performance.

Emanuel better hope that Biden doesn’t read his Atlantic piece. I suspect if Good Old Joe ever did, he would yell that Emanuel was full of smelly stuff and demand that his public-health adviser step outside.

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