Monday, 19 August 2013
Elders' Tough Decisions
Some of you may recall late last year when I told you about Travels with Epicurus, a lovely little book about living a fulfilled old age written by philosopher Daniel Klein.
In his introduction Klein explains why, at age 72, he rejected his dentist's recommendation of dental implants in favor of dentures.
The implants, he knew, would be far superior but they would also involve more than half a dozen visits to an oral surgeon an hour's drive from Klein's home over the course of a year or more with a great deal of pain for several days after each visit. Not to mention an expense in the thousands of dollars.
So Klein asked himself:
”In my early seventies did I really care if I presented to the world an old man's goofy smile?
“And even more to the point, with my years of clear thinking and reasonable mobility dwindling as quickly as my jawbone, did I honestly want to dedicate an entire year to regular visits to an oral surgeon?
“I did not.”
Klein makes it sound like a quick-and-easy decision; he's even kind of funny about it but I doubt he got there without a personal struggle weighing the pros and cons.
While chatting with an old friend this past weekend, I was reminded of Klein's teeth.
Like many men in their mid-70s my friend, over the years, has had medical problems with his prostate and he knows that prostate cancer is the second most common cancer in men.
Surgery is the usual recommendation but there is a variety of serious risks and there is also reliable evidence that when prostate cancer has not spread beyond the organ, men on average live just as long without the surgery as with it.
Knowing all this, my friend is left finding a balance, should it become necessary, between what can be formidable negative side effects of prostate surgery against his expected longevity - of living out his normal life before the cancer has any affect on his well being. Tough choice without many signposts to guide him.
And it's not the kind of decision anyone wants to be wrong about either, given that it's a strange old person who doesn't want to reach the end of life having suffered as few health and medical difficulties as possible.
So if the choice becomes necessary, it is probably going to be a crap shoot.
On decisions of this magnitude, we elders don't arrive at old age with much useful experience. What prepares most of us for making advance directive choices and do-not-resuscitate orders?
Since we can't predict the circumstances or condition we'll be in when those documents come into play, how to decide? And can we be certain the proxy we've named to make those decisions if we are incapacitated will do the wise thing?
No, we cannot, and none of the other late-life decisions that come up are much easier.
No one gets to be old these days without knowing the late actor Bette Davis's dictum: Old age ain't for sissies.
She said that, by the way, following a period of 13 months during which she endured a double mastectomy, four strokes in quick succession and a broken collar bone. So more than many elders, she knew whereof she spoke.
Life isn't fair. Like Ms. Davis, some people are plagued with too many of the diseases and debilities of old age while others are granted passage through the late years with only minor inconveniences. But no thinking person can avoid the tough questions old age imposes on us.
In my two decades of reading, research, talking with experts and ordinary people, no one has mentioned these hard decisions elders must make, decisions for which we have little preparation and for which there are few blueprints.
We are mostly on our own and from what I've seen, we do remarkably well. Even so, I think we should talk more about it among ourselves because god knows younger people don't want to hear these things.
At The Elder Storytelling Place today, Vicki E. Jones: The Hummingbird