The Beginning of the End
The media critic Michael Wolff has written a long and disturbing piece on the physical and mental decline of his 86-year-old-mother. Like many people her age, Mrs. Wolff can no longer speak, walk, or care for herself. She lives alone in an assisted-living facility in Manhattan. For this, her long-term-care insurance and her family pay $17,000 a month. Her daughter visits daily, the author a few times a week. Mrs. Wolff also has another son who lives in Maui and apparently sees her rarely.
Under these circumstances, Wolff confesses frankly that he wishes his mother would die sooner rather than later. More precisely, he wishes for “a fair-minded body to whom I might plead for my mother’s end”. Death panels, of course, don’t exist. So Wolff and his family face an excruciating wait as Mrs. Wolff’s functions “depress” sufficiently for her to be moved into palliative care. That could take weeks, months, or years.
The piece has attracted criticism. Former TAC associate editor Michael Brendan Dougherty tweets that Wolffs thinks “his sick old mother should be helped to death for being sick and old.” I suppose that’s literally true. But it also entirely misses the point.
Wolff’s main argument is not that he wishes someone would take his mother off his hands. It’s that modern medicine has created an unprecedented condition in which otherwise healthy people can expect to experience long-term incapacity. There have always been people in comas, suffering from degenerative illness, or simply in the process of dying. What’s new is that situations like Mrs. Wolff’s have become so predictable, and that they last so long. Another big change is the physical dispersal of families. Although most of the Wolffs live close enough to see their mother regularly, none seems to have a house large enough to take her in. Finally, the costs are enormous. In addition to contributions from her family and insurance, Mrs. Wolff’s care has cost Medicare, and thus taxpayers, nearly $500,000.
One might argue, that these considerations are morally irrelevant: no matter how unpleasant or inconvenient it may become, we shouldn’t destroy innocent life. That’s the Roman Catholic perspective and, with certain adjustments, the orthodox Jewish one. It’s also shared by some secular ethicists, particularly those worried about slippery slopes from assisted suicide to medical murder.
On the other hand, the ideal of prolonging life as much as possible is not of Biblical origin. Rather, it’s rooted in the conquest of nature theorized by Bacon and Descartes. According to the Bible, death is a central part of the human condition–a fate that should not be hastened but also is not to be escaped. According to the founders of the modern project, it’s a problem to be solved by technology, which is supposed to be infinitely improvable.
The problem, then, is not that theologically-grounded deference to life and modern utilitarianism point in opposite directions. It’s that they’ve been synthesized in a medico-bureaucratic cult in which deference to life has been severed from the recognition that it must and should end at some point. Although he doesn’t put it in those terms, that cult is Wolff’s real target. It’s also the knot that we’ll all have to unravel as the number of very old Americans increases to nearly 20 million by 2050.