“When I'm 64”

Tom Koch

doi:10.1503/cmaj.081090

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Will They Still Feed Me....When I'm 64 ?
Dr. Herbert H. Nehrlich

Posted on: 17 September 2008
Missing the mark
Joel R. Wohlgemut

Posted on: 05 September 2008

Posted on: (17 September 2008)
Page navigation anchor for Will They Still Feed Me....When I'm 64 ?
Will They Still Feed Me....When I'm 64 ?
Dr. Herbert H. Nehrlich
A touchy subject.One that reeks of arrogance and very underdeveloped souls.
I well remember the year 1984. Richard Lamm, then governor of Colorado had just turned 48 when he, as part of his vision for his country under a hoped for Lamm presidency, announced that (I quote) "elderly people who are terminally ill have a duty to die and get out of the way.....they are like leaves falling off a tree and forming humus...
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A touchy subject.One that reeks of arrogance and very underdeveloped souls.
I well remember the year 1984. Richard Lamm, then governor of Colorado had just turned 48 when he, as part of his vision for his country under a hoped for Lamm presidency, announced that (I quote) "elderly people who are terminally ill have a duty to die and get out of the way.....they are like leaves falling off a tree and forming humus for the other plants to grow up."
Needless to say, Governor Lamm never had a chance, even in a country where caribou-shooting Hockey Moms do.
It has been my experience that there are many who die in their sixties, an age that Lamm has, according to my calculations, now reached. Let us hope he is healthy.
I also remember my father's first reaction after cataract surgery at age 90, "it's like someone has turned on the light."
Shame on those who are blind and deaf to compassion.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Posted on: (5 September 2008)
Page navigation anchor for Missing the mark
Missing the mark
Joel R. Wohlgemut
I came away from Tom Koch’s piece on the importance of geriatric medicine(1) impressed by the vehemence of his argument, but not sure that the sentiments he targets are anything more than a fringe view. I haven’t heard any colleagues arguing that we should withhold medical care from people over 65 years of age. Koch assumes that we attribute the financial burden of the last 6 months of life to seniors as a group, and res...
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I came away from Tom Koch’s piece on the importance of geriatric medicine(1) impressed by the vehemence of his argument, but not sure that the sentiments he targets are anything more than a fringe view. I haven’t heard any colleagues arguing that we should withhold medical care from people over 65 years of age. Koch assumes that we attribute the financial burden of the last 6 months of life to seniors as a group, and resent them. In my experience, this doesn’t happen. Daily, I treat elderly patients for hypertension and heart disease, diabetes and degenerative arthritis, recognizing that the benefits to individuals and to society outweigh the costs.
However, rather than being merely misguided, the position taken by Koch dangerously clouds the issue when it comes to treating seniors who are severely debilitated or terminally ill. In clinical practice, disability and prognosis are much more important factors than chronological age. Yet because medical co-morbidities tend to cluster at the end of the lifespan, I open myself to the accusation that I am “begrudging” health care because of age if I suggest less aggressive courses of treatment. Thus the flailing that sometimes occurs in the last weeks or months of a patient’s life: life-extending therapies of dubious value are ordered, either to satisfy demanding family members or to reassure myself that I did everything I could. This is where the real work needs to be done--learning how to help patients who have lived well to die well.
1. Koch, T. When I’m 64. CMAJ 2008; 179:388.
Conflict of Interest:
None declared
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Competing Interests: None declared.