Everybody wants to go to heaven,

But none of us want to go now.

A mean conservative Newt Gingrich argues: “we need a new federal resolve to truly defeat Alzheimer’s. As America’s largest generation ages, we have no time to lose.” On the empathic left Ezekial Emanuel (brother of the gentle soul, Emanual): “Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”

Now, as my friends complain, I’m not the most pro-life person around. I see abortion as a tragic choice, but one that is (rarely perhaps) the lesser of two evils. Then, there’s what my family has long called the “Edmondson syndrome” – it’s probably Alzheimer’s; without an ability to speak and think rationally, what I consider me is so far gone I’d like my body to accompany it. Still, my friends’ respect for life seems the better position than any that demean it. Choosing life seems to always be the logical default. Take Alzheimer’s – the greatest solution – a cure – is not the inevitable result of nationalized health care (we notice few cures from nationalized systems) but probably the inevitable one in a society that values life, sees the individual, and sees this tragedy in both personal terms as tragic and public ones as a great loss of productivity.

That strange category, “a culture of death,” best describes the values of many in our times. Certainly, Bill Ayers’ quite rational if quite evil belief that tens of millions would have to be sacrificed to bring his idea of a perfect society into being is a culture of death. And a certain percentage of post war art can only be described as an aesthetic of death. Then, in literary criticism we find, for instance, critics who believe a character better defines herself by suicide than loving. This may not be surprising when the most influential critic of the eighties and nineties found frequenting gay bathhouses after he knew he had AIDS an interesting adventure.

We aren’t gods – we probably won’t find ways to live forever. But some play with a nihilistic pride that defines control by negation. In any traditional and certainly any religious scheme, we would have thought that was prideful. And I suspect we were right. This is the dangerous pride our religions as well as our literature has so often warned us against – our arrogant desire to spoil what we can not have, to destroy beauty because we can neither feel it nor own it. We are reminded of Claggart’s great sorrow – that he can never be the person who has not felt the bite of jealousy, tht he can never be as content, as blissful, as Billy Budd. Ah, he says, I’ll make him feel that pang – I’ll destroy him, one way or another. And looking out at people who need convincing that nihilism is the final end, they start the convincing.

Others accept the big boundaries, but not the little one – recognizing their limitations, they celebrate the life they can create within this inevitable rise and fall. They roll up their sleeves and go to work: that is the work of the life force and that is the work of love. Pragmatism is enough of an answer for some. And it is part of the answer for others. Curing Alzheimer’s is not only the humane and indeed the human thing to do, it is also remarkably cost-effective. Enabling people who have had a lifetime’s experience to share that experience is productive as well as pleasant. Scholars (and there are many) who’ve been writing for half a century and are looking over proofs of a book coming out next year – they have much to teach us. So do auto mechanics who have seen cars change beneath their wrenches from Studebakers to Kias, of retailers who have seen skirt lines rise and lower and rise and lower through the decades, of great grandfathers who remember the ways of those who are their children but are another’s grandparent.

Fatalism isn’t helpful; humility before the inevitable and pride in our ability to create – these can go hand in hand. As Helen points out, historians don’t learn from history when they deny it. One would think we’d remember where the roads diverged in the sixties, and which was the path to nowhere and which the path to life: Paul Ehrlich’s Population Bomb, which began “the battle to feed all of humanity is over. . . . hundreds of millions of people are going to starve to death.” But, then, instead of the ‘Great Die-Off”, Borlaug (and people like him) combined sympathy and ingenuity to pull off the Green Revolution.

I am grateful to the kind of medicine that Obama repeatedly describes as a failure and the people – doctors, pharmacists, even insurers – as morally inferior to those who don’t make profits. I didn’t expect any of my kids to die young. And they didn’t. The graveyards took numbers of my grandparents’ siblings. My parents didn’t expect my three siblings and me to die – and we didn’t. But we played with a brother and sister down the street who died within 24 hours of each other when we were four or five. They had polio. My father was in a coma in an army hospital in Hawaii and, experimenting with penicillin, the army doctors revived him and the four of us were born after the war.

I know far more cancer survivors than I’ve gone to the funerals of those who have died from it. Every time someone goes to M.D. Anderson, down the road from us, they come back with stories of new treatments, new procedures, new medicines. And we are all heartened. America, despite the tragedy of the youth of those who suffered, did not have a disproportionate number of AIDS victims; we did invent a disproportionate number of AIDS medicines, which we gave with an open hand. I am sure the system needs some overhauling; I doubt that we need to spend as much on medicine as we do. But I suspect the medical Nobel Prize Winners are more worthy than Paul Krugman – and that group, heavily weighted to Americans, has benefited our economy – and the world’s. On the other hand, Rachel Carson, non-profit oriented altruist that she may have been, has done more to destroy happiness and productivity in Africa than can be easily repaired by the Borlaugs and Salks of the world.

7 thoughts on “Everybody wants to go to heaven,”

  1. I wouldn’t care that Ezekial Emmanuel is a lunatic if he were just the brother of someone in the administration, but isn’t he the “Health Czar” or something?

  2. Good point Brett – and I didn’t remember what and was too lazy with my googling. So, here it is, thanks to Chicago Sun Times:
    WASHINGTON–While the Obama White House is searching for a replacement for health czar Tom Daschle, policy work on health care reform–a priority for the administration–Is ongoing with one key advisor especially well connected.

    The brother of White House Chief of Staff Rahm Emanuel, Dr. Ezekiel J. Emanuel, a noted bioethicist, is advising the Obama administration on health care reform.

    Dr. Emanuel is the Chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health and a breast oncologist.

  3. “Culture of Death” is indeed what we have all around us and it is, unfortunately, not at all “strange” in the sense of “unusual.” Many people who claim to be morally quite superior to the great unwashed, see death as the default solution for people who present ethical or practical problems.

    Stalin’s aphorism, “No man, no problem,” applies as much to Dr. Emanuel writing about those who “are irreversibly prevented from being or becoming participating citizens” but constitute a possible drain on his resources, as to Stalin contemplating what to do with a politically inconvenient individual or group–and their thinking applied/applies both at the level of individuals and groups of millions.

    The judgment of what value the person in question can offer is subjective, and prettying it up with a fake benefit-cost analysis just speaks to what gets included in or left out of the formulation. Emanuel claims to worry about applying limited resources to their most “productive” use for society; Stalin worried about how best to advance the Revolution. I am not usually a post-modernist, but in this case I really think the definition of who can be “useful” (to Emanuel’s thinking) or a “threat” (as seen by Stalin) is constructed by the individual and his social environment, and from a more global perspective I see no moral difference between Emanuel vs. Suslov, and Obama vs. Stalin, as our current leadership pursues their ends. In both cases, it boils down to denying the importance of the individual in pursuit of a particular idea of “the greatest good for the greatest number.”

    One could argue that Obama and Emanuel do not see that the logical consequence of their position wil be to deny care to, ultimately, millions, and therefore they should not be put in the same class as Stalin. Maybe, but the result is so profoundly predictable and they are reasonably intelligent people, so I must respond that if they do not see, it is because they choose not to, and there is no moral due to WILLFULL ignorance. Anyway, when Charlie Gibson asked Obama if he would limit his family to the care provided by the public option, he said no, he would want the best for his family. Points for honesty, but that answer confirms, he knows what he is trying to do to the rest of us.

    Part of his (Obama’s) problem, and of his whole administration, is they have static view of the world, and no understanding of how a complex system can order and reorder itself, of Schumpeter’s “creative destruction,” really of any idea of progress or life being anything but a zero-sum game. They would freeze the world in place if they could. (Had they lived in 1750, or 1500 BCE, they would have tried to freeze it, then.) You see this in their ideas not only about health care, but global warming and all other environmental issues, the economy, and on and on. Really, a very uneducated (notwithstanding paper credentials), incurious, unreflective bunch, though crafty and amoral in pursuit of their goals, which they do not question.

  4. “I see abortion as a tragic choice”

    I’m curious about the choice, Ginny. It is a choice between (A) deliberately killing a baby and (B)?????? Inconveniencing a mother? Creating a financial hardship for the mother? Creating a burden of responsibility on a mother she is unwilling or unable to bear? Saving the life of the mother?

    Don’t all of those “choices” pretty much apply to the Alzheimers/dimentia sufferer?

    I struggle to see the moral difference between you and Ezekial Emanuel, and therefor question your moral authority to criticize him. Couldn’t he argue – as you do – that letting the dimentia vicitm go to free up health care dollars for a young person is “the lesser of two evils”, to use your words? Let the dimentia victim go and ease the burden on the caretaker and free up health care resources to save the life of a younger person. It seems to me that your only disagreement with Ezekial Emanuel is over the end of the cycle of life at which human life is expendable.

  5. The major difference between Ezekial Emanual and me is not my morality – which you have every right to question and which isn’t as consistent as it probably should be and which has not had to face actual events where I had to make those actual choices. I believe they are complicated and am not sure which ones I would choose. I respect the ones that Sarah Palin made, but I’m not sure, for instance, that that is the one I would have made.

    But I have sufficient misgivings about my morality to believe that it should not determine other’s decisions – and a one-payer plan would make such decision-making a government policy rather than an individual moral response. It seems to me the government is much better off (even economically, let alone in ways that would make its members happy, let alone in morality) if it concentrated on encouraging cures rather than encouraging death. That was my point. And apparently I wasn’t communicating very clearly if you think I was saying babies were expendable and elderly sufferers of dementia were not. We have long – and I hope we continue to – tried to find ways to make premature infants lead full lives. Such research seems an appropriate function of medicine – and appropriately encouraged by government.

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