THR Blog   /   January 26, 2021

Love and Death

“Quality of life” calculations leave out far too much that matters.

Alan Jacobs

Much has been made of physician and ethicist Ezekiel Emanuel’s views—originally published in 2014 and reaffirmed since then—that life after the age of 75 or so is scarcely worth living, and a society that expends resources on prolonging such life is making a poor investment.

A less extreme version of the same calculation has recently been made by a British pathologist named John Lee:

But are these life-endings [of a young person and an old person] equivalent? Perhaps, on a philosophical level, they are. On a practical level, however, the death of an 85-year-old person from a preventable cause has cost them a few years at the end of life, while a 25-year-old has, on the same calculation, lost over 60 years of life, including their most active and event-filled years. However much people may object philosophically to such discussions, avoiding them in practice can have serious unintended consequences for public policies.

It is uncomfortable to think about, but it seems quite clear to me that when you examine the “quality of life years” lost as a direct result of lockdowns, and compare them to those which would have been lost to the virus had we done nothing at all (which, for clarity, I am not advocating), the former is far greater. This is because you don’t have to die to lose quality of life. Being unable to function properly because of depression, for example, or untreated cancer, or a postponed operation, still results in loss of quality of life – as does merely being confined to your house. Surely no reasonable person can disagree that this loss must be considered when evaluating the appropriateness of society-wide measures that affect all individuals?

I do not mean to suggest that Lee is wrong to believe that we must make calculations. The problem with the calculations of Emanuel and Lee is that they leave out far too much that matters for human flourishing. There are two especially important ways in which this is the case.

First of all, they evaluate the quality of life almost wholly in terms of activity, especially professional activity. Valuable years for Lee are “active and event-filled” years. Emanuel asserts, “There are not that many people who continue to be active and engaged and actually creative past 75. It’s a very small number.” It is hard to know whether this is true because he doesn’t define “active” or “engaged” or “creative,” but elsewhere in the same interview he is extremely dismissive of anything, including especially “play,” that is not “meaningful work.” He is quite explicit in his scorn for anyone, even well past retirement age, who lives for play rather than work: “But if it’s the main thing in your life? Ummm, that’s not probably a meaningful life.”

What both Emanuel and Lee manifest is what Alexa Hazel, in a brilliant recent essay, following Nikil Saval, calls “self-Taylorizing” (in backhanded acknowledgment of scientific management guru Frederick Taylor):

In 2020, “self-Taylorizing” is not about optimizing paid work, but about optimizing everything, including one’s method for optimization. The influential political theorist Wendy Brown calls this contemporary subject Homo oeconomicus. All human activity, regardless of whether it bears the potential for financial profit, is modeled on the market. We understand ourselves as human capital. We self-enhance to “attract investors” and “strengthen competitive positioning.” Before COVID–19, Homo oeconomicus spent his long weekend in Peru for a course on leadership development and posted pictures from Machu Picchu to Instagram. Or, he criticized the course, skipped it, accumulated social capital as a renegade, and still posted pics from Machu Picchu. All returns on self-investment ought to be optimized. And because optimization cannot be established without data, all human conduct must also be quantified. A body that measures calories, steps, heartrate, Pomodoros, sexual potency, sleep, swipes, likes, content output, and optionality is a perfectible body. What’s quantifiable is certifiable and comparable. Humanity’s coarse incommensurability is smoothed into a universal language of winners and losers.

Going to Machu Picchu after your retirement—and not even Instagramming your visit? Nothing to quantify, nothing to display? You’re definitely one of the losers.

This is pernicious enough, but it is made even more so by the single greatest absence from Emanuel’s and Lee’s respective calculations: other human beings, especially the ones you love. Lee invokes “the appropriateness of society-wide measures that affect all individuals,” but seems not to reflect that many “individuals” live in families and the well-being of those individuals cannot reliably be calculated in isolation from the well-being of their loved ones. Whether “merely being confined to your house” actually “results in loss of quality of life” will depend to a significant degree on whether you’re there alone or with people who know you and care for you.

Some older people live with their adult children and their grandchildren, or in close proximity to them. For some of these families, I have been told, Covidtide has been a time of increased intimacy—and in that sense is a reminder of the price we can pay for fragmenting families, having them live apart from one another, whenever it’s economically feasible. Of course, in a time of plague care must be taken; and especially early in the pandemic, before its means of dissemination were well-understood, people who lived with older family members endangered them. But for many of those who have taken proper precautions, this season has offered opportunities for renewed connection and a deepening of affection.

Through most of my childhood my father was in prison, and my mother worked long hours to keep our family afloat. That meant that I spent many days in the company of Grandma, my father’s mother. Her health was not good; she was not productive, except in her regular but desultory cross-stitching. When I was very young she was an excellent cook in the old Southern style, but gradually she lost the energy for that. She was not “active”; she was largely “confined to her house”; she did little of what Ezekiel Emanuel would call “meaningful work.” But she gave me everyday counsel and comfort. She was my sheet-anchor in a stormy world. My life would have been greatly impoverished without her.

And, for that matter, hers would have been impoverished without me. For I was to her a kind of late-in-life compensation for a great loss, her second son, Bobby, who had died of polio at age six. (He was Robert Alan; my father, his elder brother, named me Alan Robert.) We were for many years the closest of companions, and one of the most important days of my life came when I was able to introduce her, when she was bed-ridden and suffering from dementia, to my own new son. For a moment her mental fog lifted and she smiled a great smile: She knew this child, and kissed and held him.

This is all I’m saying: There are more things in heaven and earth, Dr. Emanuel, than are dreamt of in your philosophy. It would be good if some of our public-health experts would find a way to incorporate those ineffable but vital things into their calculations.