Public health professionals are trained to understand the difference between length of life, and quality of life: major decisions are based on the financial implications of both. Physicians and health care are placing more and more emphasis on this distinction, too, as evidenced by the growing hospice and palliative care programs in traditional medical care centersPersonally, I've grown aware of some of the complexity of quality of life issues through some work I have done with Kaiser Permanente, but mostly through the aging process of my parents. 

Ezekiel Emanuel, the University of Pennsylvania's Department Chair of Medical Ethics and Health Policy, and one of the designers of the Affordable Care Act  (not to mention brother of Rahm and Ari Emanuel, Chicago Mayor and former White Chief of Staff and Hollywood producer, respectively) published an article in the Atlantic, called "Why I Hope to Die at 75." This incredibly personal, data-rich, and wildly controversial essay discusses some of the issues commonly brought up in end of life care–rising costs in the face of  increasing disabilities and limitations. The article uncovers some newer, more emotional ground, too, such as the role that an older generation plays vis a vis their adult children, or what Emanual refers to as mentorship versus constriction.

Controversial, interesting, and thoughtful, the piece has achieved much acclaim from some and positively enraged others. Perhaps summing up the conflicting views, one author called it "a stunning combination of wisdom and insight (and) moral idiocy, impling that the logical extension of Emanuel's argument (never stated) is eugenics.

The growing elderly population is a new topic: this is the first time American's have had these issues to think about, and it is a subject that will only grow in relevance and importance. While I regard Emanuel's view as one way of building sustainability, happiness, and health into the aging process, the methods being studied here on the same issues are much more interesting and compassionate to me. More on Redesigning Long Life in my next post, and meanwhile, send your thoughts in here. I'd love to know what you think.