How to Die With Dignity

"Want to live longer? Live in Israel's center," Yedioth blared in its leading headline on Wednesday, going on to explain that people living in central Israel live an average of three years longer than people in the periphery.

Yedioth's report was essentially about another aspect of the gap between rich and poor: the rich even manage to live longer, which is what everybody wants most. Right?

Most people would immediately say Yes. But there is at least one reason to think twice.

Without meaning to, the Finance Ministry underscored the reason in its proposed economic policies for 2007. Among other things it proposes to close down two chest and heart surgery units at government hospitals. The treasury concluded that Israel doesn't need as many chest and heart surgery units as it has, because occupancy in these wards has dropped steeply in recent years. The number of cardiac patients has fallen by tens of percent. Cardiologists, it turns out, have been cutting off the branch on which they sit. Their medical achievements simply reduced their number of patients.

Cardiologists evidently have the leisure to dwell on philosophical questions about the price of professional success. But their patients need a philosophical moment too, which is that not only the doctors are being hurt by their own success: so are the patients. The doctors' success deprived them of the opportunity to die suddenly and mercifully from heart failure. An easy death is becoming harder and harder to achieve.

The place of heart attacks is being gradually superceded by a protracted journey into death: cancers that drag their sufferers into a death of torment, slow decline into deterioration once called "senility" and today coyly hidden in euphemisms such as "mental exhaustion".

This is the heavy price of extending the human life span, but nobody wants to talk about it: the physical and mental, and economic, price of undignified advanced age. One of every five aged persons needs geriatric care, and the number is growing fast.

According to the National Insurance Institute, in 1995 Israel had 95,000 old people that it helped. By 2004 the figure had reached 114,000. The Brockdale Institute, which studies aging, concluded that the number of aged receiving geriatric aid would grow by at least 10% by 2010. How many old people Israel will have needing help in 20 or 30 years is anybody's guess.

Geriatric care costs thousands of shekels a month. It could be a few thousand for a person who still basically functions, or NIS 10,000 to NIS 15,000 for incarceration in an old-age home. Once people stayed in such places about two years, but the duration is growing with life-span. It is no longer rare for old people to hang on four years and more in helpless condition, at the expense of the dignity of all involved, and depresses their pension account too.

Death is not as merciful as it once was. It casts a heavy shadow over the 'golden years'. The upward spiral in lifespan means much more than more years after retiring from work, which have to be financed with our savings during our working years. A person who just wants to spent his dotage in a nursing home will find that a 30 square meter unit costs $200,000 to $300,000, and if he requires physical care, the bill can jump to half a million dollars.

The golden years cost gold, it turns out, and the mental capacity to withstand the torments that the years may bring. Want to live longer? You have to be rich, and the younger generations of today seem to have no idea how rich you have to be.