I had an opportunity to read some of the comments on my last posting which explored Michael Wolff's personal experience with aging and deterioration and death. 

Although I applaud his efforts to bring light to a subject long shrouded in darkness and despair, I do not necessarily embrace all of his positions.  When referring to Long Term Care insurance, I personally believe it is a reasonable "investment".  No one ever wants to pay for insurance.  It always seems like a waste of money.  But when the time comes to provide for what it is intended to do, those who don't have it will likely regret it. 

I also need to emphasize a personal perspective.

Age alone should not be a determinant of medical care.  I have personally referred an 87 year old woman for colon surgery diagnosing cancer.  She was phenomenally alert and otherwise healthy.  She had no evidence of metastases and tolerated laparoscopic colon resection remarkably well.  My impression was that she had an excellent quality of life, was mentally alert and could easily live another 10 to 15 years or more.  

 My own aunt is nearly 102 but of such mental acuity and awareness that to not address her medical concerns would be unconscionable.

On the other hand, if I had  a 40 or 50 year old patient with dementia, multiple medical problems, bedridden and with a horrendous prognosis, I would not even recommend a diagnostic colonoscopy. Provide comfort, support and defer dangerous and costly testing which will not alter this particular patients quality of life.

 I only hope the time does not arrive when decisions about health care and other therapeutic modalities will be based on age.  Each person is unique.  Each medical decision needs to be addressed as such.  

 I do believe, however, that we need to face the reality that all existence is temporary.  We are born, we live, we die.  How we  experience each one of these stages remains personal and profound. 

Death is not always the brutal enemy that needs to be defeated at all costs.  For those who suffer, who no longer can function without extreme difficulty, to those whose life offers no quality–then death of the physical body can come as a blessing. 

 To those of us who believe that we are spiritual beings who are having a physical experience, death is re-birth into another existence.  Although it is not something we hasten, it is a truth we must accept with serenity and equanimity.

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