Interesting juxtaposition of two articles in the NYT, November 30

My eyes were drawn to these two article in the NYT.
Why?
Well, I'm old and getting older. And...........Matilda, my beloved pussycat, now blind, is aging with me.

November 30, 2013

On Dying After Your Time

By DANIEL CALLAHAN

HASTINGS-ON-HUDSON, N.Y. — THIS fall Google announced that it would venture into territory far removed from Internet search. Through a new company, Calico, it will be “tackling” the “challenge” of aging.

The announcement, though, was vague about what exactly the challenge is and how exactly Google means to tackle it. Calico may, with the aid of Big Data, simply intensify present efforts to treat the usual chronic diseases that afflict the elderly, like cancer, heart disease and Alzheimer’s. But there is a more ambitious possibility: to “treat” the aging process itself, in an attempt to slow it.

Of course, the dream of beating back time is an old one. Shakespeare had King Lear lament the tortures of aging, while the myth of Ponce de Leon’s Fountain of Youth in Florida and the eternal life of the Struldbrugs in “Gulliver’s Travels” both fed the notion of overcoming aging.

For some scientists, recent anti-aging research — on gene therapy, body-part replacement by regeneration and nanotechnology for repairing aging cells — has breathed new life into this dream. Optimists about average life expectancy’s surpassing 100 years in the coming century, like James W. Vaupel, the founder and director of the Max Planck Institute for Demographic Research in Germany, cite promising animal studies in which the lives of mice have been extended through genetic manipulation and low-calorie diets. They also point to the many life-extending medical advances of the past century as precedents, with no end in sight, and note that average life expectancy in the United States has long been rising, from 47.3 in 1900 to 78.7 in 2010. Others are less sanguine. S. Jay Olshansky, a research associate at the Center on Aging at the University of Chicago, has pointed out that sharp reductions in infant mortality explain most of that rise. Even if some people lived well into old age, the death of 50 percent or more of infants and children for most of history kept the average life expectancy down. As those deaths fell drastically over the past century, life expectancy increased, helped by improvements in nutrition, a decline in infectious disease and advances in medicine. But there is no reason to think another sharp drop of that sort is in the cards.

Even if anti-aging research could give us radically longer lives someday, though, should we even be seeking them? Regardless of what science makes possible, or what individual people want, aging is a public issue with social consequences, and these must be thought through.

Consider how dire the cost projections for Medicare already are. In 2010 more than 40 million Americans were over 65. In 2030 there will be slightly more than 72 million, and in 2050 more than 83 million. The Congressional Budget Office has projected a rise of Medicare expenditures to 5.8 percent of gross domestic product in 2038 from 3.5 percent today, a burden often declared unsustainable.

MODERN medicine is very good at keeping elderly people with chronic diseases expensively alive. At 83, I’m a good example. I’m on oxygen at night for emphysema, and three years ago I needed a seven-hour emergency heart operation to save my life. Just 10 percent of the population — mainly the elderly — consumes about 80 percent of health care expenditures, primarily on expensive chronic illnesses and end-of-life costs. Historically, the longer lives that medical advances have given us have run exactly parallel to the increase in chronic illness and the explosion in costs. Can we possibly afford to live even longer — much less radically longer?

This rise in chronic illness should also give us pause about the idea, common to proponents of radical life extension, that we can slow aging in a way that leaves us in perfectly good health. As Dr. Olshansky has tartly observed, “The evolutionary theory of senescence can be stated as follows: while bodies are not designed to fail, neither are they designed for extended operation.” Nature itself seems to be resisting our efforts. (Swift’s Struldbrugs, it is often forgotten, had immortal life but with it all the afflictions of aging, and so were declared legally dead at 80.)

What’s more, an important and liberating part of modern life has been upward social and economic mobility. The old retire from work and their place is taken by the young. A society where the aged stay in place for many more years would surely throw that fruitful passing of the generations into chaos.

The fundamental difficulty here is that we cannot proceed in the usual way with this medical research, taking small steps, seeing the results and then, if they are positive, moving further. It will take decades for the changes in length of life to play out to allow assessment of their benefits and harms. By then it may be too late to reverse the damage. One likelihood, even in just a few years, is that older people who stay longer in the work force, as many are now forced to do, will close out opportunities for younger workers coming in.

And exactly what are the potential social benefits? Is there any evidence that more old people will make special contributions now lacking with an average life expectancy close to 80? I am flattered, at my age, by the commonplace that the years bring us wisdom — but I have not noticed much of it in myself or my peers. If we weren’t especially wise earlier in life, we are not likely to be that way later.

I have often been struck, at funerals of the elderly, of the common phrase that while the deceased will be missed, he or she led a “full life.” Adding years to a life doesn’t necessarily make it any fuller.

We may properly hope that scientific advances help ensure, with ever greater reliability, that young people manage to become old people. We are not, however, obliged to help the old become indefinitely older. Indeed, our duty may be just the reverse: to let death have its day.

Daniel Callahan is the president emeritus of the Hastings Center and a co-director of the Yale-Hastings Program in Ethics and Health Policy.

November 30, 2013

All Dogs May Go to Heaven. These Days, Some Go to Hospice.

By MATT RICHTEL

More and more, cats and dogs get the human treatment. There are pet spas, pet therapists, pet clothes. And as it goes in life, so it now goes in the twilight. The latest phenomenon: pet hospice.

Around the country, a growing number of veterinarians are offering hospice care, and marketing it as a way to give cats and dogs — and their owners — a less anxious, more comfortable passing.

The approach, in the spirit of the human variety, entails ceasing aggressive medical treatment and giving pain and even anti-anxiety drugs. Unlike in hospice care for humans, euthanasia is an option — and in fact, is a big part of this end-of-life turn. When it’s time, the vet performs it in the living room, bedroom or wherever the family feels comfortable.

That’s a big part of the job, the vets say, relieving pet owner guilt, giving them an emotional bridge to a pet’s death, and letting them grieve at home — rather than in a clinic or animal shelter. The intimacy carries a premium, sometimes costing 25 percent or more than euthanasia in a clinic. Vets, and their customers, say it can be worth it.

“They’re in their own environment, not only the pet but the owners,” said Dr. Mary Gardner, co-founder of Lap of Love, a Florida-based company that is one of the leaders in a small but growing market. “They’re allowed to have other animals present, other cats or dogs present, other children,” added Dr. Gardner, who refers to a pet’s owner as its “mom” or “dad,” and has since relocated her own practice to Los Angeles. “I’ve been to some homes where they had barbecues for that dog, and invited me and the neighbors, and the dog was the man of the hour.”

Lap of Love’s business has blossomed since 2010 from two providers to more than 68 vet partners in 18 states. The International Association for Animal Hospice and Palliative Care, a group started in 2009, now has 200 members, mostly vets, but also several family therapists, lawyers and an animal sanctuary in Northern California that takes in and provides holistic healing and hospice for terminally ill and elderly pets.

“There is a formal end-of-life movement, a formal hospice movement,” said Dr. Eden Myers, a veterinarian in Kentucky who runsJustVetData.com, which tracks industry trends. Of the providers who do this, she said: “They’re everywhere.”

Dr. Amir Shanan, a vet in Chicago who started the International Association for Animal Hospice, described the movement as growing, but still not mainstream; veterinary schools are only now embracing the idea. “There are skeptics out there,” he said. “But 20 years ago, there was almost no one other than skeptics, and that’s changing rapidly.”

There are no formal standards for this hospice care, and Dr. Shanan said there was a debate about what those standards should look like. “The core of the debate is who is to decide when is the right time to euthanize, if at all,” he said, noting that some hospice supporters advocate giving pets palliative care until they die naturally, as in human hospice.

Hospice and in-home euthanasia are different things. Their growth is owing to similar factors, says Dr. Myers, including a growing acceptance of hospice for humans, as well as cellphones, laptops and online marketing that make mobile vet services easier to operate. Plus, she said, more vets offer the services as a business alternative to the high cost of starting and maintaining a traditional clinic.

“And,” she added, “you’ve got people willing to spend scads of money on their pets.”

For pet owners, the financial implications of this end-of-life movement cut two ways. In one light, hospice can be seen as reducing the cost of aggressive medical care, or it can be seen as its own version of aggressive comfort care, at least when compared to euthanizing a pet sooner.

A hospice or euthanasia visit from Lap of Love generally costs $200 or $250, including drugs. Euthanasia at a clinic typically runs less, though prices vary widely, and is even less at a nonprofit shelter, like a local animal shelter. Some pet owners say costs are irrelevant given the peace of mind — their own.

“It was more for me than him,” said Jan Dorr, a bookkeeper in Boca Raton, Fla., who was an early Lap of Love customer in 2010. She’d spent $5,000 on chemotherapy for her chocolate lab, Darby, but the dog’s health continued to fail. When she heard about the idea of pet hospice, her reaction was positive; a year earlier, her own father died after a positive hospice experience. She called Dr. Gardner, who helped make Darby comfortable by increasing his pain medications, and giving Ms. Dorr a checklist of ways to recognize when it was time to let go, such as when Darby stopped eating, walking or interacting.

When Darby’s condition worsened just days later, the vet returned to perform euthanasia. Ms. Dorr lay down on her bed with Darby, hugging him. “She let me say when,” Ms. Dorr said, referring to the vet’s final injection. It was far preferable, she said, to the alternative: “I just couldn’t get it into my head to put him on a steel table in a cold room and let him go.”

Kathryn D. Marocchino, a professor of death and dying at California State University in Vallejo, who in 1996 founded the Nikki Hospice Foundation for Pets, said the end-of-life movement for pets addressed what she described as a “sense of coercion” faced by owners of sick pets forced to decide between aggressive treatment or euthanasia. She said that her group got calls from people thanking them, and saying things like: “Where were you 30 years ago? They made me kill my dog.”

Dr. Michele Price, a veterinarian in Northern Virginia whose in-home end-of-care business has doubled since 2009 to 20 percent of her practice, got a call recently about an ailing Labrador named Champ. She’d first seen the dog in August when his owners thought it was time to euthanize. But when Dr. Price got to the house, Champ was doing O.K., and she and the family decided on hospice treatment and pain meds. Later, Champ took a sharp downward turn and couldn’t walk. Dr. Price returned and they set up for the euthanasia.

Champ was on a quilt next to the fireplace when Dr. Price administered the initial sedation. “They hugged him, and told him what a good dog he was. They said, ‘We love you’ and ‘We’ll miss you,’ ” Ms. Price said of the dog’s owners. As for Champ, “He fell asleep. That’s the last thing he remembered.”