Failure to Thrive

To be immortal is commonplace; except for man, all creatures are immortal, for they are ignorant of death; what is divine, terrible, incomprehensible, is to know that one is immortal.

-- Jorge Luis Borges

My mother died soon after her 88th birthday from the effects of vascular dementia, an ailment with many of the same symptoms as Alzheimer’s disease. However, the primary cause of death was listed as “failure to thrive” – a term of art that was new to me at the time. It seemed to me that failure to thrive might describe almost any death by natural causes. In fact, when applied to the elderly, the term refers to the combined effects of multiple diseases. My mother had experienced numerous small strokes that in turn were responsible for her dementia. She did not recognize her grandchildren or recall any of her accomplishments in an unusually accomplished life for a woman of her generation. She suffered from depression. At the end of her life, she was incontinent and confined to a wheelchair. Her skin had the mottled look of an overripe banana. She could no longer swallow properly and went on a soft diet to avoid aspirating solid food into her lungs, which might lead to pneumonia. Her death came as a relief to those who loved her, and probably to my mother as well.

When we talk about a fate worse than death, it’s really the process of dying we are talking about, not so much being dead. We witness the terminal suffering of those we hold dear and wish for a quick end for ourselves when our time comes. My father, who was not in the best of health but still retained his faculties into old age, suffered a massive stroke soon after his 80th birthday and hung on for only a day or so before dying. Even though my mother lived eight years longer, I think he got the better part of the bargain. By then my mother was already showing signs of the disease that would slowly rob her of her memories, then of her personality and ultimately of her life.

Better than a quick end to it, we hold out hope that our time will never come. Americans reportedly spend some $50 billion per year on nostrums that promise to promote longevity. The impulse is hardly new. More than one Chinese emperor met his end by imbibing mercury or other poisons that were purported to be the elixir of life. As early as the fifth century BCE, Herodotus was writing about a magical fountain in Ethopia that lengthened the lives of those who bathed in it. According to legend, at least, Alexander the Great – who was all of 32 when he died -- set off in search of a river with regenerative powers on one of his military campaigns. Ponce de Leon, who is most closely identified with the fountain of youth, was probably more interested finding gold when he mounted his famous expedition to Florida.

By one measure, at least, efforts to extend longevity have been succeeding. Average life expectancy in the U.S. has tripled in the last two centuries. However, this is due almost entirely to improvements in nuitrition, sanitation and infant mortality, as well as in the eradication of many infectious diseases. As a consequence, more people are living into old age, but individually they aren’t living to be much older than they used to – at least not yet. The oldest person now alive is 115, compared with 110 a century ago and 103 two centuries earlier. Is there an upward limit to the human lifespan? That question is hotly debated. Medical experts insist that none of the anti-aging remedies now on the market has a proven effect on longevity. Human cells are not immortal, as was once believed. There is a limit to the number of times a cell population can replenish itself before its component DNA strands are unable to replicate themselves further, the so-called Hayflick phenomenon. At the very least it would seem that any major extension of our lifespan would require a fundamental change at the cellular level.

With aging increasingly viewed as a disease, it may be only a matter of time before a “cure” is found. However, bioethicist Leon Kass has warned that prolonging human life beyond natural limits could have serious unintended consequences that would more than offset any benefit to individuals. Employment, family relationships, cultural institutions, government, business and retirement systems will all be profoundly affected. How long would workers have to stay on the job to support retirement benefits for large numbers of people living past 100? How would career advancement work with the top rungs occupied by vigorous octegenarians? Would our political institutions effectively devolve into gerontocracies? The other day I overheard an elderly gentlemen refer to his great-grandson-in-law, the type of designation that could become commonplace with generations piling up. Looming over everything else is the prospect of a “tragedy of the commons” in which global resources are depleted as the old refuse to give way to the young.

By analogy, we might consider an old Ealing Studios comedy called The Man in the White Suit in which a young Alec Guiness plays a research chemist who invents a synthetic fabric that repels dirt and never wears out. Guiness’ character is an idealist who regards his invention as a blessing to humanity. Imagine never having to replace your wardrobe or take clothes to the cleaners. But textile mill owners and workers alike regard this development as a threat to their livelihoods and band together to suppress it. Guiness is even taken to task by a washerwoman who scolds, “Why can’t you scientists leave things alone? What about my bit of washing when there’s no washing to do?” The hapless research chemist is astonished to discover that his blessing to humanity can also be viewed as a curse.

It is hard to argue against medical advances to combat the ravages of age, even if they might have dire economc and social consequences long-term. Certainly no one wants to see his or herl oved ones suffer as my mother did, ravaged in mind as well as in body. And yet, you could also argue that my mother would have been spared much of her suffering had she died, as my father did, at age 80, before developing symptoms of dementia, rather than at 88. The main reason Alzheimer’s disease and other dementias have reached epidemic proportions in the U.S. is that so many people are already living well into their eighties and beyond, when as many as half will develop significant cognitive impairments. At the very least, we would need to find a cure not just for aging per se but for Alzheimer’s disease, arthritis, Parkinson’s disease, cancer, cardiovascular disease, depression, hearing loss, strokes and a host of other maladies that afflict the very old.

“Perhaps,” suggests Leon Kass, “mortality is not simply an evil, perhaps it is even a blessing—not only for the welfare of the community, but even for us as individuals.” How so? “The virtue of mortality is that it adds to our ability to reflect on our own finitude, forcing us to make proper use of the time that we do have,” Kass writes. “Without a limit, humans risk falling into the abyss of insatiable desires to an even greater degree, becoming even more attached to the things of this world and less likely to reflect on our true end.”

Kass believes the our longing for immortality is motivated less by a fear of death than by a deep desire for transcendence, whether channeled into progeny, community or the welfare of the human race. As he expresses it, “the human soul yearns for, longs for, aspires to some condition, some state, some goal toward which our earthly activities are directed but which cannot be attained in earthly life. Our soul’s reach exceeds our grasp; it seeks more than continuance; it reaches for something beyond us, something that for the most part eludes us.” There are indeed fates worse than death. One of them is to lead a meaningless life, which is the same as never having lived at all. What is it that gives life its meaning? There is no single answer to that question. But surely one prerequisite is the certain knowledge that we do not live forever.

Leon R. Kass, “L’Chaim and Its Limits: Why Not Immortality?” in First Things (May 2001)

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