Jimmy Carter, Cancer & Redefining the New Old Age
Carter said he was "surprisingly at ease" when he received his diagnosis. Perhaps part of that serenity comes from the knowledge of the good works he has done in his life.
This past week, former President Jimmy Carter announced that his skin cancer has metastasized to his brain and other parts of his body. The 39th president is undergoing immunotherapy, which is considered the vanguard of treatment for the disease.
Now, the nation — and much of the world — is watching, waiting, and praying for his recovery. Carter said he was "surprisingly at ease" when he received his diagnosis. Perhaps part of that serenity comes from the knowledge of the good works he has done in his life, including his many accomplishments during the years of what's commonly characterized as "old age."
Of the many reasons that the world is a better place thanks to Carter, his productivity in later life has inspired me the most. Carter has shown by example that old age can provide the most defining decades of one's lifespan.
The 91-year-old former president and his 88-year-old wife Rosalynn Carter's list of achievements includes contributions to the field of aging, dating to both Carter's term in office and afterward. While president, Carter signed into law the creation of the National Institute on Aging, a vital part of the National Institutes of Health that has added greatly to our understanding of, and improvements in, human aging. His wife of 69 years, Rosalynn, has been among the first and most articulate advocates of family caregivers and their needs.
Meanwhile, during his "old age," Carter's rigorous schedule of international diplomacy, charitable work (including, but not limited to, his dedication to Habitat for Humanity), religious education outreach, public speaking, and book authorship has seemingly become more demanding with each passing year.
His example is especially meaningful in the context of the current-demographic longevity revolution, which has added 30-plus years to the average American life since 1900, a trend that stands to continue. As we live longer, more of us reach old age, and birth rates slacken, a question in health, social, and aging policy circles has developed: How old is "too" old? When, the thinking goes, is aggressive treatment of disease, especially terminal conditions, appropriate? How much should "we" (presumably meaning individuals, families and society) invest in those advanced in years and with advanced disease?
Dr. Ezekiel Emanuel articulated this school of thought in a recent article in The Atlantic titled "Why I Hope to Die at 75." Physician-turned-philosopher Emanuel writes:
By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations. Dying at 75 will not be a tragedy.
In fairness, Emanuel is nowhere near making a Logan's Run-esque argument for euthanasia at a set age. However, he is suggesting that 75 may be the time when most of us are officially over the hill: the moment when our years of making a contribution and experiencing love are behind us, while years experienced through only depleted physical and cognitive capacities stretch out before us.
Carter stands as a sterling example of how wrong this approach can be. Yes, as a former United States president — the most select and smallest of clubs — he in no way represents any kind of norm. But that's precisely the point: thanks to his high visibility, Carter has redefined aging, and now certain types of cancer in old age, in the public mind. At 91, he is busy by anyone’s standards. He finished this summer's tour in support of his most recent book, A Full Life: Reflections at Ninety, despite an earlier cancer diagnosis. And even after his most recent diagnosis, he taught Sunday school for 45 minutes this week — something he does 40 Sundays a year. Despite age and cancer, he has significant future goals. If his physicians approve, Carter hopes to travel to Nepal in November to build houses for Habitat for Humanity.
It is true that Carter is an epidemiological anomaly in terms of his contributions to society as well as the demographic norms of his cohort. Few of us will write a book, especially not in our ninth decade, but Carter just finished his 29th, at age 91. Few will build homes for the poor in countries two continents away, or battle such public health scourges as the guinea worm, let alone do so in their 70s, 80s, and 90s. But thanks to Carter, we all now know that such later-life contributions are possible.
At the same time, neither science nor public policy has developed the means to know at what age all grandfathers are capable of telling their last joke to a grandchild, or when all grandmothers will have rolled their last meatball. Moreover, we do not have the tools to determine what we individually consider and experience as quality of life. Science and policy may be informed by data and facts. However, unlike scientists and policy wonks, the public learns from — and bases their expectations on — stories. Carter is a character in an important story, rich with lasting and emotional imagery. He is someone that everyone feels they know: Carter and his wife Rosalynn have worked for decades to make their lives more personal than distant to all of us. His life in advanced age is creating a new narrative about how we might live and confront disease, even in our 90s. Suddenly, living far longer than our parents is expected, not out of the ordinary. Battling advanced cancer in our ninth decade is not only possible, but also (possibly) appropriate. And, with all deference to Emmanuel, maybe, just maybe, 75 years old may be at least 16 years too early to declare life complete.
As Carter said while teaching Sunday school this week, "I'd like for the last guinea worm to die before I do."
MIT AgeLab’s Luke Yoquinto contributed to this article.
- The meaning of the word 'confidence' seems obvious. But it's not the same as self-esteem.
- Confidence isn't just a feeling on your inside. It comes from taking action in the world.
- Join Big Think Edge today and learn how to achieve more confidence when and where it really matters.
If you're lacking confidence and feel like you could benefit from an ego boost, try writing your life story.
In truth, so much of what happens to us in life is random – we are pawns at the mercy of Lady Luck. To take ownership of our experiences and exert a feeling of control over our future, we tell stories about ourselves that weave meaning and continuity into our personal identity.
Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.
- Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
- They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
- The research raises many ethical questions and puts to the test our current understanding of death.
The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?
But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.
What's dead may never die, it seems
The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.
BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.
The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.
As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.
The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.
"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.
An ethical gray matter
Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.
The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.
Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.
Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?
"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."
One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.
The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.
"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.
It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.
Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?
The dilemma is unprecedented.
Setting new boundaries
Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."
She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.
A space memorial company plans to launch the ashes of "Pikachu," a well-loved Tabby, into space.
- Steve Munt, Pikachu's owner, created a GoFundMe page to raise money for the mission.
- If all goes according to plan, Pikachu will be the second cat to enter space, the first being a French feline named Felicette.
- It might seem frivolous, but the cat-lovers commenting on Munt's GoFundMe page would likely disagree.
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