Emanuel and Silverstone

The articles written by Emanuel and Silverstone present two classic viewpoints representative of the medical approach to patient care vs. the social work approach. The medical approach is to tell a patient what is good for them and then to do everything they can to arrange services/treatments that will point the patient in that direction.The social work approach is to be patient-centered: to listen carefully to what the patient says that they want, and then support them in achieving their goal. It is no wonder then, following these two different approaches, that Emanuel is instructing us all to give up the ghost at 75 while Silverstone is suggesting that we all live in our own homes for as long as possible.

Emanuel makes a bold statement that he thinks people generally should be aiming to die by about 75 years of age, and that people who live to be older than that are  going to be doomed to lists of physical and mental ailments that make the quality of their life substandard. He and Silverstone have not been reading the same research apparently, since Silverstone's article states that the seniors of the future are expected to have less chronic illness and have more short term conditions that will allow them to be discharged more quickly back into their own homes where the real process of value will be in coordinating all of the necessary home services. It is telling that  Silverstone's article is from 2005 while Emanuel's was published just last month - has anyone told Silverstone that the future has arrived and it does not look so healthy?

The first thought in my mind when starting Emanuel's article and reading about life expectancy was "what about race?" Life expectancy is different for different races, with white people living the longest. Not only do African Americans suffer more from chronic illness, but they are also less likely to be treated for it because of lack of access to care and treatments. This is not mentioned anywhere except that Emanuel gives a swift, passing glance to African American men as having an unacceptably low life expectancy; this is mentioned about 3 paragraphs up from the end of the article. Emanuel seems unaware of the white privilege that is inherent in the luxury he has of being able to deliberately choose to die at 75 while his African American counter parts are struggling just to retire from full time work while they still have a few years left to enjoy the fruits of all of their hard-earned labor. If Silverstone were to apply her patient centered approach to our poverty-stricken minority populations, she may well hear the request to help folks live healthier lives for longer, while talking to the wealthy whites may get Emanuel's response that folks want to die sooner. The irony!!