Nortin Hadler: Rethinking Aging- An Excerpt

Although aging and dying are not diseases, older Americans are subject to intense marketing in the name of “successful aging” and “long life,” as if both are commodities. In Rethinking Aging: Growing Old and Living Well in an Overtreated Society, Nortin Hadler M.D. offers a doctor’s perspective on the medical literature as well as his long clinical experience to help readers assess their health-care options and make informed medical choices in the last decades of life.

“A book for all readers entering the aging years, especially those who wish to avoid unnecessary and futile tests and procedures . . . . Rethinking Aging is a sobering book, calling for a careful and blunt dialogue about end-of-life and aging issues. It should evoke much discussion and debate about the proper application of medicine and surgery in the aging population.”
–Clifton K. Meador, M.D., in the
Journal of the American Medical Association

The following is an excerpt from Dr. Nortin Hadler’s book Rethinking Aging: Growing Old and Living Well in an Overtreated Society (pp. 195, 196):


I was walking on the beach hand-in-hand with Lucy, my larger-than-life six-year-old granddaughter. We were breathing in life at its finest and at its fullest. Out of the blue, Lucy looked up and said, “Peepa, I want to stay a kid because kids don’t die.” Leaving aside the sad truth that she’s not 100 percent correct, for me this was a Kantian moment. Of course, I didn’t say that to Lucy, but I hope I can live long enough to explain it to her. For now, we settled for a discussion of joyful moments together in the present.

There are two ways to conceptualize time. Both are familiar, but only one is generally recognized as “time,” the empirical, Newtonian, reliable, predictable, linear scales that we need to mark events: seconds, minutes, years, and so on. In Critique of Pure Reason, Immanuel Kant (1724-1804) offered an alternative conception of time. Kant explores the fashion in which the mind imposes time on our experiences. Kant’s treatment of this notion is as dense as any of his writings, but also as important. It speaks to such parlance as “time flies” or “time drags” or “time goes quickly when I’m having fun.” Such parlance is sensible because we accept the interactive nature of experience and perception. And we generally accept it—except when it comes to advance care planning and end-of-life decisions. When death is inevitable and imminent, advance care planning and end-of-life discussions are tolerated by many, encouraged by some. But when the specter of death is based on prognosis, many patients prefer to take things one day at a time rather than contemplate serious illness and death. [1] [. . . ] Prognosis is not a knell; it’s enlightenment.

I have written Rethinking Aging so that readers will learn to think of prognosis as a call for advance health care planning even if that planning proves unnecessary. I want prognosis to signal a change in the parlance of time from “my time is limited” to “my time is valuable, too valuable not to capture every moment I can.” Whether robust or frail, if you h ave the mental capacity to do so, then make time slow down. In that context, advance care planning is a part of staying alive and not of dying.

But we will die.


Nortin M. Hadler, M.D., M.A.C.P., M.A.C.R., F.A.C.O.E.M., is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill and attending rheumatologist at UNC Hospitals. His most recent books are Worried Sick: A Prescription for Health in an Overtreated America, Stabbed in the Back: Confronting Back Pain in an Overtreated Society and Rethinking Aging: Growing Old and Living Well in an Overtreated Society.


  1. [1]T.R. Fried, K. Bullock, L. Iannone, and J.R. O’Leary, Understanding advance care planning as a process of health behavior change, Journal of the American Geriatrics Society 2009; 57: 1547-55