When Are You Old Enough to Die?
Illness is inevitable in the human body but suffering doesn't always happen or have to happen. Accepting the mortality of our bodies is a beautiful gateway towards understanding health.
UPDATED: July 21st, 2025
Welcome to the Healthy Aging Newsletter, a free publication where I translate trustworthy medical research into simple habits so my clients can stay healthy and avoid common chronic conditions. I’m Dr. Ashori, a family medicine doctor turned health coach.
In her book, Natural Causes, Barbara Ehrenreich argues against the many screenings and interventions that are meant to keep us alive as long as possible. Not because these are futile pursuits but because death may not be something you can outrun. Far from having to lay there and await death, life can be lived to its fullest without knowing our expiration date. In fact, maybe life is best lived and most enjoyed when we no longer try to escape death. More on that later.
As a physician turned health coach, focusing on healthy aging, it might seem that I’m part of the longevity movement, trying to prevent chronic disease or delay it as long as possible to help delay early death. Far from that, I’m more of an advocate of living our best lives. I don’t believe in lecturing someone on their vices if that defines their best life lived, instead I want them to live intentionally, whatever that means to them. For that, we use a little science (biomarker testing), some accountability (coaching), and a lot of good conversations.
What’s Your Definition of Health
I’ve asked physician colleagues and patients and so far I’ve not received an answer, at least one that wasn’t a generic definition of how health is defined in popular media. What does health mean to you, to me?
Health to me is the oscillation of feeling well and illness and my body’s ability to bounce back from it. It’s the way I feel inside my body and the balance of of living a good quality life while at peace with the reality of a body that ages.
To so many others health means having healthy biomarkers, a healthy looking body, no physical suffering, and being free of the diseases we label with ICD10 codes at the doctor’s office.
Illness & Suffering Don’t Have to Correlate
I have patients with cancer who don’t suffer and I have patients with misshapen but painless bunions who suffer greatly. It’s one of the things you learn as a physician when you treat patients long enough, that suffering and disease severity don’t always match.
One patient is unfazed by the diagnosis of diabetes while another without diabetes has a CGM, monitoring her nightly glucose curve to avoid even the occasional spike above 100. I admit that the advances of clinical medicine and social media have perhaps injected a bit of healthy anxiety into our society.
Echoing Barbara’s book, fortunately Western medicine has evolved enough to help with the physical suffering rather well but not so much the emotional, which to me is the far bigger kernel of suffering.
Living Our Best Lives
Too much alcohol, any amount of cigarettes, and staying up late playing video games are now considered universally bad. And while many more people follow this dictum, longevity or overall lifespan hasn’t increased in our society.
As a health coach I have clients with addiction, risky lifestyles, and chronic diseases. I also have clients who are incredibly healthy and their goal is to keep it that way. My goal is to help each discover what ‘good living’ means and help them come to term with sometimes the inevitable - the things that happen to us even if we do everything right, call it entropy or chaos theory.
If the goal is to never have any diseases, I think the longevity doctors have some solutions for that, though it involves a lot of testing, vigilance, and a strict lifestyle. If your ideals are more along the lines of living the best life possible, really enjoying the moment while tending to your responsibilities, that’s often much more achievable.
Accepting Death
So when are we old enough to die? Some will reach this level at a young age either by choice or because of a terminal diagnosis. The morbid yet good news is that many before us have traveled the path of death and they did okay. There are no stories of people who individually were devastated by death.
By no means am I making light of death. At 47, I’ve long passed my fertility window and according to modern evolution theory, there is no biologic force trying to keep me alive. At the same time, I’ve long surpassed the age at which many, many people die from infection, trauma, cancer, heart attacks, and accidents. So, I’m old enough to die which makes accepting death so much easier.
Mind you, accepting death doesn’t mean you’ll accept it in every moment of every day. You’ll have moments of panic when you feel a lump in your breast, a dull ache in the chest, or an odd headache. Often, all you have to do is to conjure up that acceptance of death and at least the panic will go away and you can set out to figure out what’s going on.
Screening for Disease to Prevent…?
Starting at age 25 we get our blood pressures, cholesterol, and blood sugars checked. Then we get pap smears, mammograms, prostate exams, chest CTs, colonoscopies, vision exams, dental cleaning, and some will get routine whole body MRIs. We do this to catch disease early, to treat it early, to give us the best chance at survival, so that we can live longer.
I’ve mentioned in my other articles that it’s likely how we live our lives that has the most impact on our longevity and less so the tests we suffer through, but that’s not universal. The breast cancer you catch early might have never killed you or by treating it you may have bought yourself another 30 years. If we knew which patients fell into which category then we could put Dr. Welch’s cancer theory of bird, rabbits, and turtles.
Does this mean that mammograms and colonoscopies are useless or that you should skip them? Instead of looking at it as good or bad, it’s perhaps better to revisit what health means to you and whether this tool of, for example, cancer screening fits into you model of health and healthy living. For me, I don’t see the need to get a colonoscopy, prostate exam, or lung CT because it doesn’t fit my personal health paradigm.