My 91st birthday on 3 April is a good reminder that there is not very much time left in my life. Reading a lot of information on the Internet, it is kind of natural that my mind collects information from obituaries, and identifies the ages when these people’s lives came to an end. Just as I saw it recently: all were younger than I: 88, 75, 82, 64, 90, 58.

Statistics from the USA are easily available: the currently calculated average life expectancy of children being born now is approximately 77 years for men and 82 years for women. With my 91 years I am obviously overdue, statistically. A good reason to think about it.

Among the many things that came to my mind was also this sentence from the Bible, from the 90th Psalm: “Teach us to number our days, that we may gain a heart of wisdom.”

The writer of these words was clear that a human life is very short, compared to the world in which we live, as he thinks how God is looking at us:

“For a thousand years in Your sight
Are like yesterday when it passes by.

As for the days of our life, they contain seventy years,
Or if due to strength, eighty years.
Yet their pride is only trouble and tragedy;
For it quickly passes, and we disappear.

So teach us to number our days,
That we may present to You a heart of wisdom.”

I am impressed that such profound thought was held and written down by a person who lived around 3500 years ago. This text is considered to be one of the oldest parts of many others that were later collected to become the Bible of the Jewish people of Israel, and later taken over also by the Christians. It is a serious challenge to THINK about “to number our days” before we disappear.

That is a challenge to use the number of days wisely which we have – whatever our age is.

Every life is different – we cannot produce a list for everybody of what to do and what not to do. The only thing that is clear for everybody is the challenge to be aware of our reality: the reality that we have only a limited time, and it is even running shorter day by day.

I could stop here, but there is one increasingly serious problem. In modern societies, the number of old people who loose the capacity to be aware of themselves and of their environment – that includes family and friends – is steadily increasing.

They suffer from Dementia.

The medical term Dementia describes a general decline in cognitive abilities, memory, thinking, problem-solving, and communication, severe enough to interfere with the daily life of a person. This is a complex phenomenon, related to old age.

Widespread dementia occurs only in modern societies. Medical texts from the ancient European Roman and Greek times mention only very few exceptional cases of memory loss. Why is the number of sufferers from dementia increasing now? There is the easy opinion that dementia increased because the general life expectancy increased. In the USA, the average life expectancy is now 75 years for males, and 82 years for females; 100 years ago, the numbers were much lower: 58 for males and 61 for females. The present higher years are due to a better control of infectious deceases and lower infant mortality. But Japan, Switzerland, and Australia now have higher life expectancies than the USA, and it is interesting to consider why: the figures in the USA are probably lower because of many cases of obesity, traffic accidents, gun use, and the overuse of drugs.

The relationship between the increase in life expectancy and the increase in dementia is surprising. Is modern medical care promoting dementia?

Obviously physical health can be improved by medical care and life style efforts – nutrition, exercises etc. – and this enables the body to replace old and damaged cells with new ones to maintain healthy function. Some parts of the body are regularly replaced, like the skin, which renews itself after approximately every 27 days, shedding old cells and replacing them with new ones. Medication can initiate similar processes for sick tissue, and such medically assisted cell renewal processes are increasing – and so did the life expectancy.

But such processes of natural or medically assisted processes, which are able to renew or replace cells, does not function for the most complex part of the body: the brain. There, old cells can accumulate and cause degeneration.

Modern care can extend a well functioning body – but not a well functioning brain.

What is the result?The course of the life of thousands of people is derailed into suffering. I will share here, as an example, what happened with Walter Jens, a famous professor of Rhetoric at the University of Tuebingen in Germany. He lived his life and work about words, until dementia changed everything, when he was over 80 years old. After suffering from progressive dementia for four years, he could no longer formulate a sensible sentence, he no longer knew anything about the world, or about himself and about his life’s work. His wife once found him surrounded by books, but she noticed that he was holding one book upside down. He no longer recognized visitors, nor his wife, having been married for 57 years. “He is no longer my husband. He is in a world that I have little or no access to” she said in an interview with the SPIEGEL magazine, where she shared more details: sometimes he goes shopping with his nurse, and when he gets a little sausage offered at a meat stall, it makes him happy. “Dying is cruel, living like this is even more so” she said. “I pray that one morning he simply won’t wake up.”

Another sufferer from a debilitating disease who received wide attention was Professor Hans Kueng, who became a university professor at the early age of 32, but later he lost his permit to teach Catholic theology, because he had been a voice for reform in the Catholic church for decades, about issues such as papal infallibility (the claim that the highest authority in the Catholic church, the pope, can never make a mistake in defining doctrine), the celibacy of priests (that priests shall not marry and shall not have sexual relations), and euthanasia (the intentional ending of human life in order to eliminate pain and suffering).

In a SPIEGEL press interview, his acute hearing loss and the degeneration of his eyes were pointed out to him, as well as his Parkinson’s disease – he interpreted these things as warning signs to be aware that the number of our days is limited, on our way to our impending death, while he was still working every day.

He was also reminded of his friend Walter Jens, who had died some years ago: “I visited him several times. Up until a few years ago, his face would still light up when I came to see him. But, in recent years, he could no longer remember whether I had visited him the day before or a month ago. In the end, he no longer recognized me. It was depressing to think that Jens, one of the most important intellectuals of the postwar era, had fallen back into a childhood of sorts.” The interviewer remembered also that Kueng and Jens had together written a book in 1995: “Dying with Dignity.”

The SPIEGEL asked Kueng: “Was the dementia hard on Jens, or just on his relatives and friends?” At the beginning of his illness, he always said “terrible” or “bad.” At the same time, he became appreciative of small things, like a child, of animals and sweets. Kueng used to bring him chocolate. At first, he would eat it by himself, but later on it had to be put into his mouth. “It is not possible know what Jens experienced at the end. But I can’t be expected to accept being in a condition like that.” So Kueng was asked: “As a Christian, are you allowed to put an end to your own life?” Kueng: “I feel that life is a gift from God. But God has made me responsible for this gift. The same applies to the last phase of life: dying. The God of the Bible is a god of compassion and not a cruel despot, who wants to see people spend as much time as possible in a hell of their own pain. In other words, assisted suicide can be the ultimate, final form of helping in life.”

“What I do want to achieve is, that the issue is discussed openly and amiably. But, today, assisted suicide takes place in a gray zone because it’s banned in many countries. Many doctors increase the morphine dose when the time is right, and risk of being convicted of a crime. There are some patients who, when they cannot find such doctors, jump out of hospital windows. That’s intolerable! We need legal regulations.”

At the end of this exchange about life and death, the SPIEGEL became very personal: “Do you live in celibacy?”, and Kueng responds: “I am not married, and I have neither a wife nor children.” The SPIEGEL insisted further: “There is a woman in your book to whom you refer as ’my ideal companion in life.’” So Kueng answers: “Yes, in the sense of an ideal traveling companion. We live in separate apartments. I described all of this in my memoirs, and I stand behind it. I have nothing else to say about it.”
Probably his last words recorded for the public.

While Kueng openly supported the concept of Medically Assisted Death and considered it for himself, due to his Parkinson’s disease, he had written a carefully worded advance directive, for the event that his illness worsens. But there is no evidence that he chose it before his death in 2021. Some people assume that he missed this decision because of his sickness.

His statements on this topic sparked significant public debate in Europe. But this is different from Cambodia. I am not aware that there is a similar public debate here.

In several economically higher developed countries a public debate about the considerable increase of people suffering from dementia has been put aside by creating expensive Intensive Care Hospices, caring for persons who lost the capability to care for their daily life, beyond what family care – if available – might cover, somewhat hiding the suffering of dementia patients from the public

Such intensive care establishments are not available in Cambodia. And a public debate how to achieve a dignified death in Cambodia can only be hoped for in a distant future: how to avoid long suffering of patients as well as of family and friends, requiring a social environment, where the many different aspects of medical care, its social availability, and its ethical consequences can be openly discussed.

So we all stay with this challenge, whatever our age is: to consider that we must die – and how – so that we live wisely.