Dr Zabel's assertions are not based on data, but on his premise that "the physician must never accept death as inevitable." One who cannot believe what is demonstrably true cannot deal effectively with the issues raised in my article.Regarding Dr Portnoi's comments, my article does not claim there has not been progress made in medical care, that "healthy practices" do not increase life expectancy, or that old people do not have "major disease." Nor does the article maintain that bronchopneumonia, septicemia, and thromboembolism are trivial. These entities were accepted as the cause of death in many patients. The point was made that many old people die with little tissue injury from such causes, injury that would be trivial in younger persons. Comparing mortality data for different years for the age group older than 85 years can be misleading because information is usually not available on shifts within
Kohn RR. Cause of Death in Very Old People-Reply. JAMA. 1982;248(19):2449. doi:10.1001/jama.1982.03330190018010
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