What do we think of death?

Large majorities in most Western countries now support legal doctor-assisted suicide. An Angus Reid poll conducted last year found that four fifths of Canadians are in favor of legal euthanasia for terminally ill patients, given certain restrictions.

There is a persuasive argument in favor of consensual killing that combines the asserted liberty of the person over his/her own body with an emotional concern for the distress felt by the terminally ill. It is the apparently self-evident answer to the rhetorical question: “Why should we prevent someone putting him/herself out of misery?”

For those who reject the rhetorical answer, it is probably not squeamishness about death that motivates their opposition to euthanasia. (I will not distinguish between euthanasia and assisted suicide for the purposes of this article.) Euthanasia was less popular in the past, at a time when far more people were familiar with death. Doctors, who witness death more often than most of us, are known to be less supportive of legalization. In fact, only a fifth of Canadian doctors report a willingness to assist in suicide.

The concern of euthanasia’s opponents is also probably not for making every effort to keep a person alive—palliative workers understand, for example, that it is best not to force dying patients to eat when they resist, having arrived naturally at the point of death. There is a more subtle explanation for the aversion to assisted killing that I will return to in a moment.

On the question of the death of terminal patients, more philosophic types might reason away the distinction between allowing (temporarily preventable) natural death and euthanasia, by appealing to some kind of utilitarianism. If the patient dies, they say, it makes no moral difference whether you caused it or allowed it to be caused by something else.

This idea is not unreasonable, in a theoretical world of utility-maximizing agents, but it is not terribly useful to us—humans are not known to act that way in life-or-death circumstances, because there is more meaning attached to death than the materially apparent.

A cancer patient on the verge of death may be equally extinguished by the physical toll of the disease or by a lethal drug, but the moral difference to the individual who pulls the trigger, so to speak, is profound. Grief in these situations is unavoidable, but how many parents would want to live knowing they had chosen the moment of their child’s death? No longer could the parent comfortably attribute to the death any transcendent significance—it was not an act of God or nature, but of human discretion.

Of the $200 billion Canadians spend on health care each year, nearly half is spent on the elderly. This is something like $3,000 for every Canadian—a large part of our gross national income. It would be easy to find justifications not to spend so much money on the aged if we did not believe that health and life were sacred; if we began consciously attaching quantitative values to lives.

I doubt that Canadians would ever begin withholding care in this way, but I am not certain that we would be able indefinitely to avoid slipping a little farther down the slope, in the same way that the Netherlands has gradually expanded the class of people who may end their lives (it now includes anyone over 12 whose situation is sufficiently “hopeless”). By allowing intentional, consensual killing in select circumstances, we would inevitably find individuals in those circumstances who would feel as if they ought to be killed, or perhaps as if others wanted them to die.

It is not difficult to imagine a sick, elderly hospice patient noticing the fatigue of his caregivers and beginning to wonder whether they would rather he died. We cannot write off as ridiculous the idea that under a new death policy, medical workers would be more likely to bring up the possibility of euthanasia, or that ambivalent patients would more often be agreeable to being killed.

If for no other reason, let us maintain our current laws for the sake of the emotional security of those who are in the majority of the very ill who do not want to die. If we must err, it may be better to err by prolonging a hundred or so lives a year, than by risking the trauma of killing some who would otherwise have been fine with living. This is not to mention the fright it would spare the elderly, or anyone else, who might (reasonably or otherwise) begin to think that a euthanizing culture does not value their lives as highly as they do.

Life remains something sacred (having transcendent value) to us. Implicit in the social norms and laws that surround death is the assumption that a human life is nearly infinite in value—“No matter what,” our law seems to signal to us, “your life will always be secured by our society and government. Even if you become temporarily hostile to your own existence we will make sure, to the extent possible, that your life does not end. We cannot risk losing a valuable life for the sake of any benefit or in the face of any particular cost.”

This sense of sanctity is why we spend billions to save the infirm and disabled, and why we proscribe euthanasia and suicide. We may find that undoing this sacredness will lead to moral disorder.

“Why should we prevent someone putting him/herself out of misery?” The question is far too easy to answer (in isolation) to be of good use to us. The reader can consider how he/she would answer the question if it were posed by his/her suicidal child, parent, or friend.

This article first appeared in the Prince Arthur Herald on October 8, 2013.

2 thoughts on “What do we think of death?

  1. You reaffirm some of the great points made at http://www.nytimes.com/2012/11/01/opinion/suicide-by-choice-not-so-fast.html:

    My problem, ultimately, is this: I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless — to pressure you ever so slightly but decidedly into being “reasonable,” to unburdening others, to “letting go.”

    Perhaps, as advocates contend, you can’t understand why anyone would push for assisted-suicide legislation until you’ve seen a loved one suffer. But you also can’t truly conceive of the many subtle forces — invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami — that emerge when your physical autonomy is hopelessly compromised.

    [Invisible forces of coercion] include that certain look of exhaustion in a loved one’s eyes, or the way nurses and friends sigh in your presence while you’re zoned out in a hospital bed. All these can cast a dangerous cloud of depression upon even the most cheery of optimists, a situation clinicians might misread since, to them, it seems perfectly rational.

    And in a sense, it is rational, given the dearth of alternatives. If nobody wants you at the party, why should you stay? Advocates of Death With Dignity laws who say that patients themselves should decide whether to live or die are fantasizing. Who chooses suicide in a vacuum? We are inexorably affected by our immediate environment. The deck is stacked.

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