Tuesday, October 13, 2015

The grinning skull beneath the skin

"Death is the only experience of life that is not lived through."--Ludwig Wittgenstein

I've written on this subject before; and perhaps the entry to any discussion of euthanasia should face on time ("when") rather than subject ("what").  Be that as it may, this is a very good article on the conundrum of physician assisted suicide.  Yes, it is a lovely idea that say that we can have a "good death," but like a "good war" we only know that in our intentions, never in our actions; and we only get to determine which one was "good" in retrospect; we never get to set the conditions so the outcome will be as we wished it.

And frankly, let me say up front that "physician assisted suicide" is still just suicide.  The shock of suicide, the pain it brings to those left behind, is that whatever problem led to the death is now irresolvable.   It leaves a tangled mess, a "why?" that can never be answered, never be undone.  It is neater and easier when physicians are involved and everyone agrees only if everyone agrees never to look back and everyone agrees death was better than asking, perhaps, just one more question.

One of my law professors impressed upon me the problem with euthanasia, the "easy death" that we now couch as "physician assisted suicide."  He pointed out we can never be sure the deceased agreed to the plan because they wanted the succor of death, or simply because they wanted to stop being a burden on the living.  Or perhaps it was the living who wanted to drop the burden of the dying, and get on with it.  The case in the article is a case in point:  a father is dying, and wants to end it early but not, it turns out, because the pain is unbearable (that is corrected for him); it is mostly because he doesn't want to burden his child, who is caring for him.  She has the opportunity to assure him he is not a burden, and his death is not hastened but met when it finally comes.  It wasn't necessarily easier that way for either of them, but no one was "responsible" for his death, and no one left a question unanswered that death would leave unknowable:  why did he want to die?

The author is right, too: we fear death.  We do all we can to keep it away from us.  I've known people refuse to return to a church building because a funeral was held there, and the memories of that being the last place the beloved was before burial, is too much.  It's why people prefer funerals at funeral homes.  We used to die at home, and the family prepared the body for burial and stayed with it.  Someone would stay up through the night, out of respect for the loved one.  Now death happens in hospitals and strangers take the corpse and perform operations on it you don't want to know about, and keep the body in a building we only visit if we absolutely have to, and inter it in a place no one goes who doesn't have a reason to be there.

"My death, is it possible?"--Jacques Derrida

No, it isn't.  Your death is possible; mine?  Inconceivable.  I will be a ghostly presence observing the world without me.  The world will fill up the hole you leave behind as certainly as water closes over a stone.  But I will be the stone descending into the water, aware I am sinking and wondering why no one will retrieve me.

You, on the other hand, will just be gone; and we will mourn you and get on with our lives.  My life cannot end, because I cannot imagine the world where I am extinguished; to even do so, is to imagine I am there to observe it.  It's a neat trick of consciousness; in order to be self-conscious, we cannot also be conscious of our absence.  Which is another reason we fear death.  It is the only experience of life that is not lived through.

And so we think we don't have to live through it at all; not if we don't want to.  We can go to death, rather than let death come to us.  We can live through it by being in charge of it.  And then what?  Like any first experience, we can report that it isn't that bad after all?  No.  And we can't decide it wasn't such a good idea after all.  It is the one irrevocable act.  Perhaps that is why, today, we fear it more than ever.


  1. There will certainly be consequences of making assisted suicide legal that are not good, I suspect that it will come to be seen as irresponsible for people to die a natural death, probably the question of cost becoming one of the more coercive aspects of it.

    This issue gives me a lot of problems because if it is seen as a question of the rights of a mature, rational adult who knows enough to make an adult decision, it's one thing, if it's someone who is impaired, pressured, bullied or acculturated into the choice to have someone kill them, that's quite the opposite. And I don't see any way to keep the second of those alternatives from becoming common.

    I didn't see this post until I mentioned the Nazi "merciful death" T4 program this morning, that's another big reason to have reservations about this whole thing. It's a small step from assisting someone who can give informed adult consent to someone making the decision for someone who can't give informed adult consent. And I have no confidence that any kind of bright line will keep that from happening.

  2. I think there's something inalterably selfish about suicide. That's one reason it's so incredibly painful for those left behind. I knew a girl, barely and only for a few months, who committed suicide after college. I heard about it, quite by chance, from someone I met later who turned out to be a mutual acquaintance. I found it a horrible thing to think about or reconcile to, even with someone I barely knew.

    The "physician assisted" part doesn't make it any less suicide, to me. The best cases of rational adults making a decision are cases of people committing suicide long before the end is near, just because they want to be in control/not face the consequences. They are inevitably portrayed as brave, but I always think of them as cowards and incredibly selfish. I would have a hard time forgiving a family member who thought so little of me and the rest of the family as to commit a socially approved suicide just to avoid some inconvenience in later days. My parents, on the other hand, are closing in on 90, and doomed to die sooner rather than later. Life is a series of small problems that add up to days of dealing with physical limitations and new pains, but as they aren't dying of any disease process just at the moment, assisted suicide is out of the question.

    Why? Their suffering isn't great enough, or enough to elicit our sympathies? Seems to me much of what is approved about such deaths is that we, too, don't want to suffer "that way."

    I don't especially want to suffer the way my parents are, in small ways that remind them hourly of their mortality. But that isn't socially approved for an "easy death," so I see my future in them, and know suicide won't be an option, most likely.

    It's less about the clear wisdom of the act, and more about what we think, in this "disease of the week" era, what suffering is tolerable, and what suffering is intolerable. Truly, no person is an island, and we bless some and curse others for their deaths; yet we insist it is an "individual choice," when it is no such thing at all, and making it such, we often simply reinforce the awful selfishness of the act.

  3. "I would have a hard time forgiving a family member who thought so little of me and the rest of the family as to commit a socially approved suicide just to avoid some inconvenience in later days."

    This assumes they are not doing it in the context of a family that has been informed up front about the patient's prognosis, wishes, etc. To me, it's just the same as any death that happens later, with people generally taking the time to prepare everybody. As opposed to a spur of the moment thing, with no note, etc.

    Personally, if anybody in my family were just lingering and wanted out because of the pain, and to spare us all the long death (which I've experienced with a number of family in hospice at various times), I'd appreciate it.

  4. suicide seems to bring out an angry and judgmental side of people. I never quite get there- it seems to me that we all know it is a deeply wrong thing to do, that it is going to scar people we love- and yet some of us do it anyway. Who am I to demand someone else should go on in the face of mental or physical burdens that I simply cannot understand from outside?

  5. ntodd---the "pain of the long death" is not a guarantee for anyone. I've seen people die of cancer in days; and in weeks. Pain was mostly a matter of control with drugs. And suffering is, well... a very subjective standard of measure.

    But my hypothesis was aimed at the young woman who was diagnosed with cancer and chose death as early as possible, rather than suffer through treatments at all, treatments which might have spared her life (stranger things have happened). She was lionized as brave and courageous, because her suffering was the kind society approves of avoiding.

    I have an aunt declining rapidly into dementia. She doesn't suffer so much as her children do; or does she? We can't be sure, we can't communicate with her anymore; only with the memories that dominate her waking state. Is she allowed to die to end what is an irreversible loss of sentience?

    No. Her suffering is not of the right kind.

    Therein, it seems to me, lies the problem. And in escaping "suffering," we imagine, I have no doubt, an end to the "pain" but not to "me." Because I don't think we can imagine the end of "me."

    It is not the escape clause we imagine it to be, because we simply can't imagine our own deaths.

  6. jim--the anger and judgment come from pain, a pain that may indicate there wasn't as much communication as all parties imagined before the "final solution" is implemented, because it is hard to imagine just how final it is.

    I don't seek to judge, but to warn. As I say, some "suffering" is socially approved for "escape," while other sufferings are not. Why not? Why can't I just end my life when I choose to? I'm tired of having a congested head, a result of air conditioning. It's late in the season, but unseasonably warm, and I have to live with A/C still. It's an allergic reaction, one I've had all my life; I'll die with it.

    Why not now? It's a kind of suffering I'm tired of. But it's not 'real" suffering. And what is "real" suffering? We have a vague idea, and we include cancer in the idea; but we don't really know. Like pornography, we're just sure we know it when we see it.

    But do we? That's the issue raised by the situation in the Salon article. I just think these issues are more complicated than we generally acknowledge them to be. We want it to be simple: "Suffering should end. Boom!"

    But then we never think about what kind of suffering should end, and why. The end of a life is not the end of a concern for that life.