Deciding when to die

Originally published in Daily Maverick

There are at least two ways of maintaining or enhancing the significance of death. First, you could attend to death, in the manner that many of us have – sharing the final days, months or years with someone you love. Second, you could remember to take life seriously. So seriously, that when it’s time for the life to end, we can make that decision carry all the significance typically found in protracted, often painful dying.

These responses are not mutually exclusive. Personally, I’d want neither a casual “honey, I think it’s time to go” chat over tea, nor that a decision to end life be taken after years of excruciating pain. A balance can be struck, and where it lies can be determined by the preferences of those involved, along with contemporary medical knowledge.

But however one strikes that balance, the notion that the only proper death is one that occurs without intervention needs to be defeated, in public perception as well as in law. A death with dignity might mean different things to each of us, but whatever it might mean to you should determine the time and manner of that passing. It’s the last choice we’ll be able to make, and we have reason to be dismayed at the interferences of those who would deny us that choice.

There are some compelling reasons for being wary of assisted dying. As I’ve previously noted, a person who is very ill might not be the best judge of her prospects for recovery. Of course, neither might her family be, either because of wishful thinking that she might recover, or wishful thinking about an early inheritance.

There are ways to legislate against these dangers, though. Advance directives such as living wills are one example, and the case of Tony Nicklinson, described in the column linked above, offers another. For years, he was still able to attest to his desire to die, though not capable of much else. Yet, that wish – perhaps the strongest he had – was denied to him.

Another set of reasons against assisted dying might be found in religious views of life and death, often in the idea that ending a life is not something that we should start taking charge of. Leaving aside potential inconsistencies (it’s rare to hear complaints about saving lives as opposed to ending them), these reasons could be treated as compelling for those who hold that religious view, leaving others free to make different choices.

The strangest sort of reason for opposition to assisted dying, though, is that expressed by Dr Giles Fraser in his weekly Guardian column earlier this month. In case you don’t know Fraser, he is “priest-in-charge at St Mary’s Newington in south London and the former canon chancellor of St Paul’s Cathedral”. His argument was not the religious one outlined above, though, nor any other explicitly religious argument.

Fraser says “I do want to be a burden on my loved ones just as I want them to be a burden on me – it’s called looking after each other”, and argues that the experience of suffering and death allows for us to transcend individualism, affirm human connections, and remind us of all the wonderful things on offer in life.

He also worries that our “excessive fear of dying”, and the lengths we go to in protecting children from being exposed to death, reflects unhealthy anxieties and an attitude that “death is something strange, weird, and spooky”, rather than natural. In short, he concludes, his “problem with euthanasia is not that it is a immoral way to die, but that it has its roots in a fearful way to live”.

As I said at the outset, this is one way to approach death, and I wouldn’t begrudge anyone who was dying from choosing this approach. But it’s not my, nor Fraser’s, place to tell people who are dying how to do so – and it’s an unfortunate fact of death that one would often not be in a position to express those preferences.

When you are able to do so, as in the Nicklinson case, or in the case of Craig Schonegevel, the subject of a recent book by Marianne Thamm, it seems rather selfish, perhaps sometimes even ghoulish, for the healthy attendants to this death to insist on prolonging that death.

There’s no getting around the fact that it’s rarely going to be easy to say goodbye, whether you’re the one staying or the one leaving. As Christopher Hitchens observed in his autobiography, Hitch-22, “I do not especially like the idea that one day I shall be tapped on the shoulder and informed, not that the party is over but that it is most assuredly going on—only henceforth in my absence”.

Terminal illnesses can offer an opportunity to spend final and valuable moments together, and if that’s what the relevant parties want, so be it. But death, and the sure prospect of it, should also serve as a reminder to us to lead better lives. In doing so, it might become easier to allow others to leave when they want to do so, instead of keeping them around while we regret wasted time.

If you haven’t watched it before, here’s a documentary in which Terry Pratchett explores these issues. It’s well-worth watching.

By Jacques Rousseau

Jacques Rousseau teaches critical thinking and ethics at the University of Cape Town, South Africa, and is the founder and director of the Free Society Institute, a non-profit organisation promoting secular humanism and scientific reasoning.