Death is a word most doctors avoid; it is a defeat. Anathema. It is, in all their texts, in all their studies, blasphemous. Heresy. And my specialty is certainly not immune. In Obstetrics, it is an especial desecration: we are so used to dealing with the opposite that the very word, let alone the concept is an apostasy. Omega has no place in the delivery suite –it is an alpha space. It is where humanity begins, a place where, in the moment, mortality is banished and there is no dark night of the soul. It is a place of hope and expectation –it should not be otherwise or all is lost…
But we cannot sweep the inevitable behind a curtain for long; the curtain moves; the patterns change and we mourn and then celebrate the new. It is necessary: too soon we all will find ourselves and those we love in the company of the mourned.
It is hard to put ourselves in that place, but we feel with Dylan Thomas when he writes:
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
It seems natural to cling to the only thing we have experienced: Life. We have crowned it with sanctity and clothed it in holy vesture for a reason –it is all we know for certain. All else is faith. Persuasion. Myth. Hope.
Most of us do not meet Death in our daily lives. Indeed we insulate ourselves and our children from it as if it were a disease -a contagion which, once met, may consume us by its very nearness. As if breathing it, watching it, or touching it contaminates us. As if by ignoring it, we will postpone our own personal encounter and move our name further down the roster.
And yet there is much to be said for attending to it, however peripherally. We fear the sudden stranger more than the as yet unexpected visitor whose name we almost recognize, and whose expression we acknowledge, however reluctantly.
This is not to say we should surrender the ghost without a struggle –the terms are sometimes negotiable. It’s the codicil of which we must be mindful -what else it requires. Or subtracts.
Anguish –suffering- may be a part of the human condition, but when it is endless, irremediable and pointless, one may well question its prolongation. Horace’s exhortation: Dulce et decorum est pro patria mori goes a bit too far, perhaps, and is clearly intended for different a circumstance, but it is at least an acknowledgement that even Death may be preferable to Life under intolerable conditions.
The point of this essay, as you may have guessed, is to question how much suffering is too much, and whether there is ever a moral –and perhaps ethical– need to intervene. The obvious consequence of that intervention, however, is where the controversy lies; if the suffering is too great, is intolerable, immutable, should there be a right to death? Must we do everything in our powers to prolong the agony? Or can we –should we- grant passage into that other realm of which we know so little -the dark Magisterium of others? And what if the sufferer herself requests it? Does that change anything –or do we merely assume she is asking under duress and therefore cannot be believed? An excuse not to act.
I was drawn to the subject by an article in the BBC news in which no less a personage than the retired South African Anglican prelate Desmond Tutu commented on the right to die: http://www.bbc.co.uk/news/uk-28282323 The article also discusses, and has links to, the issue of ‘assisted dying’ and various church and UK governmental positions on it.
Assisted dying is an issue that is troubling, to say the least. Ironically it has risen in importance in tandem with our ability to prolong life, but not necessarily mitigate suffering. That we are able to transit a woman with advanced ovarian cancer to an ileostomy bag and a wig may seem like progress to some, but unduly punitive to others. That someone might feel cheated, not just of health but even of hope, is understandable. We are tempted –dare I say inveigled?- to make treatment decisions not fully understanding that what is offered may not be a cure, sometimes not even an amelioration, but simply a postponement. We are all fond of wishful thinking –even doctors.
But then what? What does one do when further survival is not only pointless, but intolerable? When analgesia is not enough? When deterioration is felt in the core of one’s being and this devalues that which we have always held sacred: our ability to recognize the person we have always been? Surely mercy should dictate our help, and compassion our decision. I hope that in a society as humane and sympathetic as ours purports to be, no one actually conflates aquiescing to a request for help in ending unbearable suffering, with ending a life without a reasonably and ethically obtained consent. And now that even some in the Church are beginning to espouse a right to die, the laws should change. Must change! The laws would force no one, but perhaps enable those who wished to die to do so with some dignity, however tattered, still intact.
I remember a Bill Moyers interview on television many years ago with the American mythologist Joseph Campbell –a man who had a profound influence on me when I was young, both for his writings on comparative religion and mythology, and for the advice that you should ‘follow your bliss’. I think he was dying at the time of the interview, and looked unwell. But there was still an inextinguishable twinkle in his eyes that revealed the man I had always admired -although it was deep inside, and peering out bravely through the curtain of his wrinkled face. I’ve forgotten his exact words in the interview, but his smile convinced me of his belief. He said he thought of his body as a car he’d driven all his life. It had been good to him, and he knew every dint and scrape it had sustained. But when death came and the car stopped, he said he’d merely open the door with a sigh and walk away.
He died in 1987, long before the current assisted dying movement had taken root, but one hopes that when the time came, it was Joseph that got out of that car still following his bliss –not some stranger changed by drugs and wild with pain, raging against the dying of the light.