Friday, April 22, 2011


I'm thinking about death because today is my birthday, and birthdays are days for reflection. I have now undeniably used more than half of the upper extremity of years granted me by the 90th Psalm and must face the real prospect that, by the pure mathematical progress of years, there are fewer ahead of me than behind.

Death. It happens to the best of us. I’m not particularly afraid of it — the prospect is more disappointing than anything else — but most deaths these days are drawn out, painful, and personally degrading. Consequently, I want the event to be as brief and trouble-free for me and everyone else when the moment comes, and indeed I’m trying to avoid it, if at all possible. Douglas Adams wrote that the “trick” to flying is to throw yourself at the ground and miss. When the moment comes, I intend to hurl myself, unflinching, at death. And hope to miss.

Many Christians say that life must be considered sacred from “conception to natural death”, although polls show that most of them are willing to make exceptions in cases where they have something personally invested in the matter. I’ll leave the argument about my views on fetal life for another time. Let me instead observe that in our society there is very rarely such a thing as “natural death.”  Most dying patients receive highly unnatural forms of palliative care, which often involves essentially stupefying them for their last few days. But there is far more to it than that, even. In the modern western world, even before we are born, we begin to receive the most radical and decidedly unnatural forms of medical treatment and intervention to extend our lives for as long as possible. Any pregnant woman who has had an ultrasound, teenager who has had symptomatic wisdom teeth removed, middle-aged man who has a prescription for blood-pressure; anyone at all who has had antibiotics for a serious infection, stitches to close a wound, a suspicious mole removed, or his tonsils taken out, simply cannot believe in the concept of a “natural death.”  If we allowed “nature” to take its course the majority of us would have gone down to the same fate as the majority of people throughout history: we would have died in childhood.

Now, to the moment of death. 
If we are of sound mind we have a right, of course, to refuse treatment, and when we are incapable of making it for ourselves our family usually is permitted to make it for us. The decision to “pull the plug” is made by thousands of people every day when it is a clear that their brain-dead loved ones are being kept alive only in the sense of having a machine respirate for them. No one serious denies this right, as theoretically machines could keep us all respirating indefinitely, long after the brain has ceased to function. This is non-controversial.

Now, let me put another case to you. Supposing I have been diagnosed with a terminal disease and, at some late point in the disease’s progress, only pain, misery, and total loss of dignity lies ahead.  I have an undeniable right to refuse treatment, of course, but with the consequent and probably quite unbearable pain that would accompany such a decision; I have the right to receive large doses of painkillers and spend my last days or weeks in a narcotic haze, which is the standard method of passing for most people nowadays.  However, I do not have the right, not even in the clearest of mental states, to ask a physician to give me a lethal dose of drugs to end my life as quickly as possible.

Well, not quite. I can ask, but as matters stand no physician in Canada legally can fulfill my request. He or she can leave me dead to the world but not actually dead. But why not? There are, of course, serious concerns about the administration of such treatments, were they to be legal. There would have to be careful safeguards to ensure that people with reasonable prospects for recovery don’t end their lives prematurely. We mustn’t have angst-ridden teenagers showing up at our hospitals, asking for lethal injections because they can’t go on after their most recent breakup. But if I am in the later phases of a terminal illness, with no reasonable prospect of recovery and – most crucially – I have been professionally determined to be of sound mind, I see no grounds on which I ought not be permitted to choose to dispossess myself of the one thing that is most my own: my life. The easiest method for doing so would be to ask for the assistance of a willing physician to administer a lethal dose of painkillers.

And why can’t I? There is one answer. Because of opposition on religious grounds, by those who maintain that even fully consensual, physician-assisted suicide that meets precise criteria is a violation of the principle that life is sacred until “natural” death, even though very few of them really believe in the concept of “natural death” at all. In this regard, the only people who are being consistent are those members of certain religious minorities who refuse nearly all medical treatments on the grounds that it is a violation of God’s will. I regard this as perverse, but at least it has the virtue of consistency.

Canada’s constitution guarantees me religious freedom — a freedom which must necessarily include the freedom to be free from the religiously motivated dictates of others. I therefore regard my inability to secure a physician assisted suicide as a violation of my constitutional rights. Some will attempt to make the argument that all of our laws have religious antecedents, and that therefore my argument applies equally to laws against murder, rape, theft, and the like.  But there are many grounds for opposing such crimes quite apart from the fact that there are religious proscriptions against them. The conditions of human solidarity and of maintaining human society require them whether your particular god wants them or not. By contrast, secular objections to fulfilling the wish of a terminally ill and clear-minded individual to expedite the process are harder to locate. 

It goes without saying, of course, that no physician should ever be forced against his or her conscience or under threat of professional sanction to terminate someone’s life; we all recognize that the decision to end a life is, from both sacred and secular perspectives, a momentous one. The suggestion will be made, of course, that to permit physician assisted suicide will serve to further the secular society’s cruelest failing of all: the supposed devaluation of human existence.  But as a historian of war and conflict, I am not at all convinced that, in proportional terms, the century recently concluded was any more violent than others that preceded it nor indeed that it valued life less.   Indeed, allow me to suggest that it is possible that from a secular perspective the value of life is even greater – it has an inherent and intrinsic value, because it is the only life that we will ever have.


Graham Broad said...

This early update brought to you on the occasion of my 41st birthday.

The painting above is "Death and the Maiden" by Egon Schiele, who knew what he was painting about.

KStarr said...

Firstly, happy birthday! I have continued to follow your blog since I was your student in American history, and I always find it very thought-provoking.

Have you read "The Death of Ivan Ilyich" by Tolstoy? It is quite possibly the most frightening and morally degrading story of one man's death that I have ever read, and there's a chilling description of the process of dying as "a black sack into which he was being thrust by an unseen resistless force."