the choice to die

In contemporary western society, the relationship between death and us is constantly evolving. Death is a natural inevitability of life - but is it actually something beyond our control? And, should that be the case?

 

The complexity of death manifests itself in many ways - firstly, and most obviously, in the societal anxiety surrounding confronting and interacting with death. If social commentary surrounding euthanasia and assisted suicide is anything to go by, we tend to defend a particular dynamic between death and choice: death should choose us, and not the other way around.

 

Even after a choice has been made, there are other unavoidable decisions that manifest when death presents itself: The “chores” that comes with dying, like creating a last testament and will, for example. When is the right time to write one? Who should it include? What should be left behind? What is important to pass on, and what is not? 

 

The suffering that death involves adds another layer of complexity: a particular death could involve a great amount of pain, the final tortuous punctuation of a progression of worsening circumstances. If the death is surprising, it causes a wave of tragic suffering to the lives of those connected, now suddenly faced with a slew of unexpected holes to fill.

 

Then, there are the questions one must confront if we find ourselves in a position where we have a say over the conditions of our own death. What kind of death would you accept? How long will you delay the inevitable? What should you prioritise in that instance: more time? Comfort? Other people’s comfort? 

 

Basically, for something that is largely subject to chance and beyond our control, there are a lot of things that are suddenly thrust upon us that we are expected to control. People, by and large, tend to avoid making these decisions for as long as possible; rather keep your head in the sand, blinded but safe, than confront the truth that one day we will cease to exist.

 

There is, however, a place where death is planned for. It is a place I am very familiar with. In a hospital, death is, for the most part, prevented - but, it is also (at least in theory) accepted.  And when something can be acknowledged, it can be proceduralised… introducing rules, regulations, ideas of what is and isn’t acceptable… and goals or outcomes - like comfort.

 

Modern society has created many ways in which we start to be allowed to be part of the choice to die. 

 

For some, the decision is up to God, though this is complicated by medical interventions humankind can provide, which may seem at odds with God’s authority over our fate.  There is general support for the religious patient inside a hospital. Thus, the religious patient often feels a sense of peace; they are allowed to make choices that are accepted and in line with their values. 

 

The voices of the religious are also the strongest in the opposition to an active decision to die. From this perspective, making a choice for your own death is disrespecting the life that was gifted to and intended for you by God. But what might influence our desire for active participation (in euthanasia, or suicide) in death?

 

Perhaps introducing choice to something as terrifying as death is a way to introduce autonomy into an otherwise powerless situation.  

 

For some, it is about deciding how much your body needs to fight, and as a result how much your body does not need to be subjected to. For some, it’s about whether you are comfortable with letting your body deteriorate “naturally”, and about considering options when it comes to intervention and providing treatment that might prolong your life: maybe a day, a week, a month, a year, depending on all of the above. 

 

Advanced care directives and resuscitation plans are increasingly integrated into regular treatment within medical care. It becomes introduced into patient care not only when someone is already dying, but even (and perhaps more appropriately) when they are well and clear enough to make decisions based on their core values and beliefs, rather than in a state of high stress.

 

This progress reflects the changing health dynamic where patients and their families are empowered, to the point of being responsible, to make these choices, though often in highly emotional times associated with a sense of fear and loss that lead to irrational (but understandable) decisions.

 

In the meantime, the countries that allow deaths assisted by medical professionals include Netherlands, Belgium, Colombia and Luxembourg. As of 2016, assisted suicide is legal in Switzerland, Germany, Japan and Canada, as well as the US states of Washington, Oregon, Colorado, Vermont, Montana, Washington DC and California. In Washington (where Euthanasia is legal), 166 reported cases of physician assisted deaths occurred in 2015 - and 5,516 deaths due to Euthanasia in the Netherlands.  And these are only the ones that are confirmed to be motivated by this.

 

At the extremes of the choice spectrum are euthanasia (not necessarily involving the assistance of a medical professional), and suicide. In 2015, 3,027 suicides occurred in Australia.The percentage of violent suicides, or those perpetrated by those with mental illness is high. In the case of suicide, we will never know for sure whether this was the “right choice”, as there are no external filters to check the logic of the one who dies.

 

Our opposition to both suicide and euthanasia stem from the supposition that death is a bad thing, in that it opposes life, the definitive element of our existence. It presumes that those in the unique position to choose death (an unnatural and unimaginable position for many) do so with a skewed perception. It even assumes, perhaps, that people who make the decision to end their own life are doing so because they don’t understand the severity of their decision, or don’t have capacity.

 

But, choosing to die is hardly an easy decision- Even those in the midst of a deep depression, where death seems a kind relief or an appealing alternative to a life which has already hit a point beyond bearability, will tell you this. Is there a way, however, to introduce ways to decide who is and isn't fit to make this kind of decision?

 

The key issues include:

• Capacity- like mental illness eg depression

• Prognosis- and the potential of a future cure

• Potential- of the individual - the outcome of their staying alive

 

In the case of legalised euthanasia, determining a suitable motivation is perhaps a more challenging problem- because we have the time to work it out.  To assess a person's capacity, determine their likely prognosis and consider their potential.  To ask them the questions we need to ask to be sure we know that the situation can be judged as ‘appropriate’, as ‘qualifying’ for death.

 

And yet we are never sure.  Why?  Because the question is bigger, and smaller, than any of us can ever truly understand. How clear is clear enough, when it comes to consenting to our own death?  How certain is a probability, when it comes to prompting the inevitable?  How important is one more day?  How likely is a ‘what if’ solution?  How bad is the suffering?  How good is life?  How much do we get to own our own lives?  

 

These questions leave us constantly battling with the choices we all need to make with the process of dying.  And yet, all we have to do is die… something that will happen, whether we like it or not.