End-of-Life Planning and A Noble Death?
Someone tell me: Just how did it happen that I need to defend my right to die? Death is part of life, the tail end of a bargain none of us struck. Asserting that I have a right to die is gibberish. Would that I had a right to remain alive; that would be a right worth any fight. Death is a necessity, not a right.
But we must assert the right to die against government. Somehow, the state has become a guarantor of life, a gift it did not give. We must assert the right to die and to remain autonomous against the power of strangers who would seek to keep us alive against our will, but not forever. We must live until nature defeats the sovereign; only when necessity speaks does the state yield. This is obscene.
When we fall terminally ill, government says assisted suicide is a crime. The law presumes that suicide is the product of a diseased mind, and a person can be compelled to receive treatment they do not want. The mad imperative to breathe every last breath inspires medical technology to battle against the inevitable as though it were noble to deny the obvious.
How did this happen?
I happened upon a great book about death the other day: A Noble Death: Suicide and Martyrdom Among Christians and Jews in Antiquity, written by two Bible scholars, Arthur Droge and James Tabor, and published in 1992. The authors were inspired to write the book by the right to die controversy in our time, and by listening to Christian apologists assert that the Church had forever outlawed acts of self-destruction. The authors argue convincingly that this tradition of outlawing suicide, a term foreign to ancient languages, took form and lasting shape only with the writings of Saint Augustine in the fifth century of the Common Era. For 800 years, from the time of Socrates' trial and death until Augustine, there was a vibrant tradition holding that self-destruction was not only acceptable, but justified in certain circumstances.
I was drawn to the book for two reasons: First, a general interest in ancient social thought at or about the time of the Jesus' crucifixion. Second, a struggle with the prospect of client suicides, a not uncommon prospect in a law practice devoted to the defense of serious felony accusations. I recall an occasion when, upon being informed of an attempted suicide, my response was simply to observe that given the situation in which the client found himself, suicide was not an unreasonable response. If the point is not to live, but, as Socrates is reported to have said, to live well, it seems logical to conclude that there comes a point at which the weight of sorrow is far heavier than the benefit of remaining alive. I can imagine reaching a point in which I would prefer simply to let the light within flicker and die than to linger in half-lit agony.
So I was relieved to read in yesterday's New York Times that a new Medicare regulation will permit doctors to engage in end-of-life planning with patients. And I shuddered to think of the chatter about "death panels" that the right will use to denounce the regulations. The absence of end-of-life planning easily translates into a guarantee that each of us shall be forced to breathe our last amid the agony of pumps and the machinery of artificial life, even if we prefer otherwise. The fear of litigation will prevent any physician from engaging in anything other than so-called heroic acts until we gasp our last. I say let those who want to cling to every moment do so; those who want death with dignity, or who say enough when life becomes simply a statistical fact devoid of satisfaction, should be permitted to say their goodbyes in their own way and in their own time. The state did not give life; it should impose no limits on life's end.
Of course, what motivates fear about end-of-life planning is the prospect of euthanasia: the government's deciding when the fight should stop. A person who wants to continue the battle, no matter how futile, should not be told by government when the fight should cease. That is true. What should unite right and left in this debate is a concern with human autonomy and dignity. End-of-life planning permits the world weary to say good bye; those who want every moment should be permitted to fight to the end.
How to draw the line between a life ended too soon, and one taken at the right time and for the right reason, is a an old an ancient topic. The ancients recognized that there was a time to die. The gods, or God, as the case may be, could signal when the right time to die had arrived. This was the tradition before Augustine made any act of self-destruction a mortal sin. The ancients seem never to have advanced much beyond the justification for Socrates' decision to submit to death in Athens after being convicted of corrupting the city's youth with his irreligious teaching: He was offered exile, but he chose, honorably, death, reasoning his time had come. Plato's Phaedo still teaches about death with dignity.
Droge and Tabor's work reflects an eight hundred year tradition that recognized a right to self-destruction under limited circumstances. Sure, there could be, and were, excesses. Dualistic thinking that made the world a prison for the soul suggested a too easy set of keys with which to set a soul free; and there was a time when Christians were too keen on suffering -- the invitation to take up their own crosses to follow Christ was taken as too literal an invitation. But this tradition seems less frightening than one which regards death as an unmitigated evil to avoid at all costs. One consequences of this worldview has been the empowerment of the state with police powers designed to keep us alive at all costs and against our will. Just how a state conceived as one of limited powers acquired this right is a mystery.
A Noble Death is a great place to start reading about a tradition that cared more for the dignity of people than we do now. A culture than understood death to be part of life, put the living in control of their destiny. The same cannot be said of our time, a time that regards death as so alien and so threatening that we sacrifice our liberty, autonomy and self-respect to the state to avoid the inevitable.