I want to talk a little bit about death. More specifically, I want to talk about how we die, and how we might think about death in the future. I understand that topic terrifies a large number of people, but stick with me for this short blog post, because it’s incredibly important that we talk about this.
On February 29th 2016, Canadian author and Right to Die activist John Hofsess died in Switzerland, after battling a number of diseases and heart failures for over six years. He died at his own mercy; the perfect ending to a lifetime of advocating people’s right to end their own lives.
On March 1st, John’s final article was published in Toronto Life, where he admitted to helping eight people end their lives in Canada; an act that – if caught – would have classified him as a murderer and possibly served him life in prison. The people he helped end their lives had all asked him for his assistance, and would have died in much more pain, had he not offered his services. Still, however, the Canadian penal code would have treated him the same way they would a serial killer who murders people in cold blood, consent or no consent.
SOMETIMES THERE IS NO OTHER WAY
Assisted suicide – or euthanasia – is legal only in a handful of places. Specifically, around seven countries and a handful of U.S. states. Anywhere else in the world, you could potentially serve a long time behind bars for ending another human being’s suffering, even if you have their written consent. And the arguments against it are typically the same two: People can change their minds, and it’s a slippery slope to helping depressed teenagers end their own lives.
Let’s look at the first argument, that people may regret their decision in the final moments of their lives. I’ll start by quoting John Hofsess, straight from his own article:
Looking into his eyes, respecting his intellect, hearing his wishes repeated over time, knowing him to be an independent person and thinker, I needed no further assurance that he, in a rational state, had authorized me to be his agent and partner in ending his life. All he would have to do was sip his wine and say farewell to the love of his life, while his favourite music played quietly in the background.
– John Hofsess on the death of poet Al Purdy.
In countries that permit euthanasia, it’s not the open-and-shut kind of case that opponents of the law typically describe it as. In Netherlands, for example, several conditions have to be met. Among those is a requirement that the patient requesting termination of their life is suffering unbearably, and has no chance of improving their health. It also requires them to consistently stand by their wish, to express no doubt, and to know all the details of their condition and the options available to ease the suffering. If, however, the patient still wishes to go through with the procedure, their wish is ultimately respected, and their lives will be ended at their own mercy.
WE CAN’T ALWAYS PREVENT DEATH, SO LET’S PREPARE FOR IT INSTEAD
BJ Miller, a palliative care physician at Zen Hospice Project, held a TEDtalk in March 2015 titled “what really matters at the end of life.” I urge you to see it for yourself, but I’ll give you some of the more important points here. BJ talks about the people in his care at the hospice, and how – once they realize death is waiting on the doorstep – change their priorities in life almost completely. He recalls one of their residents, Janette, whose breathing is getting more and more difficult due to ALS. She wants to take up smoking again. BJ acknowledges the morbid irony, but Janette’s reasoning is almost impossibly profound: “She simply wants to feel her lungs while she still has them.”
So much of our lives are spent keeping death at bay, extending our lives, and we’re perfectly happy not even acknowledging death; so it’s no surprise that we’re not prepared to deal with people who are perfectly content with the fact that they will not see this New Year, or the next. When people are terminally ill, we put them in hospital rooms that monitor every heartbeat, we drug them until the pain subsides, and we offer them this sterile, quiet environment in which their lives seem to drag on endlessly, and – even worse – pointlessly. It is so important for us to stay alive, that we will not allow others to make that decision for themselves.
We have to understand that it is impossible to see the world through the eyes of people living with terminal illness, when we are not in those shoes ourselves. But these people understand their condition, they know what the future has in store for them; and we cannot deny them the choice. When someone has suffered from lung cancer for two years, and knows it won’t get better, he’s not going to suddenly change his mind on his death-bed. He’s already on it, and he knows it. So let us trust that he knows, better than us, whether he wishes to go through the pain.
So let’s look at the second argument; that it’s a slippery slope. Before we know it, we’ll have physicians killing people against their wishes, and depressed teenagers requesting euthanasia like you order a Happy Meal. Here’s the short rebuttal, before we get to the longer one:
In the most recent review paper on euthanasia in the Netherlands, namely the 2009 paper entitled Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain? written by researchers from the Department of Public Health in the Netherlands, it was found that “public control and transparency of the practice of euthanasia is to a large extent possible” and that “[n]o slippery slope seems to have occurred”. The researchers find that the legalization of euthanasia in the Netherlands did not result in a slippery slope for medical end-of-life practices because:
The frequency of ending of life without explicit patient request did not increase over the studied years;
There is no evidence for a higher frequency of euthanasia, compared with background populations, among:
people with low educational status
the physically disabled or chronically ill
people with psychiatric illnesses including depression
racial or ethnic minorities.
Euthanasia doesn’t work the way suicide does. It cannot be an impulse decision; it requires several psychological assessments, not only by doctors and physicians, but typically also psychiatrists and other trained professional. Their one and only job is to determine whether or not you really, truly want end-of-life assistance, or if you’re simply acting out of spontaneous desperation. And that’s all adding to the conditions we previously discussed, namely that the patient has to be suffering and unable to improve their condition regardless of the medical procedures offered. Quite simply, even if it’s legal to die at the hand of your physician, it’s not easy; and those who go through it, really want it. So who are we to judge for them, that they have to suffer through their cancer every day, only to eventually die anyway? Let us treat death with dignity instead of desperation. And more importantly, let’s treat peoples life with the respect we would want for our own.
So, as we commemorate John Hofsess and the Right To Die activists; and as we celebrate Canada’s recent ruling that permitted assisted suicide, let’s try to expand the law so that everyone, everywhere can die with the dignity they deserve. I know I would want that dignity in my own life.