The Privatisation of Death

Campaigners for the legalisation of assisted suicide argue that the choice to end one’s life is ultimately a personal decision. But is the choice to die ever just personal? asks Joseph Evans. 

George (let’s call him that) was the head of a leading higher education institution. Respected by staff and students, he enjoyed his job, bore the pressure well, and had a real vision for his institution.

He was also my friend. This was all the more remarkable – and says so much about him – because I am a Catholic priest and he was a professed atheist. 

But George was a genuinely open man and, while I was always careful never to try to ram my faith down his throat (not that he would have let me do so), he was always happy to discuss deep questions. And we would do so from time to time.

And then one day, as we were having dinner out together (he always insisted on paying: “I have a good salary, you don’t”), he simply mentioned: “I have terminal cancer.”

At first I didn’t register what he said. Having driven past his comment, I had to reverse to fully take it in. And the months which followed, as I witnessed George’s heroic efforts to live as normally as possible while the cancer invisibly destroyed him, were months for me to try to come to terms with the decline of someone I cared for but who did not share my beliefs.

How could I, as a priest, and George, as an atheist, find common language to speak of the approach of death?

What helped greatly was George’s united family. George had a wonderful wife and marvellous children. And over those months I saw how the cancer made the good even better, bringing out the best in all of them and uniting them ever more.

“George,” I said one day as together we tentatively sought to make sense of what was happening to him, “I’m not going to try to give you a religious argument” (a grateful nod). “But at least let me say this: this cancer might be pretty shitty” (I remember using that word), “yet what I have seen is how it has increased the love in your family. It has brought you all closer together and made you love each other all the more. That love shows there is some sense in all this.”

George assented to this. He knew it was true. And then some weeks later I heard he was dead.

Pedro 

Fast forward a number of years. Pedro Ballester was an extraordinarily gifted and attractive young man. But having earned a place to study Chemical Engineering at the prestigious Imperial College in London, he had been diagnosed with cancer.

I most knew him in the last six months of his life when he had returned to his native Manchester and I was the priest who, having myself moved to that city, had been given the great blessing of supporting him spiritually in his path to death.

Pedro did have faith. A devout Catholic, his three years of intense, often agonising, suffering brought him ever closer to God and led him to have an enormous effect on all those he encountered. People would come to visit him to cheer him up and leave feeling they had been cheered themselves. 

Not long before his death, after so much suffering, Pedro confided to his mother in more or less these words: “If this could help more people, I would go through it all again.” About a month before he died, knowing how little he had to live, he told a young friend: “I have never been happier.”

Fallacious 

What do the deaths of George and Pedro have in common? What did they teach me? They taught me that no death is a uniquely personal matter. We don’t just live or die for ourselves, whether we have religious beliefs or not. We live and die also for others.

And this has convinced me that the principal argument for legalising assisted suicide – that each person’s life is their own possession and so they can decide when to end it – is a fallacious one.

Every life, and every death, is a profoundly social event. The choice to die never affects just the individual alone.

Allowing someone to end their life, and even more helping them to do so, is not just respecting their decision. It is us also deciding that their life has no further value. It is us deciding we have given up on them. And do we ever really have the right to make that decision? Isn’t that always a cowardly and cruel choice?

Choosing to die is claiming that your life no longer has value for yourself or others. But you can never know if that’s the case. And in fact it always can have value. You might feel a burden but you might be bringing out the best in a relative or careworker. To see it even in the most pragmatic, economic terms, your care might be providing much needed employment for some people. In more elevated terms, your care is bringing a bit more love to the world.

Using your autonomy to kill yourself is losing your autonomy. It is not a brave decision any more than driving oneself over a cliff is a brave decision. Certainly, it requires some guts to do so, but ultimately it involves far less courage than living on to face all the suffering one’s condition brings with it.

Simply to live on and suffer brings massive social capital. You are adding to the pool of courage in the world, giving others an example of heroism in the face of forces one cannot control but one can at least face up to bravely. A smile, a squeeze of a hand, in one’s incapacity could speak volumes to others. And you are adding value to the lives of others by giving them the opportunity to care.

There is no such thing as a uniquely personal decision. Personal decisions affect society. Death is too important a matter to leave to individual choice. 

Who are you, you alone, to say your life has ceased to have meaning? Is your own subjective sense a sufficient guide to decide this, particularly when your judgement might be impaired by the suffering you are going through?

Religious answers

Different religions have all tried to find answers to the conundrum which suffering and death are. Islam and Judaism see them as a mystery which we simply have to accept. God’s plans are beyond our understanding and our merit, our growth, is in accepting this.

Buddhism sees suffering as a test: am I able, even in this, to be totally dispassionate, to achieve in intense suffering a freedom from passion which will eventually lead to my being freed from the cycle of birth and death?

One might disagree with these. I myself see the Buddhist position as very mistaken and the Islamic and Jewish visions as correct but still limited. Yet religious approaches to suffering can’t simply be ignored as they are expressions of sincere, and often deeply thoughtful, reflection on the mystery of suffering and human mortality. 

They have a right to be taken seriously, and even more so when non-religious approaches to suffering and death are so shallow. The most common secular response to these is to see them as nonsensical curses which, when they cannot be eliminated, must be borne because there is no other choice. And in the name of personal autonomy, in a context of intense, prolonged suffering or a subjective sense of meaninglessness, I can end my own life.

Is this really any better than a religious approach? Besides, who can properly assess what meaninglessness is? And who knows whether a change of circumstance, such as improved, more creative, care, might not end this subjective impression?

The Christian approach to suffering and death is what most gives these meaning. We believe that God did not give us a theoretical answer to them, in a sense recognising himself that in so many ways they do not and cannot ever make sense. But God chose to enter human suffering and death himself, as Jesus Christ, to transform them through love and turn the curse into a source of blessing. Suffering borne for love begins to make sense, if not necessarily in theory, at least in practice.

Escape culture 

Someone told me recently about his experience of seeing numerous people he knows getting divorced. He talked of the ‘divorce points’ in relationships, the various crises which can drive a couple apart. But this is because divorce is possible. And not surprisingly, it has become more common than stable marriage in the places where it is legalised, leading to much unhappiness, broken families and a profusion of psychological problems. But with better help, divorce points could become challenge points, growth points, where each person learns to face up to their own defects in order to make the relationship work. 

We have entered into an escape culture where, if one has a problem, one runs away rather than growing in courage and self-awareness to face it. 

We now want to escape from suffering rather than learn all the lessons it can teach. We want to offer a lethal injection rather than invest in the palliative care which will most help people face their suffering with dignity. There is no dignity in giving someone a lethal injection or taking an overdose.

We trumpet autonomy as the ultimate value but it can easily fall into abdication of a challenge.

But accepting that we cannot control everything can lead to growth, courage and mutual support. The experience of dying can become a great growth point for all involved in it. Paradoxically, as we decline we grow, individually and as a community.

In our capitalist society, privatisation is vaunted as the way towards lower prices and better services, giving the consumer more choice. Others can judge better than I can whether or not collective ownership might be better in some circumstances. But what I can say is that we have to be careful lest this mentality spreads to other areas of life. Not everything can be judged in terms of cost-effectiveness and choice. We cannot privatise death.

Doctor-patient

And finally, introducing assisted suicide will also radically change the patient-doctor relationship. Here too, the choice to die is never a uniquely personal choice. Doctors and healthcare workers will suddenly find themselves at least pressurised, and with time perhaps obliged, to cede to a patient’s wish to end their life. As one young clinician put it (one, coincidentally, without religious beliefs), “I didn’t become a doctor for this”.

A doctor has to be someone you can trust absolutely, who, beyond personal opinion, beyond even your opinion, will keep you alive because he or she is charged by society and their professional calling to do so. 

He will only ever try to keep you alive, using every reasonable means to reduce your suffering and help you face the dying process with as much dignity as possible. The moment might come when she has to accept the inevitable, she cannot keep you alive, but that is recognising a situation beyond her power. It is not taking your life into his or her hands, even with your permission.

We need to re-think personal autonomy. Our choices affect others. Our good choices help them, our bad ones harm them. With assisted suicide too many people risk facing the harmful consequences of bad choices, and not just the people who make them.

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