Humanist Perspectives: issue 187: Death Without Hysteria

Death Without Hysteria
by J. Anthony Cassils

D

eath and suicide go to the heart of core issues regarding the purpose and value of human existence. They focus on that controversial point where the general fear of death and human volition meet. They involve two key characteristics of the human animal: self-consciousness and, as a social animal, the need to interact with others of his or her kind. The human fascination with these issues has created a maelstrom of ideas derived from philosophy, religion, politics and, more recently, from sociology, psychology and the field of medicine. They raise questions relating to the duties and rights of the individual as opposed to the rights and duties of the state. Does an individual have a right to take his or her own life? Does the state have an obligation to oppose or assist a rational person who chooses suicide? The written record on these issues extends back about 2,400 years to Plato and Zeno the Stoic, who, of course, presented opposing views. Contemporary attitudes and laws pertaining to suicide have emerged from this tangled inheritance.

BETTER HEALTHCARE is reducing the fatality rate of many illnesses that used to bring a quick death. The consequence is a rapidly growing cohort of seniors condemned to a long debilitating decline with impaired functions.

The catalyst for writing this paper is the emergence of a serious problem which has not been addressed adequately in Canada. People are living longer than ever. Better healthcare is reducing the fatality rate of many illnesses that used to bring a quick death. The consequence is a rapidly growing cohort of seniors condemned to a long debilitating decline with impaired functions. Some would prefer to end their own lives to avoid the pain, frustration and cost of a long period of incapacity. Existing laws make the implementation of that decision unnecessarily difficult and lack compassion.

To address the problem, this paper will propose a solution in the context of the following headings:

  • Humans are often hysterical about death and suicide;
  • Fear of death gives rise to activities that imperil the Ecosphere and civilization;
  • Ecological ethics will transform attitudes to death and suicide;
  • A proposed solution;
  • Barriers to a solution;
  • Removing the taboo from suicide.
Low
Photo from 2001: Steve Russell, Toronto Star file photo
Humans are often hysterical about death and suicide

In 1973, Ernest Becker, in his Pulitzer Prize winning book The Denial of Death, wrote that

...the idea of death, the fear of it, haunts the human animal like nothing else; it is the mainspring of human activity – activity designed largely to avoid the fatality of death, to overcome it by denying in some way that it is the final destiny for man….To be sure, primitives often celebrate death because they believe that death is the ultimate promotion, the final ritual elevation to a higher form of life, to the enjoyment of eternity in some form. Most modern Westerners have trouble believing this anymore, which is what makes the fear of death so prominent a part of our psychological make-up.1

Nothing displays the human fear of death as clearly as the existence of some widely-followed religions with millions of members held together by shared beliefs in some form of afterlife. However improbable these beliefs may be, they gain power from groupthink and become true for members because others in their religion believe in them. Not to believe entails the punishment of expulsion from the group.

As the power of religion has waned, the state has filled the vacuum and defines the duties and rights of its citizen. Like most religions, the state demands allegiance, at least indirectly, to ideas that enter the realm of the fantastic. Those who create and purvey these fantasies to the general public are well aware of their lies, but they know that promises of a brighter future pacify populations and make them easier to govern. In this vein, contemporary Western states genuflect before the idol of “the economy” which must grow continuously on a finite planet to supply abundant consumer goods so as to assuage, with more of everything, the gnawing human fear that enough is never enough. Membership is rendered more secure by overlooking the disastrous environmental impact of human numbers and insatiable consumption. Advertising reinforces the ritual of consumption and urges consumers to snap up trinkets like the latest iPhones with a fervour once reserved for those who used to buy indulgences.

Fear of death gives rise to activities that imperil the Ecosphere and civilization

The fear has motivated medical advances that have contributed to the exponential growth of human numbers to a point where human demands exceed the capacity of the Earth to meet those needs on a sustainable basis.

Awareness of death sharpens the desire to consume more on the presumption that living well means having more of the accoutrements of the “good life.” As social animals, humans mimic one another and, if others have more, those with less do their best to emulate them. For example, travel has always been a sought-after luxury and the experience of it has conferred some prestige on the traveller. Now the advent of mass tourism finds some tourists striving to see as many countries as they can before they die. Even though many know better, they overlook that an aircraft on a middle distance trip consumes as much fuel per passenger as the average person uses to drive a car for a year and ejects the greenhouse gases into the upper atmosphere where they cause the most damage.

...an aircraft on a middle distance trip consumes as much fuel per passenger as the average person uses to drive a car for a year...

The life force is opportunistic and takes immediate and full advantage of any opening. Now, as a result of human actions, the atmosphere warms, the oceans acidify, fisheries collapse, underground aquifers are drained, forests are flattened and the soil is eroded and/or filled with chemicals, many of which are detrimental to life.

It is ironic that the fear of death has instigated individual human activities that, collectively, threaten all life on Earth.

Ecological ethics will transform attitudes to death and suicide

Ecology is an integrative science that changes the scope of ethics by making clear that everything is connected to everything else and that there is an interdependence among human beings, other life forms, and the elements. This enlarges the scope of ethics from a preoccupation with human-centered concerns to include the impact of human activities on all life.

Ecological ethics transcends the duality of the debate between the rights and duties of the individual, and the rights and duties of the state, to include another dimension – the duties of both the individual and the state, either separately or together, to contribute to the health of the Ecosphere. This creates new tensions. What are ecologically informed people to do if the countries where they live accept the fantasy of continuous economic growth on a finite planet even when it is evident that some critical limits have been exceeded already? How does an individual respond when his or her national government continues to support policies to produce and consume more fossil fuels while overlooking the perils of climate change? The individual has a duty to the Ecosphere and, among a number of options, may choose to reduce the burden on the planet by shortening his or her own life. Since a huge human population is destructive to all life, an act to reduce that impact is laudatory, a personal sacrifice for the public good as defined by the informed individual and not necessarily by the state, whose leaders may have become corrupt and self-serving with a short-term perspective. It is time to put aside the instinctive fear of death and to accept that suicide can be a public good worthy of support in some circumstances.

A proposed solution

Every person of adult age and of sound mind should have the right to die at a time of his or her choosing, and appropriate drugs should be readily available to ensure a quick, painless and peaceful death. The drugs and dosages to achieve this end should be scientifically determined so that the user will have confidence that they will do the job as expected.

Let’s consider an example of how suicide could work in the future if these changes were adopted. A man, 77 years old, is diagnosed with cancer. It can be treated, but at considerable pain, and the outcome is by no means assured. Since the man is an avid outdoorsman who does not want to live with diminished capacity, he makes the decision to end his life. He goes to a special public agency to make his case and is prescribed some lethal drugs. He discusses the matter with his wife and children, puts his affairs in order and then arranges a gathering to say farewell to friends and family. At the time chosen by him, he takes the lethal drugs with immediate family nearby. He goes to sleep and dies peacefully within half an hour.

This is a gentle way of dying. It causes few shocks. Issues can be discussed and resolved beforehand.

This is a gentle way of dying. It causes few shocks. Issues can be discussed and resolved beforehand. Public costs and social burdens associated with the end of life are kept to a minimum. It is a rational approach to death. However, given the ever present fear of death, it is an unlikely choice for many. The important thing is that there should be a choice. Giving the individual a choice over when and how death comes can reduce anxiety. A week before his recent death, Dr. Donald Low, the infectious disease specialist who shepherded Toronto through the 2003 SARS crisis, expressed those feelings well in a videotaped appeal for Canada to legalize assisted suicide and let people die with dignity. “I know it’s going to end, it’s never going to get better. So, I’m going to die. What worries me is how I’m going to die.” He hoped to face death “without the fear of death itself.” But he worried death would be long and protracted, and that he would not be able “…to carry out my normal bodily functions, and talk with my family and enjoy the last few days of my life.”2

Certainly, some laws and regulations governing the implementation of the proposed solution would be required but these need not be onerous, as can be observed from precedents established in other jurisdictions such as Switzerland and the Netherlands.

Barriers to a Solution

Emotion over Reason – Since the issues of death and suicide are emotionally charged, many will latch onto positions they find comforting, making them unwilling to part with their pet doctrines. This atmosphere provides thin soil for reason.

Muddled Thinking – Many fail to understand the differences among assisted suicide and doctor-assisted suicide (both done with express consent) and euthanasia, which is mercy-killing without the consent of the person acted upon.

Commentaries on death and suicide have a long recorded history. Many related insights gathered over the millennia surface in contemporary debates, but the ideas have not been well integrated. To understand the depth of the confusion, it is helpful to set out a synopsis of the debate about suicide.

Plato took a strong stand that suicide is disgraceful and that its perpetrators should be buried in unmarked graves. He allowed for some minor and narrow exceptions. Aristotle was more ambivalent and concluded that self-killing does not treat oneself unjustly so long as it is done voluntarily because the harm done to oneself is consensual. However, he still viewed it as a form of wrong to the state or community.

In the eighteenth century, David Hume wrote most convincingly in support of suicide in certain circumstances. He considered the dominant Christian view of suicide muddled and superstitious.

To the contemporary reader, the texts of Plato and Aristotle overemphasize the social roles and obligations of the individual and display a relative lack of concern for individual well-being or autonomy. This gap was soon filled by the Stoics who held that when the means of leading a naturally flourishing life are not available to an individual, suicide may be justified. The Roman Stoic, Seneca, claimed that the focus should be on living well, not on mere living, since a wise person lives as long as he ought, not as long as he can. Seneca and the Stoics emphasized the quality, not the quantity, of one’s life.

The coming of Christianity brought a blanket prohibition on suicide, even though there was nothing in the Scriptures expressly forbidding it. St. Augustine is generally credited with the prohibition which he saw as a natural extension of the fifth commandment “Thou shalt not kill.” It is remarkable that Augustine’s facile argument for prohibition endured for many centuries, since a logical extension of the fifth commandment would require complete pacifism, thus forbidding martyrdom, crusades and the frequent wars that were endemic to Europe after the fall of the Western Roman Empire. It was not until the Renaissance that the rediscovery of the ancient texts precipitated a slow thaw that led eventually to the Enlightenment and to views on suicide that differed from the traditional Christian stance.

In the eighteenth century, David Hume wrote most convincingly in support of suicide in certain circumstances. He considered the dominant Christian view of suicide muddled and superstitious. In his opinion, suicide does not necessarily violate any duties toward other people. Reciprocity may require a person to benefit society in return for what was given by society, but all individuals reach a point when they provide at best a “frivolous advantage” while causing significant hardship to themselves. If they become a burden to society, it is even laudable for them to choose death. Hume rejects the thesis that suicide violates the duty to oneself when misfortune leads to misery that is worse than death. For those who argued that opening the door to suicide a crack would lead to a slippery slope, Hume stressed that the natural fear of death was sufficient to ensure that suicide would not be committed capriciously, and that only after careful deliberation and assessment of their future prospects would people have the clarity and the courage of mind to kill themselves.

By the twentieth century, sociologists and psychologists viewed suicide as a social ill reflecting widespread alienation caused by the stress of modernity. Some European nations considered suicide to be a sign of cultural decline, leading policy makers and medical doctors to emphasize suicide prevention and even to institutionalize suicidal persons. This approach sides with those who view suicide from the perspective of the good of the state while downplaying the autonomy of the individual. The existential philosophers provided a counter-balance by maintaining that suicide was not a choice shaped mainly by moral considerations but by each individual’s concerns as the sole source of meaning in a meaningless universe.3

...one logical place to start is to allow assisted suicide when requested by those who are in a terminal illness and near death.

At the present time in Canada and many other countries, suicide still evokes strong negative emotional and moral connotations. Most policy makers consider suicide a social ill that should be discouraged even if it cannot always be prevented. Some institutions like the World Health Organization (WHO) keep meticulous records of national rates of suicide and view rising rates with concern. The WHO notes that “Every year, almost one million people die from suicide; a ‘global’ mortality rate of 16 per 100,000, or one death every 40 seconds. In the last 45 years, suicide rates have increased by 60% worldwide. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998.”4 It is odd that the WHO categorizes suicide as a disease and not as a potentially rational decision made by individuals on an assessment of their misfortune.

Clearly, the WHO sides with those who have argued against suicide and consider it a social and moral wrong. It reflects the preferences of states that want to keep control over their citizens so that they can deploy them for various public activities like military ventures or in miserable jobs spending twelve-hour days in coal mines to maintain the lavish lifestyles of those at the top. Perish the thought that the individual might choose to escape by death from a living hell that nevertheless might be “good for the economy.”

Existing Law in Canada – In 1972, suicide was decriminalized in Canada. Until that year, suicide was punishable by up to 14 years in prison (presumably only in cases where suicides were unsuccessful). Decriminalizing suicide did not resolve the quandary of those of sound mind, in great pain, with a terminal illness and who request assistance to end their misery. To curtail that avenue, article 241 of the Criminal Code states that “Every one who (a) counsels a person to commit suicide, or (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.”

Sue-Gloria
Sue Rodriguez (left) in 1993 [Photo by Nick Didlick, Vancouver Sun], and Gloria Taylor in 2012 [Photo by Darryl Dyck.]

To loosen the legal constraints on suicide in Canada, one logical place to start is to allow assisted suicide when requested by those who are in a terminal illness and near death. In the forty-one years since suicide was decriminalized, the issue of the right to assisted suicide at the request of terminally ill patients has been before the courts several times. To date, the ban on assisted suicide remains in place. It is hard to believe that twenty years have passed since the Supreme Court of Canada ruled on the case of Sue Rodriguez, who in the terminal stages of Lou Gehrig’ s disease, was denied the right to assisted suicide. In the interim, not much progress has been made. On October 10, 2013, the British Columbia Court of Appeal upheld Canada’s ban on physician-assisted suicide in a split 2-1 decision. This overturns a decision made by the B.C. Supreme Court in 2012 granting to Gloria Taylor, a terminally ill patient with Lou Gehrig’s disease, the right to seek doctor-assisted suicide. To advocates of assisted suicide, this is a reversal in a year that was looking quite promising with the Government of Quebec introducing a bill to permit medically assisted death under stringent guidelines. The step was greeted with applause in the Quebec Legislature. However, it was qualified as a measure to encourage debate in a non-partisan way and it is likely to die on the order paper should the Government of Quebec decide to call an election soon over the Charter of Quebec Values.

The Swiss have taken a more rational approach to assisted suicide. Article 115 of the Swiss Criminal Code, in effect since 1942, states:

Inciting and assisting suicide: Any person who for selfish motives incites or assists another to commit or attempt to commit suicide shall, if that other person thereafter commits or attempts to commit suicide, be liable to a custodial sentence not exceeding five years or to a monetary penalty.

Consequently, assisting suicide is a crime only if the motive for doing so is selfish, such as personal gain. The process is controlled by administrative requirements. The assistant need not be a medical doctor thereby overcoming a potential conflict with the Hippocratic Oath.5

The law regarding assisted suicide in Canada lags behind the evolution of public values. In 2011, the Forum Research survey reported that 65% of Canadians supported making it legal for doctors to help the terminally ill kill themselves.6 It is likely that this support will grow more rapidly in the years ahead. Public healthcare in its present form started in Canada on November 1, 1970. It has helped people to live longer, and more people are living into the twilight years of extended dementia. Many of their children, who have witnessed the long and tragic decline of their parents, say to themselves: “This is not going to happen to me.”

The Baby Boomers, the large generation born between 1946 and 1964, are now entering their senior years. They have been instrumental in changing values and institutions as they progressed through life; they will transform the way that people perceive and practice death and dying. Many will not stand for a long and lingering decline, a form of living death. They do not want an increasingly privatized system of healthcare and homes for the aged to bleed away their assets to the detriment of their heirs and loved ones.

Timid Politicians – Politicians like to avoid problems, and that includes most contentious subjects, unless they are wedge issues which will work in their favour. Suicide is a highly-charged issue. It is avoided by Conservatives because the religious right opposes it and forms a substantial percentage of their supporters. Accordingly, politicians leave it to the courts to deal with the pleas of supplicants for a more liberal interpretation of “aiding and abetting” suicide. The courts apply and interpret existing laws and are guided by principles established by decisions in prior cases. It is a cautious and retrospective approach. But it is politicians that have a duty to make laws and, on the subject of assisted suicide, they lag behind the wishes of the majority of Canadians. Members of Parliament should stop hiding behind the skirts of the courts. At the very least, they should amend the Criminal Code of Canada, guided by the Swiss example, to permit assisted suicide when requested by the terminally ill.

Removing the Taboo from Suicide

Most who reach middle age have known a few people who have ended their lives. Their reactions to the news of the suicide of a friend range from a sense of shock, sadness and empathy to regret at failing to be supportive. They may harbour a grudging admiration for the courage of the act. However, there remains some social stigma attached to suicide that can be hard for family members to bear. Desperation and loneliness are the usual hallmarks of suicide. In Canada, the act of suicide remains, in practice, something that is still taboo and unspeakable. While it is true that a person can go to places that counsel suicide prevention, this provides little help to a person who seeks suicide assistance. Those who want to end their lives are dogged by the added anxiety that they may botch the attempt and end up helpless and brain dead, exactly the condition they seek to avoid. Given the laws against aiding and abetting, those contemplating suicide refrain from discussing it with loved ones in case they are implicated. They remain locked in painful silence.

The existing law in Canada governing suicide is harsh and cruel. It must be amended to display some kindness, empathy and compassion in support of those who choose to end their lives.

J. Anthony Cassils has a background in law and economics. He served in senior positions with the Ontario government, including Program Executive in Cabinet Office, and also worked in the head office, corporate planning at the Royal Bank of Canada. One of his consistent concerns has been the destruction by humans of the living Earth.
REFERENCES:
  1. Becker, Ernest. The Denial of Death. New York. Free Press Paperbacks. 1997. Preface, xvii. First published in 1973.
  2. http://www.canada.com/health/What+worries+going+Donald+makes+plea+doctor+assisted+dying+days+before+death/8954015/story.html
  3. This section on the history of attitudes to suicide is a brief summary derived from the following article of the Stanford Encyclopedia of Philosophy. http://plato.stanford.edu/entries/suicide
  4. http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/
  5. http://en.wikipedia.org/wiki/Euthanasia_in_Switzerland/
  6. http://news.nationalpost.com/2011/12/29/67-of-canadians-support-legalizing-assisted-suicide-poll/

order a copy of this issue (187)

$7.50 CAD, to a Canadian address
$7.50 USD, to an address in the USA
$11.50 USD, to an address outside Canada/USA
To receive a free sample copy of a previous issue, send your address to: ae947@ncf.ca

1909_15086_magscanada_728x90_en