If I find life too much to bear, then one of the ways in which I might find life too much to bear is the unwanted responsibility for the feelings of those who care for me. If I want to divest myself of that responsibility, what are my options?
Drive them away? (Which wouldn't necessarily mean they wouldn't grieve.) Have no loved ones, or people who love you? I'm not sure what you're asking. If you have that responsibility, I don't know how you would make it cease to exist. Isn't our responsibility to each other an intrinsic part of being connected to each other in the first place?
The former clearly involves medical professionals; the latter could involve anyone providing assistance. Canada has eschewed the latter phrase for a process under which an individual would receive medical assistance in dying. To me, at least in Canada, that leaves AS as being outside of the this process and involving someone else in dying by suicide. I do not see the former as suicide.
I think there's a touch of sophistry here. There are, I think, real questions about the circumstances under which out society permits someone to be helped to kill themselves. Should it require a terminal illness, with some relatively short and pain-filled expected lifespan? What about if an illness isn't terminal, but the person is in significant pain, and current medicine offers no prospects for an improvement? Or should it be a free choice - if I am a rational human, and consistently declare that I would prefer to die than live, should my choice be respected?
I think those are real questions - under what circumstances does our society think that it is OK to choose to die.
Once a person has made the choice to die, and this choice has been accepted by whatever legal framework we have decreed, I don't really see that the mechanism of death is so terribly important. Why does it matter whether the death itself involves medical professionals, or a helpful friend, or a box full of nitrogen?
Are we equating MAID with assisted suicide? Terminology matters.
Well, it couldn't be done without the assistance of the machine and someone teaching how to use it.
I have no answer to the question. I find myself agreeing with everyone.
I've known 'lovely' deaths and awful deaths. I know which one I'd want, but it wouldn't only be about me, would it?
The dying part is absolutely about you. Other people's feelings about your death is significant, but not the same. This is part of my ongoing struggle with this issue. I'm coming to understand death as the most natural, and even (perhaps weirdly) beautiful of things. (I don't long for it in any way, mind you.) So much of modernity is vehemently pitched against it, and at different/earlier states and stages of life that may be the most healthy attitude to have. But to be able to welcome it peacefully, and in a timely way is something to aspire to, I feel. Why should orchestrating one's own 'lovely' death not be seen, eventually, as a loving gesture?
Why does it matter whether the death itself involves medical professionals, or a helpful friend, or a box full of nitrogen?
It is likely that killing someone, at their own request - however you do it - has a significant psychological impact on the person who does it. If you are required to do it repeatedly, that impact may put you at risk of psychological damage of one kind or another. Be that cumulative distress that affects your mental health, or burnout.
It is also a great deal to ask of a friend or family member, as they have to live with that afterward.
It may just be a word which carries different connotations for different people but 'preferred' would absolutely not be the word I would use here. <snip for length>
Countries which don't provide decent housing or dignity to disabled people shouldn't, as I see it, be in the business of offering euthanasia to those they won't pay to appropriately house and care for.
Preferred, decent, dignity, and appropriately are all words with a wide range of expectations... and budgets. AIUI in Canada, when the federal budget stopped supporting public housing some decades ago, this had predictable effects.
Note: Canada does not offer euthanasia. Canada offers legal Medical Assistance in Dying to those who qualify for it. Terminology matters.
Once a person has made the choice to die, and this choice has been accepted by whatever legal framework we have decreed, I don't really see that the mechanism of death is so terribly important. Why does it matter whether the death itself involves medical professionals, or a helpful friend, or a box full of nitrogen?
In Canada, it matters. Right now, a country which allows qualified legal Medical Assistance in Dying is at the same time prosecuting Kenneth Law for counselling and aiding suicide through selling materiel online. https://www.bbc.com/news/world-us-canada-65472806
You may think that is inconsistent, but it is consistent with the need for many kinds of guardrails around the ending of a life.
The former clearly [MAID] involves medical professionals; the latter [assisted suicide] could involve anyone providing assistance. Canada has eschewed the latter phrase for a process under which an individual would receive medical assistance in dying. To me, at least in Canada, that leaves AS as being outside of the this process and involving someone else in dying by suicide. I do not see the former as suicide.
I agree that terminology matters, and in that regard I don’t see how MAID isn’t a specific form of assisted suicide. That Canada’s Parliament has opted for a more narrow and descriptive term doesn’t, it seems to me, change the reality that MAID is a specific form of the broader category “assisted suicide.” Suggesting otherwise seems disingenuous to me.
Seems to me there's a difference (perhaps in Canadian law, perhaps elsewhere) in giving someone assistance to commit suicide on the one hand and withdrawal of treatment on the other.
Of course as a doctor, one is supposed to be doing the best for one's patient and in most circumstances that doesn't include withdrawing treatment or even giving medications that may actually hasten death. And obviously we can all think of situations where that basic principle of healthcare hasn't been followed.
But I'm not sure morally there's much of a distinction between doing something that will hasten death and not doing something that won't prevent death.
Of course nobody likes to think that they could be responsible for the death of another person, and yet (to take a trivial example) making and selling cigarettes likely has a direct impact on the people buying them.
Is there much moral difference in selling something to someone that will eventually kill them in one way rather than another? Temporally yes.
I agree that terminology matters, and in that regard I don’t see how MAID isn’t a specific form of assisted suicide. That Canada’s Parliament has opted for a more narrow and descriptive term doesn’t, it seems to me, change the reality that MAID is a specific form of the broader category “assisted suicide.” Suggesting otherwise seems disingenuous to me.
Perhaps it's because of stigma around the word "suicide", which - while technically accurate in terms of an individual's actions - does not describe the reality of the situation.
The latest report from Health Canada (federal department of health) about MAID has an interesting section on profiles of persons receiving MAID. More men than women; more cancer than other causes, especially lung cancer; most prevalent age, 71-75. (Somewhere in my skimming, although not in this report, I remember seeing that the typical recipient of MAID is more well-off and better educated than the average citizen - regrets I can't find the reference.) https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2022.html#a4
A composite, then, would be an older man suffering from cancer. If he would choose MAID - did the cancer kill him, or did he kill himself? Again, while technically the latter, I think most would say the former.
Perhaps it's because of stigma around the word "suicide", which - while technically accurate in terms of an individual's actions - does not describe the reality of the situation.
How doesn't it?
A composite, then, would be an older man suffering from cancer. If he would choose MAID - did the cancer kill him, or did he kill himself? Again, while technically the latter, I think most would say the former.
Seems to me there's a difference (perhaps in Canadian law, perhaps elsewhere) in giving someone assistance to commit suicide on the one hand and withdrawal of treatment on the other.
Of course as a doctor, one is supposed to be doing the best for one's patient and in most circumstances that doesn't include withdrawing treatment or even giving medications that may actually hasten death. And obviously we can all think of situations where that basic principle of healthcare hasn't been followed.
But I'm not sure morally there's much of a distinction between doing something that will hasten death and not doing something that won't prevent death.
Of course nobody likes to think that they could be responsible for the death of another person, and yet (to take a trivial example) making and selling cigarettes likely has a direct impact on the people buying them.
Is there much moral difference in selling something to someone that will eventually kill them in one way rather than another? Temporally yes.
I am of the view that withdrawing treatment, especially of kinds that have not existed until very recently (in which someone can be brain dead, yet their body can be artificially kept alive, like a machine), is absolutely not the same thing as actively killing a person.
A composite, then, would be an older man suffering from cancer. If he would choose MAID - did the cancer kill him, or did he kill himself? Again, while technically the latter, I think most would say the former.
I don't understand that at all, I'm sorry.
Let me be more specific.
AIUI a common scenario in end-of-life is that a person increasingly struggles with pain. The pain becomes unbearable. Morphine is effective against this pain. However, morphine also has the side effect of suppressing breathing. The more morphine administered, the greater the negative effect on respiration. As the pain increases, the number and amounts of morphine given increases, which also has the effect of hastening death.
What killed this person? The morphine? The doctor who prescribed this at the end of life? The nurse who administered it? The person's underlying condition which brought them to this state? ISTM we would be most likely to think and say, "This person died from their illness."
There was no reasonable likelihood of the person 'healing and recovering' in that process. They could die slowly and agonizingly, or slightly sooner without pain. Those may be the choices at end of life.
I think of MAID as a variant of this common scenario.
Perhaps it's because of stigma around the word "suicide", which - while technically accurate in terms of an individual's actions - does not describe the reality of the situation.
How doesn't it?
A composite, then, would be an older man suffering from cancer. If he would choose MAID - did the cancer kill him, or did he kill himself? Again, while technically the latter, I think most would say the former.
I don't understand that at all, I'm sorry.
I’m afraid I don’t either. While I recognize the stigma that surrounds “suicide,” to say that choosing made is not suicide seems to me to be a redefinition of “suicide.” I don’t really see how it helps the discussion to try to say it’s somehow not suicide.
I’ll readily acknowledge that I’m not Canadian, that I have no firsthand experience with MAID and that my knowledge of MAID comes only from what I’ve read. But what I’ve read, including this, suggests to me that it’s not really the same as palliative use of morphine that may have the side effect of reducing breathing to the point of death.
While I recognize the stigma that surrounds “suicide,” to say that choosing made is not suicide seems to me to be a redefinition of “suicide.”
Sorry, I didn’t catch that my attempt to type “MAID” had autocorrected to “made” until the edit window had closed.
Meanwhile, @Caissa, maybe I missed it, but I don’t see where in that opinion what MAID provides for is distinguished from “suicide,” as that word is generally understood.
I agree that terminology matters, and in that regard I don’t see how MAID isn’t a specific form of assisted suicide. That Canada’s Parliament has opted for a more narrow and descriptive term doesn’t, it seems to me, change the reality that MAID is a specific form of the broader category “assisted suicide.” Suggesting otherwise seems disingenuous to me.
Perhaps it's because of stigma around the word "suicide", which - while technically accurate in terms of an individual's actions - does not describe the reality of the situation.
For a while the phrase "physician-assisted suicide" was used in the US, and as I recall physicians hated it.
A composite, then, would be an older man suffering from cancer. If he would choose MAID - did the cancer kill him, or did he kill himself? Again, while technically the latter, I think most would say the former.
I wouldn't. That's the whole point. You don't wait around for the cancer to eventually kill you. You pick the day and time. This is also the difference between any form of assisted suicide and the withdrawal of treatment or refusing to eat and drink; you're not waiting for nature to take its course, but instead taking specific action to end your life.
AIUI a common scenario in end-of-life is that a person increasingly struggles with pain. The pain becomes unbearable. Morphine is effective against this pain. However, morphine also has the side effect of suppressing breathing. The more morphine administered, the greater the negative effect on respiration. As the pain increases, the number and amounts of morphine given increases, which also has the effect of hastening death.
What killed this person? The morphine? The doctor who prescribed this at the end of life? The nurse who administered it? The person's underlying condition which brought them to this state? ISTM we would be most likely to think and say, "This person died from their illness."
There was no reasonable likelihood of the person 'healing and recovering' in that process. They could die slowly and agonizingly, or slightly sooner without pain. Those may be the choices at end of life.
I think of MAID as a variant of this common scenario.
This scenario is a bit different from MAID though, because it operates by the principle of double effect. Morphine both relieves pain and hastens death, and the hastening of death is accepted though not desired because of the desireability of pain relief. With MAID, death is deemed desireable. Here's a document from a palliative care network that explains the difference.
Perhaps it's because of stigma around the word "suicide", which - while technically accurate in terms of an individual's actions - does not describe the reality of the situation.
How doesn't it?
A composite, then, would be an older man suffering from cancer. If he would choose MAID - did the cancer kill him, or did he kill himself? Again, while technically the latter, I think most would say the former.
I don't understand that at all, I'm sorry.
I’m afraid I don’t either. While I recognize the stigma that surrounds “suicide,” to say that choosing made is not suicide seems to me to be a redefinition of “suicide.” I don’t really see how it helps the discussion to try to say it’s somehow not suicide.
I’ll readily acknowledge that I’m not Canadian, that I have no firsthand experience with MAID and that my knowledge of MAID comes only from what I’ve read. But what I’ve read, including this, suggests to me that it’s not really the same as palliative use of morphine that may have the side effect of reducing breathing to the point of death.
If I find life too much to bear, then one of the ways in which I might find life too much to bear is the unwanted responsibility for the feelings of those who care for me. If I want to divest myself of that responsibility, what are my options?
Drive them away? (Which wouldn't necessarily mean they wouldn't grieve.) Have no loved ones, or people who love you? I'm not sure what you're asking. If you have that responsibility, I don't know how you would make it cease to exist. Isn't our responsibility to each other an intrinsic part of being connected to each other in the first place?
I'm considering the circumstances in which I might want to end my own life. That doesn't just include relieving pain and suffering near the end of life - it could also include finding life too much to bear, or simply having had enough of life.
As things stand, society, including my nearest and dearest, seem to be gradually coming to terms with the first of those scenarios (relieving pain and suffering near the end of life). But even then, I don't know to what extent I would be able to choose the manner of my own death, if it were wanting to die on my own, surrounded by no-one. I currently suspect that would entail the overcoming of various societal expectations, and even if I still possessed enough energy and willpower and the wherewithal to resist and insist, I would very much like to avoid the additional stress.
Wanting to forestall personal incapacity leads me to consider the third scenario (simply having had enough of life). While it seems likely I would be better able to negotiate the hurdles of societal expectations while I am still fit (and possibly healthy), it also seems likely there would be more societal expectations to overcome. There remains an ill-defined barrier of unacceptability to surmount.
On the other hand, if I lose my marbles or am in any way no longer self-aware, people with any say in the matter can do what they like.
I suppose these could all be dreams of hope - or maybe just dreams of privilege.
Death anxiety has been around a long time. According to the section on existential death anxiety in the wikipedia entry, ever since becoming aware of the knowledge that human life must end, the basic coping mechanism that human beings have developed is denial. I don't think it difficult to see Christianity as exhibiting a form of this.
And I don't think it's controversial to suggest there's a strong legacy of Christianity in attitudes to death and suicide in modern western societies (which would illustrate what I've said previously about our societies exhibiting secularised versions of Christian beliefs and values).
In the case of death, I think that we (society) have retained the idea that death needs to be triumphed over, but have done away with the Victor and the mechanism through which it is conquered.
In the case of suicide, various ideas opposing suicide seem to have developed in Greek and Roman thought and practice, such as being a crime against the state, but I suspect the extent to which suicide is seen as being morally reprehensible is largely a product of Christianity.
At this point, what concerns me is whether our societies are capable of making a transition from death anxiety to death acceptance, and whether innovations such as the Sarco Pod help or hinder that process.
I don’t really see Christianity, at least the older and more traditional forms of Christianity, as rejecting the reality of death at all. Whether it’s the entire season of Lent, which starts off every year with specifically being told that you’re going to die as a cross of ashes are put on your forehead, or the memento mori, or the hymns and sermons that emphasize that our time in this world is transitory, I think that the traditional Christian faith keeps our impending death in view.
It's hard to see how belief in eternal life is compatible with knowledge that life must end.
And yet we’ve done it for two thousand years.
No we haven't. Christianity says that life doesn't end but carries on after death, and in that way denies that death is the end of life.
But not in a way, at least in my experience, that denies the realities of death—finality (in terms of this world), grief, pain, unfinished business, and others.
Jesus weeping at Lazarus' tomb has always struck me as odd, because he turned right around and raised him back to life. So why cry? Didn't Jesus know he was coming back? But then why do that at all -- why interrupt eternal life? Was Lazarus not already with God in heaven?
Jesus wasn't moved in the least when Jairus' daughter died. Why not cry? Why did Jesus gaslight the girl's family and friends? And again, why not let the girl stay with God in heaven?
Sorry for the double post, but this article popped up for me today. "Proposals to give terminally ill people in England and Wales the right to choose to end their life are to be introduced in Parliament this month."
It's hard to see how belief in eternal life is compatible with knowledge that life must end.
And yet we’ve done it for two thousand years.
No we haven't. Christianity says that life doesn't end but carries on after death, and in that way denies that death is the end of life.
But not in a way, at least in my experience, that denies the realities of death—finality (in terms of this world), grief, pain, unfinished business, and others.
Jesus, after all, wept at the tomb of Lazarus.
Depends what the "realities of death" are. If the "realities of death" are the person is gone, they no longer exist, and you can not never see them again, whatever, because they've ceased to exist, permanently, then a belief in eternal life absolutely denies that.
It's hard to see how belief in eternal life is compatible with knowledge that life must end.
And yet we’ve done it for two thousand years.
No we haven't. Christianity says that life doesn't end but carries on after death, and in that way denies that death is the end of life.
But not in a way, at least in my experience, that denies the realities of death—finality (in terms of this world), grief, pain, unfinished business, and others.
Jesus, after all, wept at the tomb of Lazarus.
Depends what the "realities of death" are. If the "realities of death" are the person is gone, they no longer exist, and you can not never see them again, whatever, because they've ceased to exist, permanently, then a belief in eternal life absolutely denies that.
Which is why I gave examples of what I meant by “realities of death,” and why those examples did not include “ceases to exist permanently.”
You included the word "finality", but qualify it with the phrase "in terms of this world" so that it apparently means something other than "final".
I thought that it was pretty clear it meant final as in not coming back in the world we live in now—not becoming undead in some way—but not foreclosing some possibility, in whatever form, of what is typically called “afterlife.”
The larger problem for me is that if the answer to the question "is death final?" is "yes and no", it makes it harder to have conversations about how we die.
I don't know if you'd include it in your list of realities, but one word that occurred to me was "separation". If you believe that separation caused by death is only temporary, it puts a rather different spin on how you might view the experience of death itself.
The human race has believed in some form of afterlife going all the way back in recorded history, and has understood death in this world to be an ending of our life in this world, whether followed by another realm (nice, nasty, shadowy and sort of blah, reincarnation, Nirvana, any combination thereof, or the like). Death as humans have understood it has not included “utterly ceasing to exist, even as a soul or spirit,” until recently, historically speaking.
The larger problem for me is that if the answer to the question "is death final?" is "yes and no", it makes it harder to have conversations about how we die.
I don't know if you'd include it in your list of realities, but one word that occurred to me was "separation". If you believe that separation caused by death is only temporary, it puts a rather different spin on how you might view the experience of death itself.
Some of that depends on one’s notion of the afterlife, whether people will go to the same place, and such. But even in the best case scenario of believing in definite endless bliss forever with one’s loved ones, we’re still emotional beings, and the sense of loss still matters. It’s part of being human. People, believing in an afterlife, have always grieved their loved ones.
The larger problem for me is that if the answer to the question "is death final?" is "yes and no", it makes it harder to have conversations about how we die.
I don't know if you'd include it in your list of realities, but one word that occurred to me was "separation". If you believe that separation caused by death is only temporary, it puts a rather different spin on how you might view the experience of death itself.
Sorry if I wasn’t as clear as I thought I was earlier.
And yes, I would definitely include separation in my list. Maybe even at the top of it. Even if I have hope of being reunited at some point after death (though I’m really not sure I’d describe my own views of afterlife that way), there is separation now, in this life.
My wife and I were discussing this just a few days ago—how often we think our parents will enjoy hearing about something, often what their grandchildren are doing, only to remember they’re gone and we can’t tell them, or hear their reactions. It’s a hole that never goes away.
Yes, to the best of my understanding and experience the primary problem (most) Christians have with physical death (to be quite clear) is that it means separation from the people we love, for an unknown length of time. It's rather like what I imagine it was to immigrate to another continent, waving goodbye to family and friends, never to see them again in this life. Because realistically, the cost of a return visit, or even sending reliable mail, meant this had to be a "goodbye forever" trip for a lot of people. And I think the grief would be much the same.
Jesus weeping at Lazarus' tomb has always struck me as odd, because he turned right around and raised him back to life. So why cry? Didn't Jesus know he was coming back? But then why do that at all -- why interrupt eternal life? Was Lazarus not already with God in heaven?
Jesus wasn't moved in the least when Jairus' daughter died. Why not cry? Why did Jesus gaslight the girl's family and friends? And again, why not let the girl stay with God in heaven?
I wouldn't say Jesus wasn't moved when Jairus' daughter died--what would be your authority for that? In that case, the story moved quickly enough that you just don't get the little touches you see in the Lazarus story. Doesn't mean he was matter of fact, or didn't cry. But it's a miniature, to use an art analogy, not a full length portrait like the Lazarus story. He may very well have cried and the writer chose different elements to focus on.
Compare the third story we have where he raised a young man who was being carried out to the graveyard--that is, the son of the widow of Nain. There we are told flat out that "Jesus' heart went out" to the mother, who had just lost her last living close relative. And also that he said not only "Don't cry," but (after immediately raising the man) "and Jesus gave him back to his mother." Sounds emotional to me.
So returning to Jairus' daughter--
It wasn't gaslighting to say she was asleep, though it was definitely a statement that could be taken two ways--and that had some importance to it, as Jesus is attempting to spare the family AND himself the scrutiny of a huge crowd and possibly local authorities. By saying it he was invoking an age-old comparison of sleep to death (keep in mind that many or most Jews of his time already believed in the resurrection at the end of the world; so they, too, could relate to the imagery of sleep which ends with an awakening--it's not a purely Christian thing).
I can see why you might say "dishonesty" since some of the crowd are doubtless going to take "She is sleeping" in a literal sense, so as to avoid having to believe in her resurrection. Given that it's Jesus saying it, my personal reaction is to re-evaluate my own morality, and ask whether we are in fact obliged to give the full unvarnished truth to random bystanders who will make a bad use of it, on every possible occasion--or whether an equivocal statement like the one he made is acceptable at times. I conclude that my own inclination to spell everything out in detail to everybody, always, is ... lacking, probably in common sense, and certainly in nuance.
As for why not let the dead stay with God in heaven, I assume Jesus thought them more needed here. And yes, that falls neatly into the fact that Jesus called his miracles "signs"--he is not raising these particular people by accident, there are meanings attached to their death and resurrection which have to do with who Jesus is and what he has come to do in the world. And in such a case, the comfort of the person involved in the sign takes a back seat. So Jairus' daughter, or Lazarus, or the young man have to wait another 50 years or so to be happy in heaven? From their own point of view, that may be a bummer--but it's not like they won't get there eventually. And in the meantime, they will have served their purpose as signs, and their families will be happy to boot.
Going back to the Sarco Pod: I'd be amazed if it catches on. So claustrophobic for starters. It reminds me of a Futurama cartoon episode where there is a 'suicide booth' and the robot goes in the booth but survives all the methods the booth tries to kill him and he is then depressed that he failed!
If vulnerable people have been coerced into ending their lives, or if people have attempted such coercion, in the 25+ years since Oregon legalized medical aid in dying, there should be at least one case that Americans still opposing MAID laws could point to. But there is no evidence that this is happening. Quite the contrary:
In 2019, the executive director of Disability Rights Oregon (DRO), an organization mandated by federal law to investigate complaints of abuse or neglect of people with disabilities, reported that DRO has never received a complaint that a person with disabilities was coerced into obtaining a prescription for MAiD drugs.
Why does it matter whether the death itself involves medical professionals, or a helpful friend, or a box full of nitrogen?
It is likely that killing someone, at their own request - however you do it - has a significant psychological impact on the person who does it. If you are required to do it repeatedly, that impact may put you at risk of psychological damage of one kind or another. Be that cumulative distress that affects your mental health, or burnout.
It is also a great deal to ask of a friend or family member, as they have to live with that afterward.
If I recall, Dr. Death i.e. Jack Kevorkian, avoided this by rigging the apparatus in such a way that the person dying administers the fatal dose. "Pushes the button" so to speak.
Working in mental health, I have met a lot of suicidal people in the last 23 years - and I do care about them, But I am aware that this constant exposure means my emotional reaction, anxiety levels etc, are much less acute than the the first time someone ever told me they wanted to die.
It’s inevitable that you get desensitised to some extent - you wouldn’t cope if you didn’t. If you stop caring altogether - that’s burnout. In the context of the pandemic there was a lot of talk of “moral injury” in the context of simply not being able to provide the care patients needed. In situations of violent conflict we talk about brutalisation. I am concerned that if clinicians are regularly required to kill people, it will impact them in negative ways - I think, for example, writing the prescription for something for someone to use to kill themselves probably carries similar psychological risks to actually administering it yourself. (Of course I don’t know that, it’s speculation.)
Burnout and moral injury carry risks for other patients treated by those clinicians, as well as for the clinicians themselves.
I think that’s a very serious concern. Heck, if I were required to (say) fill such a prescription even once, I couldn’t cope. I’d have to walk off the job.
I will also add, I think it is somewhat different to abortion - because people who are prepared to perform abortions don’t conceptualise the unborn in the same way as they conceptualise children and adults. That difference, is one of the reasons many people support abortion.
I will also add, I think it is somewhat different to abortion - because people who are prepared to perform abortions don’t conceptualise the unborn in the same way as they conceptualise children and adults. That difference, is one of the reasons many people support abortion.
Is it not likely that people willing to assist someone in ending their life will find ways to compartmentalise in a similar fashion - rationalising that the desire to die from a person who is suffering but mentally competent is reasonable and that supporting that decision is simply a part of good care, albeit the final part.
People have often tried to claim that having an abortion is inherently traumatising, but in both instances I think that pre-supposes particular ways of thinking about life, death and care.
For my part, in isolation, I can't think of a good reason to prevent a terminally ill person from ending their life, with assistance if someone is willing. On a societal level I don't trust that the option won't become the expectation, as it has with the termination of foetuses likely to have Down's Syndrome.
The human race has believed in some form of afterlife going all the way back in recorded history, and has understood death in this world to be an ending of our life in this world, whether followed by another realm (nice, nasty, shadowy and sort of blah, reincarnation, Nirvana, any combination thereof, or the like). Death as humans have understood it has not included “utterly ceasing to exist, even as a soul or spirit,” until recently, historically speaking.
I'm afraid this just suggests to me that we (human beings) are the kings of wishful thinking - that our desire for there to be something more to life than our mortal years has been a driving force for creative thought and imagination for as long as our awareness of our own mortality. (And that our creativity has thrown up some pretty unpleasant ways to manipulate that desire for gain.)
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Drive them away? (Which wouldn't necessarily mean they wouldn't grieve.) Have no loved ones, or people who love you? I'm not sure what you're asking. If you have that responsibility, I don't know how you would make it cease to exist. Isn't our responsibility to each other an intrinsic part of being connected to each other in the first place?
I think there's a touch of sophistry here. There are, I think, real questions about the circumstances under which out society permits someone to be helped to kill themselves. Should it require a terminal illness, with some relatively short and pain-filled expected lifespan? What about if an illness isn't terminal, but the person is in significant pain, and current medicine offers no prospects for an improvement? Or should it be a free choice - if I am a rational human, and consistently declare that I would prefer to die than live, should my choice be respected?
I think those are real questions - under what circumstances does our society think that it is OK to choose to die.
Once a person has made the choice to die, and this choice has been accepted by whatever legal framework we have decreed, I don't really see that the mechanism of death is so terribly important. Why does it matter whether the death itself involves medical professionals, or a helpful friend, or a box full of nitrogen?
The dying part is absolutely about you. Other people's feelings about your death is significant, but not the same. This is part of my ongoing struggle with this issue. I'm coming to understand death as the most natural, and even (perhaps weirdly) beautiful of things. (I don't long for it in any way, mind you.) So much of modernity is vehemently pitched against it, and at different/earlier states and stages of life that may be the most healthy attitude to have. But to be able to welcome it peacefully, and in a timely way is something to aspire to, I feel. Why should orchestrating one's own 'lovely' death not be seen, eventually, as a loving gesture?
It is likely that killing someone, at their own request - however you do it - has a significant psychological impact on the person who does it. If you are required to do it repeatedly, that impact may put you at risk of psychological damage of one kind or another. Be that cumulative distress that affects your mental health, or burnout.
It is also a great deal to ask of a friend or family member, as they have to live with that afterward.
Preferred, decent, dignity, and appropriately are all words with a wide range of expectations... and budgets. AIUI in Canada, when the federal budget stopped supporting public housing some decades ago, this had predictable effects.
Note: Canada does not offer euthanasia. Canada offers legal Medical Assistance in Dying to those who qualify for it. Terminology matters.
I think this is true insofar as there is a gap between what the law is and what it should be. I have not heard that gap identified.
In Canada, it matters. Right now, a country which allows qualified legal Medical Assistance in Dying is at the same time prosecuting Kenneth Law for counselling and aiding suicide through selling materiel online.
https://www.bbc.com/news/world-us-canada-65472806
You may think that is inconsistent, but it is consistent with the need for many kinds of guardrails around the ending of a life.
Of course as a doctor, one is supposed to be doing the best for one's patient and in most circumstances that doesn't include withdrawing treatment or even giving medications that may actually hasten death. And obviously we can all think of situations where that basic principle of healthcare hasn't been followed.
But I'm not sure morally there's much of a distinction between doing something that will hasten death and not doing something that won't prevent death.
Of course nobody likes to think that they could be responsible for the death of another person, and yet (to take a trivial example) making and selling cigarettes likely has a direct impact on the people buying them.
Is there much moral difference in selling something to someone that will eventually kill them in one way rather than another? Temporally yes.
Perhaps it's because of stigma around the word "suicide", which - while technically accurate in terms of an individual's actions - does not describe the reality of the situation.
The latest report from Health Canada (federal department of health) about MAID has an interesting section on profiles of persons receiving MAID. More men than women; more cancer than other causes, especially lung cancer; most prevalent age, 71-75. (Somewhere in my skimming, although not in this report, I remember seeing that the typical recipient of MAID is more well-off and better educated than the average citizen - regrets I can't find the reference.)
https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2022.html#a4
A composite, then, would be an older man suffering from cancer. If he would choose MAID - did the cancer kill him, or did he kill himself? Again, while technically the latter, I think most would say the former.
How doesn't it?
I don't understand that at all, I'm sorry.
I am of the view that withdrawing treatment, especially of kinds that have not existed until very recently (in which someone can be brain dead, yet their body can be artificially kept alive, like a machine), is absolutely not the same thing as actively killing a person.
Let me be more specific.
AIUI a common scenario in end-of-life is that a person increasingly struggles with pain. The pain becomes unbearable. Morphine is effective against this pain. However, morphine also has the side effect of suppressing breathing. The more morphine administered, the greater the negative effect on respiration. As the pain increases, the number and amounts of morphine given increases, which also has the effect of hastening death.
What killed this person? The morphine? The doctor who prescribed this at the end of life? The nurse who administered it? The person's underlying condition which brought them to this state? ISTM we would be most likely to think and say, "This person died from their illness."
There was no reasonable likelihood of the person 'healing and recovering' in that process. They could die slowly and agonizingly, or slightly sooner without pain. Those may be the choices at end of life.
I think of MAID as a variant of this common scenario.
https://decisions.scc-csc.ca/scc-csc/scc-csc/en/item/14637/index.do
I’ll readily acknowledge that I’m not Canadian, that I have no firsthand experience with MAID and that my knowledge of MAID comes only from what I’ve read. But what I’ve read, including this, suggests to me that it’s not really the same as palliative use of morphine that may have the side effect of reducing breathing to the point of death.
Meanwhile, @Caissa, maybe I missed it, but I don’t see where in that opinion what MAID provides for is distinguished from “suicide,” as that word is generally understood.
For a while the phrase "physician-assisted suicide" was used in the US, and as I recall physicians hated it.
I wouldn't. That's the whole point. You don't wait around for the cancer to eventually kill you. You pick the day and time. This is also the difference between any form of assisted suicide and the withdrawal of treatment or refusing to eat and drink; you're not waiting for nature to take its course, but instead taking specific action to end your life.
This scenario is a bit different from MAID though, because it operates by the principle of double effect. Morphine both relieves pain and hastens death, and the hastening of death is accepted though not desired because of the desireability of pain relief. With MAID, death is deemed desireable. Here's a document from a palliative care network that explains the difference.
Agreed Re: morphine here.
I will link to my denomination's position paper on MAID, passed in convention in 2019 after MAID was legal in 2015. (14 page PDF)
https://elcic.ca/wp-content/uploads/2022/02/2019CalltoFaithfullyJournerywithDyingELCICResolutionvOct3.pdf
As things stand, society, including my nearest and dearest, seem to be gradually coming to terms with the first of those scenarios (relieving pain and suffering near the end of life). But even then, I don't know to what extent I would be able to choose the manner of my own death, if it were wanting to die on my own, surrounded by no-one. I currently suspect that would entail the overcoming of various societal expectations, and even if I still possessed enough energy and willpower and the wherewithal to resist and insist, I would very much like to avoid the additional stress.
Wanting to forestall personal incapacity leads me to consider the third scenario (simply having had enough of life). While it seems likely I would be better able to negotiate the hurdles of societal expectations while I am still fit (and possibly healthy), it also seems likely there would be more societal expectations to overcome. There remains an ill-defined barrier of unacceptability to surmount.
On the other hand, if I lose my marbles or am in any way no longer self-aware, people with any say in the matter can do what they like.
I suppose these could all be dreams of hope - or maybe just dreams of privilege.
Death anxiety has been around a long time. According to the section on existential death anxiety in the wikipedia entry, ever since becoming aware of the knowledge that human life must end, the basic coping mechanism that human beings have developed is denial. I don't think it difficult to see Christianity as exhibiting a form of this.
And I don't think it's controversial to suggest there's a strong legacy of Christianity in attitudes to death and suicide in modern western societies (which would illustrate what I've said previously about our societies exhibiting secularised versions of Christian beliefs and values).
In the case of death, I think that we (society) have retained the idea that death needs to be triumphed over, but have done away with the Victor and the mechanism through which it is conquered.
In the case of suicide, various ideas opposing suicide seem to have developed in Greek and Roman thought and practice, such as being a crime against the state, but I suspect the extent to which suicide is seen as being morally reprehensible is largely a product of Christianity.
At this point, what concerns me is whether our societies are capable of making a transition from death anxiety to death acceptance, and whether innovations such as the Sarco Pod help or hinder that process.
And yet we’ve done it for two thousand years.
No we haven't. Christianity says that life doesn't end but carries on after death, and in that way denies that death is the end of life.
Put simply, if life is eternal it doesn't end, so, as @pease said, eternal life and life ending are incompatible - either it's one or the other.
Jesus, after all, wept at the tomb of Lazarus.
Jesus wasn't moved in the least when Jairus' daughter died. Why not cry? Why did Jesus gaslight the girl's family and friends? And again, why not let the girl stay with God in heaven?
Depends what the "realities of death" are. If the "realities of death" are the person is gone, they no longer exist, and you can not never see them again, whatever, because they've ceased to exist, permanently, then a belief in eternal life absolutely denies that.
The larger problem for me is that if the answer to the question "is death final?" is "yes and no", it makes it harder to have conversations about how we die.
I don't know if you'd include it in your list of realities, but one word that occurred to me was "separation". If you believe that separation caused by death is only temporary, it puts a rather different spin on how you might view the experience of death itself.
The human race has believed in some form of afterlife going all the way back in recorded history, and has understood death in this world to be an ending of our life in this world, whether followed by another realm (nice, nasty, shadowy and sort of blah, reincarnation, Nirvana, any combination thereof, or the like). Death as humans have understood it has not included “utterly ceasing to exist, even as a soul or spirit,” until recently, historically speaking.
Some of that depends on one’s notion of the afterlife, whether people will go to the same place, and such. But even in the best case scenario of believing in definite endless bliss forever with one’s loved ones, we’re still emotional beings, and the sense of loss still matters. It’s part of being human. People, believing in an afterlife, have always grieved their loved ones.
And yes, I would definitely include separation in my list. Maybe even at the top of it. Even if I have hope of being reunited at some point after death (though I’m really not sure I’d describe my own views of afterlife that way), there is separation now, in this life.
My wife and I were discussing this just a few days ago—how often we think our parents will enjoy hearing about something, often what their grandchildren are doing, only to remember they’re gone and we can’t tell them, or hear their reactions. It’s a hole that never goes away.
I wouldn't say Jesus wasn't moved when Jairus' daughter died--what would be your authority for that? In that case, the story moved quickly enough that you just don't get the little touches you see in the Lazarus story. Doesn't mean he was matter of fact, or didn't cry. But it's a miniature, to use an art analogy, not a full length portrait like the Lazarus story. He may very well have cried and the writer chose different elements to focus on.
Compare the third story we have where he raised a young man who was being carried out to the graveyard--that is, the son of the widow of Nain. There we are told flat out that "Jesus' heart went out" to the mother, who had just lost her last living close relative. And also that he said not only "Don't cry," but (after immediately raising the man) "and Jesus gave him back to his mother." Sounds emotional to me.
So returning to Jairus' daughter--
It wasn't gaslighting to say she was asleep, though it was definitely a statement that could be taken two ways--and that had some importance to it, as Jesus is attempting to spare the family AND himself the scrutiny of a huge crowd and possibly local authorities. By saying it he was invoking an age-old comparison of sleep to death (keep in mind that many or most Jews of his time already believed in the resurrection at the end of the world; so they, too, could relate to the imagery of sleep which ends with an awakening--it's not a purely Christian thing).
I can see why you might say "dishonesty" since some of the crowd are doubtless going to take "She is sleeping" in a literal sense, so as to avoid having to believe in her resurrection. Given that it's Jesus saying it, my personal reaction is to re-evaluate my own morality, and ask whether we are in fact obliged to give the full unvarnished truth to random bystanders who will make a bad use of it, on every possible occasion--or whether an equivocal statement like the one he made is acceptable at times. I conclude that my own inclination to spell everything out in detail to everybody, always, is ... lacking, probably in common sense, and certainly in nuance.
As for why not let the dead stay with God in heaven, I assume Jesus thought them more needed here. And yes, that falls neatly into the fact that Jesus called his miracles "signs"--he is not raising these particular people by accident, there are meanings attached to their death and resurrection which have to do with who Jesus is and what he has come to do in the world. And in such a case, the comfort of the person involved in the sign takes a back seat. So Jairus' daughter, or Lazarus, or the young man have to wait another 50 years or so to be happy in heaven? From their own point of view, that may be a bummer--but it's not like they won't get there eventually. And in the meantime, they will have served their purpose as signs, and their families will be happy to boot.
I love reading your expositions of the scriptures @Lamb Chopped .
[/slight tangent]
But who's to complain if the victim is dead?
If I recall, Dr. Death i.e. Jack Kevorkian, avoided this by rigging the apparatus in such a way that the person dying administers the fatal dose. "Pushes the button" so to speak.
It’s inevitable that you get desensitised to some extent - you wouldn’t cope if you didn’t. If you stop caring altogether - that’s burnout. In the context of the pandemic there was a lot of talk of “moral injury” in the context of simply not being able to provide the care patients needed. In situations of violent conflict we talk about brutalisation. I am concerned that if clinicians are regularly required to kill people, it will impact them in negative ways - I think, for example, writing the prescription for something for someone to use to kill themselves probably carries similar psychological risks to actually administering it yourself. (Of course I don’t know that, it’s speculation.)
Burnout and moral injury carry risks for other patients treated by those clinicians, as well as for the clinicians themselves.
Is it not likely that people willing to assist someone in ending their life will find ways to compartmentalise in a similar fashion - rationalising that the desire to die from a person who is suffering but mentally competent is reasonable and that supporting that decision is simply a part of good care, albeit the final part.
People have often tried to claim that having an abortion is inherently traumatising, but in both instances I think that pre-supposes particular ways of thinking about life, death and care.
For my part, in isolation, I can't think of a good reason to prevent a terminally ill person from ending their life, with assistance if someone is willing. On a societal level I don't trust that the option won't become the expectation, as it has with the termination of foetuses likely to have Down's Syndrome.