Thoughts on Euthanasia and Dying

da vinci, old men

[Some thoughts on dying and euthanasia, written within the context of a local monthly discussion group. Perhaps of more interest to people over 55 or so. I’m trying to clarify why I don’t share most progressives’ blind support for voluntary euthanasia/assisted suicide, while I do support passive euthanasia, palliative sedation, more support for dying at home and hospices and a social and cultural revolution in which a ‘good death’ (the root meaning of the word ‘euthanasia’) can become synonymous with a ‘good life’, and people do not derive their self-worth from selling themselves on labour markets. As sketched below, all this also ties in with my previous blogs on mysticism and Zen and the spiritual challenges of dying to self and self-image. The image of the old men is by Leonardo da Vinci.]

Thoughts on Euthanasia and Dying

1. Easy Assisted Suicide for the Terminally Ill? The Case of Aaron (36)

Aaron’s first reactions on learning of his ‘death sentence’ are described as follows: “When Aaron first realized how sick he was becoming, that indeed he might die, he became lost in ideas of how things were and feelings of resentment and diminishment.”

This touches on my basic fear regarding unrepresented aspects of the human predicament within the active euthanasia discussions. The question it raises is: if assisted suicide had been legally and easily available and thus more culturally ‘normalised’, I wonder if Aaron ‒ quite ‘rationally’ and ‘autonomously’ in terms of his perceived suffering, medical prognosis and of his own ‘free will’ as a mature adult ‒ might have sought it out when still in the above frame of mind, ‘lost in ideas’ and negative feelings?

If he had, however, the sentence that follows on from this one quoted above would not have been possible: “But with much inward looking, a never imagined freedom often arose as he let go of these old models. Now he says he is free to just be.”

To further understand the process connecting these two stages in Aaron, here is his story as Stephen Levine (a poet, Buddhist mindfulness teacher of Jewish background and director of the Hanuman Foundation Dying Project in the 1980s) tells it in his moving, insightful book Who Dies? (1986):

“I shared some time with a fellow from LA who was dying of ALS. ALS is a degenerative nerve disease […] which results in a gradual deterioration and paralysis of the body. About two years ago, when my friend Aaron was thirty six-years old, living with his wife and two children, he was a singer, dancer, and virtuoso guitarist. But now he finds himself strapped into a wheelchair, unable even to support his body weight. His lung capacity so decreased that he must consciously breathe in sufficient air to push back past his voice box to create the few words he is able to communicate. Nothing comes automatically any longer. […] His flesh is literally rotting off his bones. His legs, arms, and body are no longer able to move of their own volition.

One day Aaron, with much difficulty, said: ‘You know, two years ago I was healthy and strong. I had a very well-tuned body. In fact, I was an athlete. [..] I made my living by singing and dancing. But now I can’t even hold my guitar. I can hardly speak, much less sing. I can’t even stand up by myself. I need a lot of help just to go to the bathroom. Yet I’ve never felt so alive in my whole life, because, ironically, I see that I am not just this body. As my body gets weaker, somehow I get stronger. Now that I can no longer do all the things I sued to do to be someone in the world, I see how unreal all those things were. I see in, fact, that all that doing separated me from everyone and everything in a way that made life a kind of dullness, a kind of separation from the vitality of things.

It seems to me that people’s lives become such an oddity. So much time is spent polishing the personality, strengthening the body, honing, and even having pride in, the separateness, the competitiveness, the painfulness. No one seems to play lightly with it. Nor did I. […] This body is rotting off its skeleton. Even so my heart has never been so open, and I have never felt so much love for so many beings. It’s not even feeling love for other beings. I just feel love. Everyone who enters this space, I love – not being to being, not out of separateness. It’s just that I am in love with them. We exist in love together. I’m touching the place inside of me I’ve never looked at before, a place I never knew.’

Aaron said that all his singing and dancing, and all the plaudits he received, all the praise, the money, never really brought such a deep satisfaction as he was experiencing right now. ”

Finally, with regard, in general, to the question of ‘rational’ decision-making, momentary feelings of despair and the ‘autonomous’ right to suicide, it also needs to be said that countless people ‘at the coal face’ ‒ doctors, social and emergency workers, counsellors and psychologists ‒ can report cases of despairing people who have attempted suicide and failed and who have then found their way back to a normal life, who no longer understand their attempts and are profoundly glad that their attempt failed or was thwarted. I think one could argue that many of these people would no longer be alive if assisted suicide were more easily available and culturally acceptable.

2. WHO Dies? Ageing, Mindfulness, Letting Go of our Ideas about Ourselves

Apart from Aaron’s story, the following quotes from Levine’s book Who Dies? may provide the tie-in between the assisted suicide topic and that of transcultural Perennial Wisdom/Ways of Liberation traditions and their perspectives on Self-No Self-Original Self/Emptiness-Spaciousness/Enlightenment. The word ‘eu-thanasia’ does indeed mean ‘good death’ in Greek. Perhaps the question of what is ‘a good death/dying’, both for self and others, needs more dialogue and clarity. Can ‘a good dying’, for example, be restricted to a reduced, externalised vision of one in which there is simply minimal pain and ‘mess’ (especially for the onlookers), or does it inherently also pose the question of some sort of internal meaning-making for all participants?

From the Perennial Wisdom perspective in which life and death are not good/bad opposites, this is the same question as what is ‘a good life’. In contrast to modern materialist culture and possessive individualism, the meaning and challenge of the latter would not be seen in the seeking of material comfort and avoidance of pain but in some form of spiritual or transpersonal insight or development throughout life, and particularly during life crises (sometimes even consciously induced ones, as in painful or ‘shocking’ initiation rituals). A large part of this life-long challenge is unlearning or ‘dying’ to the very idea of ‘self’ or self-image, individual desire/fear, and the painful identification with body, mind or ideas/feelings. From this perspective, the voluntary euthanasia question would seem to raise the question of whether or not normalising assisted suicide would possibly restrict or even preclude the potential for meaning-making, deep insight and peace within the ‘good living-dying’ process as briefly outlined below. Here is Stephen Levine:

Holding to Mind Models: The basic problem/suffering throughout life

“We see the world through our idea of who we think we are. […] Seldom do we experience an object directly. Instead we experience our preferences, our fears, our hopes, our doubts, our preconceptions. We experience our ideas of how things are. […] What is perceived is a function of the models we have. […] Our models freeze-dry the flow of experience into a ‘manageable’ reality. They are our idea of the truth, not the truth itself. The truth is what is. It is this moment, without the least trace of the last or any expectation of the next. Our models are a prison. Models can cause suffering. Holding to them, we miss the truth. We create a world of desire and fear.”

How this basic problem/suffering relates to the dying process

“Working with people during the process of their dying, I have seen how much suffering is created by our models and resistance to the givens of the present. A kind of mental cramping develops from holding to the models of who we think we are and how the world is ‘supposed’ to be.”

A Thought Experiment around Incapacitation and Dying

“Imagine that you are brought to a time when illness has caused the energy in your body no longer to be sufficient for you to participate in the world in the ways you have become used to. The ways that have nurtured your self-image. The ways you have cultivated to reaffirm this imagined self that you keep building and rebuilding like an armour around you. Imagine that your energy isn’t sufficient to keep up the doing that maintains the mirage of solidity and separateness. […] What happens when you can no longer keep up your image of yourself as a valuable member of society? […]

Can you sense how your resistance, your desire for things to be other than they are, would be like a vice closing in on you? […] But that model [of being a socially active, ‘competent’, ‘in-charge’, ‘useful someone’] is no longer available to you. How painful our models are when we can no longer fulfil that imagined reality. We wonder to ourselves, ‘Who am I? Who is it lying here in this bed? Who is dying? Who was living?’

We don’t know who we are because we can’t play out our speciality any longer. Our sense of being someone in the world is greatly threatened. And the confusion that comes about burns the mind and contracts the heart to an ember. We have become so identified with our doing, with our model of who we are, because we have always traded off our true being for some stance in the world, for some position of authority. The self-cruelty of our holding to models can be seen in the eyes of those on their deathbed unable to continue manifesting the roles they have spent their whole life polishing and developing, guilty and confused at the condition they find themselves in, wondering what is real and who they really are.”

The Alternative: Dying as an Opportunity for Awakening

“But dying doesn’t have to be hell. It can be a remarkable opportunity for spiritual awakening. I have been with many people who have experienced this falling away of energy, this same wearing away of the body, this same inability to be the individual they thought they were, who, instead of tightening into even greater suffering, began to let go of the root of their contraction. As their self-image began to melt, I saw them begin to have a little more space in which to experience themselves.

When this occurs there is an opening to a whole new participation in life as an investigation, because somehow, though you can’t maintain who you thought you were, there is a sense that who you are is still there. Such people notice that even though the energy decreases, though they may never leave their bed or work again, or do what they have done to be who they thought they were, even though they are watching their body deteriorate, somehow their spirit and their participation in the moment are getting stronger and stronger.

Finally, these things they used to present themselves to be in the world are seen as bars in a cage. They see they have lived their whole life in a prison made of models and ideas of how things are, should be, must be, will be, instead of allowing themselves the vastness of what is. They are no longer kept captive by their models of the world. They see that everything they are is present in each moment. There is nothing absent in their predicament, nothing that blocks them from their liberation. They see how identifying awareness with the fantasies of the future and dreams of the past has kept them imprisoned their whole life, rather than allowing them a full participation in their being as it presents itself moment to moment.”

3. Social Implications and Slippery Slopes

From a wider historical and societal perspective, I think it is legitimate to ask if it is a coincidence that the renewed raising of the assisted suicide debate is situated within a present context dominated by incessant talk of the large economic burdens of ageing populations and the unsustainability of exploding health care costs? Is it also a coincidence that suicide pills are now seen as ‘solutions’ for some in a capitalist culture in which there is supposedly a helpful commodity (a pill, technology or service) for all personal problems and even ageing and dying can now be reduced to processes to be ‘rationally’ managed and controlled or to ‘services’ that can be bought?

In one discussion on euthanasia a person noted the possibility of there being an ‘elephant in the room’, namely the Nazi use of involuntary euthanasia on people they considered ‘unwertes Leben’ (unworthy life): psychiatric patients, ‘misfits’, disabled children, Jews. The term ‘Euthenasie’ is indeed still avoided in Germany because of its Nazi use as a cover for murder and fascist ‘eugenics’, and, apart from some veterinarians, the term ‘Sterbehilfe’ (‘dying aid’, assisted dying) is used instead. There is of course no inherent connection between voluntary and involuntary euthanasia/assisted suicide, and I am at all not suggesting there is. However, it also important to remember that individual choices, actions and desires often have individually unintended societal consequences and that the road to hell is all too often paved with good intentions.

Thus, for example, it is quite conceivable that vulnerable people in great pain and physical or mental suffering or the lonely elderly may quite quickly internalise the notion that they are ‘unworthy’, ‘useless’, ‘surplus to requirements’, a ‘burden’ to society or their families. This is one form of the ‘the slippery slope’ argument against assisted suicide. Given a market society in which such people are, whatever their subjective feelings, objectively ‘surplus’ to the systemic requirements of job markets and economic growth (except perhaps for the lucrative potential of a new euthanasia industry which will arise once legalised) and given the necessary capitalist-cultural worship of novelty, planned obsolescence and youth, it doesn’t take much imagination to picture a Brave New World society in which the old or ‘non-functional’ see themselves as ‘obsolete’ and quickly remove themselves ‘of their own free will.’ In a culture of normalised assisted suicide, they may be even more likely to see their decision as somehow ‘noble’. As the British Royal College of Surgeons (2014) summarizes: “There is a danger that a ‘right to die’ may become a ‘responsibility to die’ making already vulnerable people even more vulnerable.”

The danger could also quite easily arise of relatives who feel overwhelmed or even stand to materially benefit from an inheritance influencing decisions and attitudes to the desirability of ‘cleanly’, ‘compassionately’ cutting short the organic dying process of a parent or grandparent. It is probably no coincidence that those simpler, pre-modern communities in which the elderly continue being socially active and culturally recognised well into extreme old age, are also those, despite the prevalence of alcohol and tobacco and the absence of modern medical facilities, with the greatest number of healthy, contented centenarians (the Hunze in Kashmir, the Abkhazians in Georgia, the Andean village of Vilcamba in Ecuador). I would assume that such societies would doubtless find voluntary euthanasia a very strange concept indeed.

Advertisements

~ by Peter Lach-Newinsky on March 7, 2016.

5 Responses to “Thoughts on Euthanasia and Dying”

  1. lots to think about here…
    as usual, seems we’re primarily molded/herded by economics…

    • Thanks Kristi, yep, and i guess the cultural and psychological patterns such capitalist economics have formed over the centuries, e.g. ‘possessive individualism’, the ‘market personality’, generalised narcissism etc.

  2. Imagine there’s no heaven. I wrote a story about a future where voluntary euthanasia has become a culturally normalized option. The protagonist’s argument ( his best friend remains opposed to the notion) is that he is able to plan his life financially (retire early), avoid deterioration and make room for the next generation in terms of resource use. He has no fear of death, and feels no great need to be enlightened or know the Truth, find the core of the onion, etc. No “bucket-list” . He has known great love, pain, joy and wonder.
    His regret is not getting to see his grand daughter grow to be a woman, but he figures it is part of the deal (there is no coercion, his commitment is part honor, part self-lessness, part homage to rationality.)

    • Story sounds interesting, Dave. Guess I’m wary of most flatland ‘rationality’ when it comes to primal matters of ‘ultimate concern’ (Tillich) like death and dying. The neocortex/ego would love to think it’s in control of everything, a control delusion indicating deep insecurity and fear of its own precarity vis-a-vis the Void it really is…

  3. The story explores that very “wariness” that is the essence of conscious humanity. With all we (as a species) have learned we are rightfully suspicious of the ego and its “rationality” ,just as we are rightly suspicious of the transcendent and its irrationality. Left with that inner argument, my character casts a wary eye at the “sacred, precious miracle of life” and opts for an illusory “freedom” to negotiate his own terms, to exercise the ultimate agency. He has lived every moment like it was his last and then chose that last moment as a collective good for society. A society of the future facing some hard choices, by the way.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

 
%d bloggers like this: