Wednesday, October 10, 2012

Valuing life, and true dignity in death

What Value Life?

Last week I had the most unexpected but insightful exchange of viewpoints with Robin Ince (comedian, writer, columnist and broadcaster), the new patron of Dignity in Dying.

You can read that exchange in the post immediately before this one.

After a few days Robin posted a well written, longer reasoning behind his decision to become patron of that group (you can read it here). There are some things he’s written that I’d heartily agree with, some that because of our very different starting places we’d understandably come to different outcomes, and some things I just profoundly disagree with.

He very kindly pointed readers of his blog to the post that detailed our exchange, and there was at least the hint of an idea that we might converse again at some point.

I wish I had half his skill with pen, word and wit, and I fear my much longer response might be less exciting. Nevertheless, here it is.

So here I want to lay out some of my own reflections. I write in a personal capacity, these thoughts don’t come from any campaigning group, and I don’t claim to even represent all people in my own denomination (Baptist) let alone all Christians.

My thinking begins with the very idea of life itself. Something is either alive, or it’s not. And, as our heart-breaking experience tells us, when a thing that was alive dies, it’s a miraculous occurrence for it to return to life again. That makes life precious. More precious than anything else. Whilst something is alive there is potential, there is hope, there is the possibility of change, experience, growth, relationship.

Amongst all those living things, for us humans, capable of relationships, of knowingly experiencing emotion, of making decisions about the directions of our lives, of knowing we are alive, and understanding that we will die, life becomes even more precious. Once it is lost in this life (whether one believes in a life to come or not) it is lost. And that complex web of experiences, relationships, preferences, choices, hopes, desires and disappointments is gone. A link in the lives of others is broken. The agony that death causes results in an even greater respect and valuing of life.

I know that those who approach this discussion from all angles have similar feelings, albeit often better expressed then I am able.

So then, life is precious, and so any decisions made about giving it up, asking others to help end it, or asking the state to legislate positively in favour of an assisted suicide must make us pause and deeply reflect on the issues raised.

Yes, some will want to say “whilst you’re reflecting people are suffering, just let them end it” but the hurry to open up that possibility without thinking through the inevitable and obvious chain of consequences seems far too hasty, short-sighted and lacking in wisdom.

So what are the concerning consequences that might make us pause?

Firstly, there is the simple, straightforward matter of ending something that is of incredible value. Some might say “It’s my life, I can do what I like with it”, and of course, on one level that’s right. However, we belong to a family, a worldwide family. And this life we share is in part theirs too. Our existence as a species and the meaning we give to each of our lives derives in part from the value we give to every individual life. By legislating in favour of assisted suicide we’re asking society to say that some lives are less precious, less meaningful. That they no longer need the protection of the state.

I'm reminded of the West Wing storyline when President Bartlett’s daughter is kidnapped. He steps down from office because he knows he will give in to whatever the terrorists demand as his own flesh and blood is at stake, he realises he’s unable to make a clear decision. I want to suggest that in our pain, and even in the thought of pain, we ought not be allowed to decide that life has less worth now. Life remains precious, despite our pain.

Secondly, I think there are massive implications for those asked to assist that haven’t been thoroughly thought through.  What does it do to a person to be implicated in the death of a loved one, in fact of any one? There is a vast difference between the administration of a pain-relieving drug, given even with the knowledge that it may reduce the chance of a prolonged life, and the active participation in a positive decision to end life. 

What does that knowledge do once the heightened emotional state has passed? What does it do to someone 5, 10, 15,30,40 yrs later? Knowing they had taken the steps to kill another person? I’m sure there might be some who’d remain convinced of the rightness of their actions (some psychoanalysts might suggest most would need to regardless of the real evaluation in order to maintain mental health), but what of the others; those who after the fact would live the rest of their lives in the knowledge they took another’s life? I wonder if it is either enlightened or dignified to ask someone to shoulder that lifelong burden?

Thirdly, the potential for abuse here is just so big. By abuse I mean both the very overt kind, where an elderly, frail or ill family member is pressurised to end it all by the explicit request and suggestion of an unloving family (so then the act is nothing at all to do with care, in fact, quite the opposite) as well as the more subtle pressure that comes from the option being open. How quickly might some feel they have become a burden, and the decision to end life be taken because of a desire to lessen the impact of their need, or their suffering on others, rather than a desire to bring to an end their own existence? Now, there will be those who say that these will be rare, and perhaps that would be true, but I would say that the fact they become a possibility at all is enough of a reason not to legislate in favour.

I'm being brief here because I want to move the conversation along, and not hog the floor - however one does that online - but I am aware that some would have expected more spiritual objections.

Yes there are some, and I’ll mention them even more briefly in a moment. But I wanted to place front and centre those first objections, 3 areas where more reflection and consideration is needed that could be helpful to those who have faith, and those who have none. I'm not here to argue that one person is better than another, and I'm not suggesting that the spiritual values that I hold and which underpin my thinking ought to be universalised and enforced. I think, first and foremost, on purely human terms this is a bad idea.

But of course, yes, I have objections that stem in a more focussed way from my faith. I'm sure many will disagree with them, and they could become the main focus of discussion. I’d rather that the first 3 were though...

So, I believe in a God, who created everything, who gives life to all that lives, and shared the divine capacity for creativity, emotion, awareness and relationship with humans.  I believe that which is given by God is not to be taken away freely by humans.

I believe too that God has revealed in timeless laws some values that society can be usefully shaped by, and that in Jesus specifically that can be applied to human relationships.

For me, I take a look at Jesus, and reflect on the idea that He is the visible image of the God we can’t see, and I wonder if he’d take a life? If we’re in this network of friendships and relationships within which we give and derive meaning, what does his example, teaching, his life inspire in us? For me, I think it is to show great compassion, through the whole of life’s experiences, even a bitter end.

I think that to know that you’re not alone, to know that you are loved, and that those around you share with you in your suffering is able to give strength, and makes it possible to re-frame and understand in a different way this part of each life’s story. To take away from someone the chance to show the kind of love that sustains to the end by short-cutting the dying process seems to me to rob meaning from the life of others. As I asked in the twitter exchange, does the enlightened life have to place “me” at the centre?

So at the end, I'm left with a statement I've been criticised for as being too naive. It's a statement that I think often leads to human progress; There has to be a better way.

That better way is undoubtedly to channel that campaigning energy into ensuring palliative care provision is freely available to all approaching the end of life. That better way is ensuring that every member of society feels loved and valued and not a burden. That better way is value every life equally, and not give up on hope. That better way is to take the precious gift, tarnished, bruised and blood-stained as it is, and nurture it until it's light goes out.

2 comments:

Rachel said...

I came to your blog via Dignity in Dying and your conversation with Robin Ince, which will immediately tell you my views on the subject. First I would like to thank you for your openness and willingness to engage in discussion. This is a hugely important question worthy of the most careful consideration and debate that we can bring to bear. In that spirit, I hope you'll forgive the length I've gone to in explaining my views and sharing my experiences.

You imply that that those of us in favour of assisted dying simply haven't thought it through properly, which I find faintly insulting. I have reflected long and hard on this subject, whilst my grandmother slowly, slowly died.

Unless I've misunderstood you, your main point is that "Life is precious, despite our pain." You value life so highly that you consider being alive and suffering to be worth more than being dead. That value judgement is certainly yours to make about your own life, but you go further. You also insist that my life is so valuable that I mustn't die, no matter how much I'm suffering (which thankfully, I'm not). I'll come back to this.

You also make the point that no man is an island, we are all part of families, both our close, blood-relative families and a worldwide family. I respect this point and its implication that my life is not wholly my own. Any decision I make about my life will also affect other people. In the context of an end of life decision, the person most affected (probably) would be the person I asked to help me die.

Here we come back to the value judgement whether a life of suffering is more valuable than death. You consider life so precious that it is always more valuable than death. Consequently, the thought of ending another person's life, even if they begged you to do it, is abhorent to you. I wouldn't ask you to help end my life; it would be too traumatic for you.

Instead, I would ask someone who shares my views. In my judgement, life is not absolutely and universally precious. Sometimes, life is a burden. In extreme cases, it is agony. Even in less extreme cases, a life may contain more suffering than joy, and any reasonable person could see that there is no prospect of improvement. There may come a point when no amount of palliative care and loving friends and relatives can compensate for the pain and struggle of that life. I judge that those lives are not so valuable that they must necessarily be preserved to the last possible moment. Note that I am not saying such a person should die, but that they may; they should not be kept alive against their wishes.

Let us not forget that everyone must die. The question is only when, and how? Let me tell you about my grandmother.

Rachel said...

Grandma was a magnificent woman of forceful personality. She was a painter, an actress, a campaigner for women's education in Africa. She was still running her own business into her nineties. It's her last years I'd like to tell you about, from the age of 95. By that time she'd outlived her brothers and sisters, her husband and her beloved only daughter (by 15 years). She'd outlived two people she'd lined up (successively) to give the eulogy at her funeral, as well as the vicar.

At this point she became unable to look after herself. She could no longer cook safely - she nearly burnt her house down once - which was a big blow as she was a better cook than anyone we could find to cook for her. She was incontinent. She had trouble breathing and though she could just about get around her house, she was increasingly incapable of leaving it. Her hearing deteriorated to almost complete deafness - she never stopped complaining that people didn't speak clearly. The volume at which she watched the evening news was a health and safety issue for anyone else in the house at the time, but she refused a hearing aid on the grounds that she wouldn't accept charity (her view of the NHS). Her eyesight was better, but poor enough to stop her painting. Her memory got so bad that I share any family news with her. She asked the same questions over and over - I sometimes tried out different answers to see which pleased her best, then then stuck with that one. She became anxious and several times was convinced that people were stealing from her (I don't believe anyone was).

Like most people, it was her dearest wish not to go into residential care. She was determined to live and die in her own home and I promised her that I would never 'put her in a home'. Luckily, she was quite wealthy, so we could use her savings to pay for live-in care, but over a few years this did use up all her money. I was investigating ways of borrowing against her house (not necessarily possible using power of attourney) when she deteriorated to the point that the live-in carer couldn't cope any more. A close friend made the decision to take her to hospital.

She wasn't ill, just very old. Hospital wasn't the right place for her and though they were wonderful and accommodated her as far as possible, they did tell me that they couldn't keep her there indefinitely. I had to find residential care for her. I did this with the heaviest of hearts. I knew it wasn't what she wanted and I'd promised I wouldn't do it, but it was the only option. She asked me at that time if perhaps we could look into having someone care for her at home? She'd completely forgotten the carers she'd had living-in for the last two years.

It was extremely painful for me to watch my proud, strong, independent Grandma deteriorate into this pathetic shell of a woman. If she'd asked me to help her die, I would have done. =She didn't ask me, she asked God. Repeatedly, she asked God to let her die and his answer, as she told us, was always, "Shut up and get on with it." She finally died in hospital at the age of 98. The last three years of her life were a miserable struggle.

How would I have lived with myself if I'd killed her? Much more comfortably than with the knowledge that I wasn't able to keep her at home until she died. I promised her that I would, and I failed.

Insisting that people continue to live when they wish to die and their lives are nothing but suffering shows a lack of respect and compassion that I find horrifying in those who profess to love others. I hope that if I live as long as my grandmother, someone will love me enough that when I ask them, they'll spare me those last few years.