'The weariest and most loathed worldly life, that age, ache, penury and imprisonment can lay on nature is a paradise to what we fear of death." So said Shakespeare in Measure for Measure. But our fear of death has changed. We used to fear death. Now we fear life. Or so it would seem.
The ethics of euthanasia and the exigencies that make it a preferred option for some have opened up a new life and death debate. Questions about modes of living have, imperceptibly, shifted to questions about methods of dying. With the increase in technological capacity to sustain life, we are now querying how, when, by whose choice, in what circumstances, at whose instigation, on whose authority, with what proof of consent, in what manner and by what means we should die if life appears to hold no further purpose. Additionally, who defines the purpose of a life?
This bioethical dilemma was brought starkly to our attention last week by the juxtaposed media images of American woman Terri Schiavo fading as the means of staying alive were removed from her, adjacent to images of Pope John Paul II at his balcony, living life's last moments to capacity, his vitality for life despite devastating disability. At the end of their lives, neither he, nor she could speak, but her silence was that of the voiceless about whom decisions are made. His silence was thunderous in its message that the most broken body contains a vibrant life until death.
Of course, the polemics of both positions have been played out predictably between those who see euthanasia as legalising murder and those who see it as legalising humane release from the indignities of debilitating illness. Permit it and assist it, the latter group say. Why prolong pain? Why witness suffering? Why burden family? Live with dignity, die with dignity. Good life. Good death. Self-deliverance. Peaceful passage. Assisted suicide. Aid-in-dying. Compassionate dying.
This euphemistic terminology underlies the ideology that the time and manner of death should be an individual choice. Nobody has the right to impose an obligation to live on another, say those who provide "assistance" to people to end their lives. When life is arduous, when one is incapacitated, physically disabled, terminally ill, "severely mentally ill", "clinically depressed beyond treatment" or, in some cases just "tired of life" and wishing for death, one is "eligible" to apply for assistance to die.
To help decide one can buy the internet advertised new edition of The Good Euthanasia Guide 2005. There is even a video version on what is "available". There are right-to-die societies called Dignitas, Hemlock and Exit to assist and a group called NuTech researching new technologies for ending one's life. Advances advertised are the "helium gas and plastic bag" or the "CO Genie" for domestic death by lethal carbon monoxide.
And as one delves into these realities, the single case "compassionate" argument goes cold; ideology becomes eschatology and the slide down that infamous "slippery slope" from euthanasia to eugenics begins. This is where we must consider the hidden coercion to end one's life that begins in a society that is prepared to define what life may end. This is where "stringent" controls become "flexible" conditions, choice becomes coercion and viability is evaluated economically. Managed care can easily become managed death.
Consider the danger of undiagnosed depression if its symptoms of psychological pain, physical depletion and morbid hopelessness become grounds for assisted suicide? What if our response to the impulse of suicide itself is to assist it? How would "intolerable pain" be defined and who would have the right to define it? Where would we draw the line between physical suffering, psychological pain, bodily incapacity and mental demise? And what would become of palliative care? Would that be merely an option: surely a compromised choice if others were choosing more immediate departures from life?
My question is this - what message as a society are we giving if already one of the most cited reasons for ending life is the "indignity" of being "a burden" to others?
Because laws are as much about messages as directives: about the mental milieu we occupy with regard to the value we place on life and death.
It is too easy, as philosopher Neuhaus cautions us, "to guide the unthinkable on its passage through the debatable, on its way to becoming the justifiable, until it is finally established as the unexceptional."
This is why despite individual cases, which must evoke compassion, one cannot subscribe to the "final solution" of "assisted suicide" because all life is worthy of life.
Investment in living rather than assistance toward death must be preferable. Health care has its own ethical imperatives and obligations: surely working to create ideal conditions for living one's natural life has to be one of them.