Dignifying Death

July 29, 2012
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Ask anyone which single event sparks the most fear, and most people's responses would include some variation of the word “death.” It's one of the few things in the world that universally affects everyone, but is ironically also one of the most avoided topics. It's something few people want to brood over, much less openly confront. What is it about death that incites such dread? The obvious proposal is that death embodies the unknown, and people generally harbor negative attitudes toward situations that haven't been (and perhaps can't be) explained. But this single theory cannot entirely explain people's attitude towards death. The aversion runs deeper.

My first encounter with death took place when I was ten. It was an oppressively hot day in Taiwan, and my mother and I were sitting uncomfortably on my grandmother's straw mats. Soft croaking sounds emanated from my great-grandmother's bedroom. My grandmother whispered to her mother, “Just one more bite. You don't want all this porridge to go to waste, do you?” The bed groaned, and I imagined my great-grandmother straining to swallow down the rice soup. I recall feeling nagging jabs of dread and helplessness; I wanted to do something, anything, to help my ailing great-grandmother. At the impressive age of 102, she seemed confined to a life devoid of much happiness. But what could I do? At the age of ten, the answer wasn't clear to me. Unfortunately, even our technologically advanced world, the answer, if there is one, still seems beyond our grasp.

The debate over how death should be handled has created one of the most controversial issues today—whether or not euthanasia should be legalized. Some advocate physician-assisted death, a branch of euthanasia that provides a competent patient with a prescription for him or her to use, with “the primary intention of ending his or her own life” (“Definition”). Physician assisted death is legal in three U.S. states—Oregon, Washington, and Montana. Now, a fourth state, Vermont, is attempting to join them. On April 13, 2012, Vermont proposed an end of life legislation that supporters call “Death with Dignity” (WPTZ), a bill named and modeled after Oregon's euthanasia act. Vermont's debate ended with an 11-18 vote in their Senate, terminating the bill. Consideration for the bill has ended for the year—in Vermont's Senate, at least.

The debate itself, on the other hand, is very much alive and well. Supporters contend that legalizing euthanasia would grant people the ability to finish their lives the way they wish. Opponents, however, believe legalizing euthanasia would produce disastrous ramifications. One of their central arguments is that legalizing euthanasia would send society tumbling down a slippery slope. They worry: What if the requirements for the Death with Dignity Act expands to include a larger group of people? What if people start opting for euthanasia as an affordable alternative to rising health care costs? (Somerville). Evidently, this type of “what if?” rhetoric peppers many of their arguments. By basing the foundation of their argument on hypotheticals, opponents give the impression that their stances aren't grounded in reality.

Their concerns, however, are valid; there is potential for the euthanasia law to be misinterpreted or misused. An examination of Oregon's current euthanasia should provide some insight into whether it has deviated from what was originally set down. Death with Dignity requires the person to be 18 years of age or older, a resident of the state that allows euthanasia, capable of making health care decisions for him/herself, and diagnosed with a terminal illness (“About the Death with Dignity”). While these regulations seem clear-cut and definitive, some still point out the ways the requirements are prone to expansion. Margaret Somerville, director of McGill University's Centre for Medicine, Ethics and Law, states: “parents of severely disabled babies can request euthanasia for them, [and] 12- to 16- year-olds can obtain euthanasia with parental consent” (Somerville). Somerville is distinct from other opponents in that she doesn't rely on hypotheticals—she backs up her concerns with concrete occurrences. She sees these as instances in which society already has loosened the regulations and deviated from the original criterions. Indeed, it does seem like society might have taken the first steps down the supposed slope.

In October of 2011, the Royal Dutch Medical Association released new guidelines for interpreting their Euthanasia Act. They now consider mental ailments such as loss of function, loneliness, and loss of autonomy as acceptable justifications for euthanasia (Baklinski). This allows doctors to connect a patient's lack of “social skills, financial resources and a social network to unbearable and lasting suffering” (Baklinski), redefining the criterion to include psychosocial factors. Evidently, the phenomenon of deviating from the original euthanasia law has not been confined to the United States. This rather broad expansion of the criterion appears to confirm opponents' anxieties.

Closer examination of circumstances, though, invites the question: is the expansion unreasonable? In interviews with physicians of patients who participated in Oregon's Death with Dignity, it was revealed that they chose euthanasia due to: fear of loss of autonomy and inability to participate in activities that make life enjoyable (Sullivan). Physical pain is, somewhat surprisingly, “in a tie for last of the six-item concerns...near the bottom in the aggregate ranking” (“Death by the Numbers”). Loss of autonomy and of the ability to participate in activities that bring joy seem to have rendered their lives as not as worth living. Psychological factors seem to play a predominant role for patients, as opposed to physical pain.

At the crux of the expansion, what's really being altered is the definition of suffering. When the act was first constructed, suffering was restricted to physical ailments. The expansion has allowed for the recognition that emotional suffering can be just as unbearable. Perhaps this is valid. Who's to say that emotional suffering is any less intolerable than physical pain? It may be equally as painful to accept that soon, one won't be able to control basic bodily functions, and regress to an infant-like state. The devastation of knowing that soon, one will be unable to communicate with loved ones can be as excruciating as physical maladies. Viewed in this light, the broadening of the law doesn't seem that unjustified. Physical well-being is not the sole factor that determines whether a life is worth living. Indeed, part of what sets humans apart from other species is the fact that our emotional states matter tremendously to us—our feelings and viewpoints are often the factors that make up who we are. Emotional factors dictate how we lead our lives, and, in some cases, whether we decide to continue those lives.

Those who participated in the euthanasia act chose to pass away rather than live a life devoid of independence and joy. Apparently, they valued the quality of their life more than the quantity of it. Some contend, though, that there are other ways to maintain the quality of life, while preserving its quantity. Many point to palliative care, the area of healthcare aiming to provide “relief from pain and other distressing symptoms...[and] intend neither to hasten or postpone death” (WHO). Through the use of morphine and other opioid medicines, palliative care can certainly reduce the level of pain patients endure. Supporters of palliative care, however, seem to have overlooked some crucial facts. Even at its optimum efficacy, palliative care has severe limitations. For one, it provides a reduction of pain, not an elimination of it. For another, it doesn't adequately address the emotional aspects of pain. No amount of narcotics can wipe away the guilt induced by the knowledge that their families are spending thousands on a treatment that isn't really a treatment at all (at least not in curing sense of the term), but just a way of blunting the discomfort brought on by the disease. Despite its attempt to ease patients' physical suffering, palliative care falls short in improving the quality of life.

The controversy over euthanasia can be reduced to a debate over whether the length of one's life is more significant than the quality of it. This pattern—emphasizing quantity over quality—also permeates other areas of society. Our generation is constantly bombarded with messages that encourage us to seek more, more, more. Walk into any store in a shopping center, and it's almost guaranteed there will be at least one sign touting: “Buy five, and get two more, free of charge!” In the article, “Why Consumerism Kills Your Happiness and How to Get Rid of It,” the author encapsulates the plight of society:

When we buy a new car or a new house...we soon find out that those things only boost
our happiness for a short period of time and we are soon back at the level where we were
before
the purchase. Damn, maybe I just need a more expensive car, we then think.
(“Why Consumerism Kills”)
Paradoxically, the desire to acquire more material products sparks more dissatisfaction. We search for happiness and satisfaction in material goods, yet often times, we don't realize we're looking in the wrong place altogether. Consumerism compels people to focus on what they don't have, instead of appreciating what they do. Perhaps what people should strive for more of aren't material products, but more of an appreciation of what they already have.

Just as more material goods don't equate to a more satisfying life, a longer lifespan doesn't guarantee a more fulfilling life. It seems that for those who suffer from fatal illnesses, a longer life actually often results in the opposite; living longer can mean more suffering and pain.

In “The Way We Age Now,” Atul Gawande describes the ways people pass, claiming that decline can occur in two ways—“with an old age of enfeeblement and dependence,” or a more gradual way, “preserving, for as long as possible, your ability to control your own life” (Gawande). Control is a crucial factor, as it can be patients' way of enforcing ownership over their lives. A life one cannot control may arguably not be one's own life at all. Perhaps the patients who participated in Oregon's Act wished to finish their lives when they still had control and dignity left. Indeed, the word “dignity” is in Oregon's law itself. What does dignity entail in this context? The Oxford English Dictionary defines dignity as: “The quality of being worthy or honorable” (OED). Seen in light of Oregon's law, however, dignity carries a distinct, nuanced meaning. For the patients, dignity seems to mean living a life not completely dependent on family members, and being able to have some say over their situations. It means living in the most comfortable and fulfilling way their circumstances will allow. Perhaps more importantly, dignity means recognizing when their lives no longer provide them with that joy and contentment. Leading a dignified life may mean accepting, if the time comes, when one's life is heading towards demise.

My great-grandmother passed away that year. We were told that she went quickly and without much pain. I can't help but wonder, though, how much shame and embarrassment she endured those last few months. She had always been a proud woman, someone who didn't like being sick, didn't like others seeing her even when she had the flu. If she had the chance to leave when she could still live her life, really live it, would she have taken it? I can't say for sure, but I think she would have liked to have the choice.

With the gift of life, comes the price of death. Undoubtedly, the length of one's lifespan is extremely important. But we risk losing some of the crucial elements that make us human—dignity, control, and independence—if we let the importance placed on the quantity of life triumph over the quality of it. Perhaps a life well-lived is not entirely dictated by how long that life persisted; maybe it can be defined by the extent to which that life was infused with dignity and contentment.


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