Dying to Live: Must the reaper be so grim?

How would you choose to die if you could choose your own death?  This isn’t a question that gets asked very often, but it’s an interesting and important one to consider.  It’s probably safe to say that most of us would choose to die without suffering, at the end of a long life.  

To some extent, we can choose our own deaths.  When faced with an illness that is likely to be terminal, we don’t need to go out fighting.  If one chooses instead to accept the terminal nature of the condition and make the most of his remaining time, palliative care may be the way to go.  

If assisted suicide were an option, it would likely provide the most pleasant of deaths.  Even with palliative care to minimize suffering in terminal illness, gradual demise can be unsettling for both the ill individual and for loved ones.  Avoiding this experience could reasonably be a desirable option.  

This is not to say that assisted suicide would be the best choice for everyone.  If discomfort can be effectively managed through palliative care, the additional time could be valuable.  One could get his affairs in order, make amends for regrets, and maybe do a few of those “things we’d like to do before we die”.

And, of course, do-it-yourself suicide in is always an option.

Most of us have a very strong aversion to death. Natural selection sees to it that those animals that are best able to avoid it survive longer and have more offspring.  Aversion to death and strategies for its avoidance obviously confer survival benefits.    

Aversion to death may also develop through associative learning.  Death often follows painful and unpleasant circumstances, like illness or catastrophic injury.  The temporal relationship with the distasteful circumstances reinforces the notion that death and suffering go hand in hand.  

While our aversion to death is understandable, it isn’t entirely rational.  The well established association between death and suffering is misleading.  Death can be as easy as going to sleep.  In fact, some people do die in their sleep.

In many cases, it’s not death itself that causes suffering, but our emotional responses to it.  A great deal of pain is typically experienced by the loved ones of the deceased.  It makes sense that we miss people who were once important in our lives. Unfortunately, the bereavement process can be intensely painful and lengthy.  It isn’t uncommon for people to dwell on a significant loss to the point where it impairs their capacity to enjoy life.  If we were to develop more accepting attitudes toward death and a greater ability to move on after loss, a lot of suffering could be avoided.  

Some of the pain associated with death is caused by our own efforts to delay it.  Modern medicine is often praised for its success in treating once fatal illnesses and lengthening the average human lifespan.  We tend to overlook the undeniable fact that many of these lifesaving medical treatments are quite awful to endure.  Cancer treatment may be more successful than it’s ever been, but it isn’t any more appealing.  Disfiguring surgeries, side effects of chemotherapy and radiation, and painful diagnostic tests are par for the course.  

Saving a human life is perceived to be one of the most noble things a person can do.  It’s often used as justification for animal research.  But what is the rational basis for our opinion that being alive is better than being dead?  Are we sure that saving a person’s life is doing him a favor? The individual whose life is extended will perceive that this is the case because he’s acquired an aversion to death.  He would similarly appreciate assistance in avoiding any event that he fears, whether the fear is rational or not.   

We’ve all been in states of unconsciousness; from sleep, general anesthesia, or fainting.  Nobody minds being unconscious. Deadness is not an unpleasant state.  Human and animal suffering for the purpose of delaying a ‘not unpleasant’ state cannot generally be justified on a rational basis.  Evidence-based medicine has made it possible to extend our lives, but where is the evidence that we should?

Life is hard.  Often it doesn’t feel much like a precious gift. Sure, there are good things in life, happy times, excitement, and fun; but there are also tough times, disappointments, and pain.  Are the happy times more frequent and pleasurable than the bad times are frequent and aversive? Think of the worst suffering that you’ve experienced in your life.  What would make reliving it worthwhile?

I suspect that many of us wouldn’t want to repeat our lives exactly as they happened. The painful experiences are too unpleasant.  Yet most of us seem to be willing to endure great suffering for the opportunity to continue to live.  We hope that the future will be better than the past.  In all likelihood, however, the future will not be much better or worse than the past was, on average.  There will be happy times and sad times, pleasures, suffering, and stress. 

I question whether we even fully comprehend what it means to be alive.  When we talk about wanting to live, what we generally mean is that we want to be conscious.  Most people wouldn’t want to live indefinitely in a coma or sleep-like state.  

If, by living, we mean conscious, we’re not really living when we’re asleep.  Edgar Allen Poe described sleep as “little slices of death”.  The key difference between sleep and death is the ability to wake up.  It’s the permanence of the unconscious state that makes death so off-putting.  Our perception that our consciousness is regained on waking rests on the assumption that the same consciousness that goes to sleep, awakens. This is not a safe assumption.

There is little reason to suppose that a person embodies a single, unique consciousness that endures throughout his or her lifespan.  Consciousness, or the perception of being alive, is generated by the brain, the physical environment, and the body’s physiological conditions. These elements change continuously, such that a unique consciousness can exist only instantaneously.  Memories generate the illusion that it is sustained.  

There is no physical aspect of ourselves that is constant throughout our lives.  The atoms and molecules that comprise us are continuously being replaced.  Our genes undergo mutation and their expression is altered by environmental influences.  Our brains change too; through learning, growth, aging, and injury.  Obviously, we don’t have the same bodies that we had when we were born.  Those physical bodies have already ceased to be.

“Non-physical” features also change over time.  Our collection of memories varies as old memories fade and new ones are formed.  Large parts of our memories can be altered by disease or trauma.  Personality traits, attitudes, and opinions are also changeable; and sensations and perceptions of the environment are renewed continuously.  

These highly variable physical and non-physical aspects generate self-identity, which therefore can’t be constant either.  If the things that make us who we are are constantly changing, how much do they have to change before we can no longer be considered the same people we were?

The differences that distinguish one individual from another can be subtle.  For example, identical twins are very similar genetically and physically, yet they are not the same person. If such minute differences can distinguish identical twins from one another, they can distinguish us from ‘ourselves’ at different points in time.  

It follows from this that what we understand to be a single lifetime is actually lived by a large set of unique individuals.  We exist only instantaneously and we aren’t the same individuals who will die with our bodies. There can be no reason for us to fear bodily death.  

Our attitudes toward death should be reconsidered also because they are no longer adaptive.  Pollution, overconsumption, and dwindling essential resources pose serious threats to humanity.  These problems are exacerbated by continued population growth.  Efforts to extend lives aren’t in anyone’s best interests when they impair individuals’ enjoyment of life and threaten the population as a whole. 

Our fear of death also affects they way in which we approach disease.  The unpleasant nature of cancer treatments should be good reason to emphasize prevention.  As human exposure to carcinogens rises and cancer rates climb, however, efforts to combat cancer focus mainly on the development of new treatments.  We don’t seem to mind the disease too much if it doesn’t kill us. 

The growing number of cancer survivors is both an indication of medical progress and cause for concern.  Not only are more people surviving, but more people are getting cancer.  As the environment becomes more toxic, medical advances enable those who are most susceptible to environmental illnesses to survive and have children.  We are simultaneously making our environment less healthy and inhibiting our capacity to adapt.  In the future, it may be normal to battle cancer on multiple occasions throughout one’s lifetime.  

I’m not advocating eugenic practices but a shift in focus from promoting longevity to enhancing quality of life.  Do we want to live long lives with frequent and unpleasant battles with disease, or do we want to live happy, healthy lives of shorter duration?  The choice is ours; we are choosing the former.

Pervasive attitudes toward death are neither rational nor conducive to human well-being, but they are changeable.  Negative attitudes are reinforced by the media.  For example, the deaths of young people are often described as tragic and untimely; presumably because we’re all supposed to live to be senescent.  We lament the milestones that the young person didn’t get to experience as if being born should entitle us to such things.  This reinforces the notion that death, for anyone who isn’t elderly, is necessarily a bad thing.

We also have a tendency to glorify those who fight disease.  Obituaries often report that people have lost their “brave” battles with cancer.  Whether it’s done out of fear of death or with the hope of experiencing life’s pleasures in the future, battling cancer is not heroic.    

Ultimately, we are individually responsible for our own attitudes toward death.  We have the capacity to question our assumptions and replace our views with ones that make more sense.  

Questioning our assumptions and practices is especially important when it comes to ethics.  Most of us wouldn’t put a family pet through chemotherapy, no matter how beloved.  It would seem selfish and inhumane to subject an animal to suffering for a mere chance to keep him alive a bit longer.  When it comes to humans, what is considered to be ethical is much different.  Even children with very poor prognoses may be forced through painful medical procedures with little honest consideration of what’s in their best interests.   

Suicide is often portrayed as a selfish act, since it causes immeasurable pain for surviving loved ones.  But why should this be a deterrent for the individual who wants to end his life?  Should we live lives that we don’t want to live to keep other people happy?  I don’t think so.  By the same reasoning, it could be argued that we should live at home for our entire lives if moving would cause our parents grief.  Maybe the onus should be on the living to deal with loss favorably.  

The ethics of assisted suicide, in the case of an adult in chronic pain, seem clear to me.  If an adult wishes to receive assistance in ending his own life, and someone is willing to help him, I think we should respect his wishes.  

We ought to have the right to do with our lives as we wish, so long as we don’t infringe upon others’ rights to do the same.  Whether ending our lives is a good decision or a bad decision, it should be ours to make.

When it comes to end-of-life practices, ethical issues are complex and highly debatable.  Because of the potential for infringement on individual rights and the potential for suffering, it is important that the debate happens. 

It isn’t my opinion that death should be glorified or encouraged, but I think it should be accepted to a much greater extent than it is.  Death is a natural and inevitable part of life; it’s our inability to deal with it adaptively that poses the greatest threat to our well-being.  It would behoove us to learn to deal with it in ways that are respectful of individual freedoms and conducive to enjoyment of life.  Quality of life is everything.