The life choice we have to make before it is too late

I relate very well to how you fear the worst (but will try not to show it) and know it will always be worse than the last time and how this time you just won’t have the reserves to take it. Your energies then turn to extending the time you have - living in the moment - until that fatal moment comes. You might not have long, but you'll go out very Zen. Is there any other freedom?

Making the most of it.

There are safe-houses full of women who fled with little but a book under their arm (or what is more usual, a couple of kids) who know this feeling better than I ever could.
(Although, that would be me not being able to show the half of it….)
There is a lot of suffering in this world ruled by oppression and indoctrination.
And we keep on adding on to false beliefs.

How to end suffering

is no longer just a Buddhist question.
We all need to take responsibility for it and preferably before it kills us.

Is an expedient exit within your own control the way forward?
Leaving God’s Will or the YOLO’s to one side, since this is not a balanced essay on euthanasia, I do find myself mulling over a few issues after reading (in some political manifesto) that we ought to recognise “the RIGHT to die” and be granted the necessary assistance therein. It would be inhumane not to. They aren't saying we should cater to every death wish, mind. This is not a plan to solve over-population on this planet; but if your suffering is unbearable you ought to be able to do something about it, right?

They feel strongly we should make up our minds about this and write up medical declarations with our last wishes specified while we are not yet terminal patients.

If this happens to be one of your wonderful days for life the entire topic will sound whimsical. And if you are down in the dumps you may find it pointless to pre-consider, since the bare bones sound fine, but how will it flesh out? Either they'd bump you off just as you were changing your mind; or you would be whimpering on a trolley in the corridor and the computer says no, and your GP is out playing golf, and nobody would know what to do with you. Does one ever get what one wants in this life of suffering?

Most of you will pull the break at "unendurable suffering" to ask, what it constituted EXACTLY. We'd get stuck on that point of perspective again, that in matters of life is never so mathematical as Piero della Francesca or Poussin found it to be in art. The whole law would get scrapped again, and some untennable situations become murder cases when they could have ended graciously.

Every nation and era feels a little differently

about the right to take your own life. In some places it is lauded as face-saving (depending on the context) or in some radical niches it is much encouraged for the Greater Cause. Sometimes faith dictates, pyres are built for man and wife (too bad if the wife is still in great health), and if you were captured by the Incas you tended to be resigned to winning some and losing some, and felt alright about human sacrifice as preferable to being enslaved.

There are plenty of examples where mankind decides death is the right thing. Never before, I don't think, has man spent so much time and effort to avoid death and refuse it. The counterweight to this is a growing trend to leave people free to make up their own minds about death and by all means get on with it if they so choose. Only, is leaving someone free the same as helping someone to attain freedom?

First, I think we need to learn how to embrace death (and the dead!) before we start to justify killing yourself as a noble act. I forsee a lot of second thoughts, ever greater disconnect and dodgy ethics without that leap forward in consciousness.

In some countries

-generally where dying is a most inconvenient taboo - people get to end their suffering legally by choosing to terminate their lives with the help of their doctors: this is called euthanasia and considered good medical practice. I am not about to disagree; I don't find opinions matter. It is more the question, what would I do if I had to decide yes or no to euthanasia should my doctor be obliged to ask me to fill in such a form at my next visit to the surgery.

It feels paradoxical to call the cessation of life merciful, when the gift of it is one of grace. I suspect it is easier to ask for than the end to all suffering; and easy may not be wrong as such in a world where repairing your fence is already difficult. Assisting the natural course of death, however, is to facilitate the process of dying, which is not quite the same thing as shortening the span of life.

Ethical conundrums

Nobody really feels okay about doctors, preservers of life, becoming too casual in matters of death.
The choice not to live is not something we can give free reign to because it would mean we would have to respect more seriously the wishes of too many teenagers who lie down to die, suffering truely intolerably (I mock this not!). We have suicide hotlines to ensure people don't use their freedom to kill themselves, considering it a shocking waste. I am trying to see how the law can close the loopholes and let you have your death without ruining your life.

If "killing yourself" is what you do, with minimal assistance, at the Swiss institute of Dignitas by drinking your toxic little drink all by yourself, the upgraded version is that you could ask somebody to administer the lethal cocktail to you intravenously in the comfort of your own bed and we more appropriately could call it assisted suicide. Why this then becomes a "good death" (eu-thanasia) I can well see, with many an instance that comes to mind, of peaceful partings and a well-earned peace. But who knows what time death keeps? Even notoriously bad planners can plan a funeral but how good is your "right timing" when it comes to making life and death choices?

Perhaps, life and death are not things we can ever make choices about. We don't seem to choose much at birth, and most of us feel that should go for death aswell. Let it be and we'll see is not just a religious shortcut to self-empowered thinking but it frees up our attention for a situation we might be better equipped to solve. Should we not be writing up manifestos on how aid the bearing of suffering rather than seeking ways to lessen it by allowing less time for it?

Basically we are talking of a shortcut.

Who will be most interested in the shortcut of euthanasia? The ones who don't believe in palliative care? The hedonists who tend to be impatient with the boring and ugly bits of life? Is it only for those who have no heaven to lose? Or what about me myself when I am stuck in bed without the use of my arms and legs, in a clinical setting with nothing to do but tolerate the tv I cannot operate?

What if, shortly after more of us will be bold enough to "take our lives into our own hands, death and all", there might develop a gentle but firm social pressure for you to make up your mind well in advance even when you are the more improvisational type of person. We might come to resent those who are clearly shuffling ever nearer to death's door (say, over 67) but who do not give their mortality a proper thought and fail to arrange such things. Who do they think they are, that they may suffer away their life? Should one not have the common decency to claim the right to death when the moaning starts becoming too loud and incredibly close? Is it also not a civilised and intelligent choice to make, proving one is not spooked by or afeared of death?

Toni Servillo in “La Grande Belleza” (Paolo Sorrentino, 2013).

In effect

what you are going to be asked to do is, wake up one morning and out of the blue decide to see your doctor to make your last wishes known. If it happens to be a sunny day you might well determine how noblesse obliges one to go out in dignity before it is too late. If it snows who knows what melancholy might beset you then.

I imagine some of us at 50 might decide something that will feel appropriate for 96 (no resuscitation) but what may quickly proove inappropriate if you should fall madly in love at 56, survive a crash at 57 and still find your sainted lover by your side ready to wash your quadraplegiac body. What a life experience to take with you when you do (finally) die! How can it be selfish? And what if it is? Or is it still the nobler thing to call it quits?

Ah, but, then we won't have a case of unbearable suffering, will we?! No. Just sweet and silent love.
So, we are going to assume you will still have the final word over your signed document, that specified - with very sound and convincing reasoning - that you would certainly find it an intolerable quality of life to end up in a clinic without the use of your arms and legs, no family, no friends, no reader to keep you entertained, just the telly (no remote control). Suddenly the medical profession will be listening to you!! And you get to reverse what you otherwise put down in black and white as your final decree. Good to know. Revolutionary.

When exactly will we be turning to that document? Who exactly will be pointing to it? There is going to be a very narrow margin in which it will proove useful in practice.
But I am all in favour of any measure that will make us challenge our current general sentiment regards suffering and dying and the need for improved palliative care. By all means let's think about it. Sad we need to be forced to by law, but oh well, baby steps in all things free.

Clauses?

I am not sure if you would be required to review your decision (annually), by some kind of clause. There are sure to be definite and meticulous parameters as to when such a request might be honored at all; but it could already become controversial when the GP has to decide if you are of sound mind when you come in to make the decision for your later self. Would you have to have a certain IQ? What if you are currently in a cult? (Or a very coercive conjugal relation where "we" decide what you want?) Fundamentally, he needs to judge whether you are fit enough to be your own God. Is there a test for that?

What about when it gets really ironic, when at your (last) review appointment, your GP would have to annul your request on the grounds of your no longer being compos mentis, just when you were hoping to prevent the absolute worst case scenario of crumbling into a hellish 8-year period of dying as somebody other than yourself caused by Alzheimer’s disease.

Deciding if that's that.

I hope whatever the weather, and however old you are, you will remember to think of my plumber who survived the unbearable embarrassments and months of agony after invasive surgery, the slow poisoning of chemotherapy, the endless tests, the remission, the relapse, the close call, and a couple of years of a restricted life indoors (ever close to the toilet, this time not for his work) to find himself now cured of colon cancer and enjoying his swims in the sea again (although his marriage did not pull through the ordeal). He is now thinking about cycling Alpe d’Huez.

If he had drawn up a medical statement that stipulated he would want to end his life when he was still suffering from cancer after a third round of surgery, and two years of fighting, and on a gloomy day he had pointed to those wishes he had put in writing, perfectly valid and appropriate to the way he felt that day, the plumber would not be with us now. He would not have sorted out my flooded kitchen last month, and I would have had to call some cowboy and that would have made me so miserable I would have had to point to my own statement.

Some things you can only decide in the moment. Good decisions are never abstract and theoretical. As in life, so in death: everything always turns out differently.

Should we really want to become designers of our own death so far in advance?

In the cold light of the doctor's office, in the five minutes you are given to make up your mind, can we know today what we can bear tomorrow? How unbearable is Alzheimers going to be for me (not you, but the me that isn't much me anyway according to you if you believe in the right to play God all by yourself - thus ignoring the spirit's best interests which may include impossible suffering, possibly, to show herself what is possible whether you like it or not)? Is it truely pointless to continue after your wife dies and you are left to learn how to boil water at 92? (Suicide pacts will probably become more popular amongst the very elderly - so the Hindus were onto something all along - would it that it had worked both ways - ...)

Is any of this knowable, before you have even read Seneca (or better yet Marcus Aurelius)? How many of us have the "right" intelligence by which to know what is best for us? How can you prepare for death before you've even grasped the dynamic processes of dying and living as states of becoming; not arriving at the final destination (or a dead end). Have you had your free portion of watching how you are dying right into the moment, today?

Dying will always remain an agonising indispensable bridge between life and death built out of suffering until we understand how to make love in the face of death.

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Photo from video by The Col Collective in which Mike Cotty educates us on how best to cycle the Alpe d’Huez. I dislike all sports, but cycling perhaps most of all, but I can watch hours of Col Collective and feel I’ve been on holiday after all. And Cotty’s legs inspire me to put more work into mine.

Pictures: Poussin’s “Holy Family on the Steps”, 1648, and a pre-study. A deceptively simple painting in perfect post-Renaissance (more obtuse/casual) triangular proportion. The radiant but old gold of the past to the left and the tip of Michaelic light in the promise of a New Man leading off to the right.