First, in mid-September, Ezekiel Emanuel caused a stir by writing in The Atlantic that he wanted to die at age 75, before his faculties dimmed too much, before his life became a litany of medical concerns. “Dying at 75 will not be a tragedy,” he wrote. “Death is a loss….But here is a simple truth that many of us seem to resist: living too long is also a loss.”
Emanuel, 57, said he wasn’t planning to end his life at 75, only that he would not pursue health care strategies designed to prolong it past that point. But as the director of the Clinical Bioethics Department at the NIH and one of the engineers of the Affordable Care Act (aka Obamacare, aka death-panel central) his piece was a magnet for criticism, and one of the most scathing attacks came from Damon Linker, a writer for The Week. Emanuel’s article “clearly amounts to a defense of eugenics,” Linker wrote, because it suggests that only lives in top condition are worth living.
That’s an interesting assertion—problematic, but interesting—but I’m not going to take it up here. Instead, I want to look at Linker’s concluding remark, because it appears to reveal the real foundation of his objection: “No one should hope to die—at 75, 80, 90, or ever.”
No one should ever hope to die. I find that an astounding thing to say, and my response is simple: Why on earth not? Is death such an unremitting evil that it is never preferred to life, no matter how onerous life becomes? On what basis do you come to that conclusion?
My grandmother is 96. She has lived a good life, but the last several years have been difficult for her, and in the past few months a cruel cocktail of dementia and assorted physical ailments have sent her bouncing between hospitals and elder care facilities. When I saw her in early September, she was confused and weak. When my mother saw her a week later, she had no idea what was happening to her, and often didn’t even recognize her own daughter. She is now in the nursing home where she will die, and I think everyone who loves her is hoping and praying that it will be sooner instead of later. Not for our sake, as the life-at-all-costs crowd would allege, but for hers.[gn_pullquote align=”right”]Several times in the last few years, my 96-year-old grandmother has said, “I wish the good Lord would just take me.” But after a lifetime of bearing up to her responsibilities with cheer, she has no right, according to Linker, to hope to die.[/gn_pullquote]
Several times in the last few years, as she watched her faculties decline, my grandmother said to me, “I wish the good Lord would just take me.” This, from my stoic grandmother who never complained about anything, who always made herself smile through life’s difficulties, who never allowed herself to admit depression or despair into her life. After a lifetime of bearing up to her responsibilities with cheer, she has no right, according to Linker, to hope to die.
I don’t know why Linker thinks death is so awful, but I suspect it’s the same reason we as a society spend most of our health care resources trying to keep people like my grandmother alive as long as possible: fear. That fear is often couched in religious belief—belief that a Heavenly Father created us to live as long as He dictates—but at bottom it is still a belief that death is a terrible thing, and life is always preferred to it, no matter how bad life becomes. Death—natural and inevitable, the cessation of struggling and striving—is feared as an evil. Mark Twain nailed the irrationality of it: “All say, ‘How hard it is that we have to die’—a strange complaint to come from the mouths of people who have had to live.”The second death story went viral last week. It is much more visceral than Emmanuel’s, and if you aren’t already familiar with it, you may want to watch the video at the end of this piece. In it, Brittany Maynard, a 29-year-old woman with terminal brain cancer and less than six months to live, explains why she is planning to end her life with an overdose of medication instead of allowing the cancer to take its ravaging course. “I do not want to die,” she wrote in a piece for CNN. “But I am dying. And I want to die on my own terms.”
Maynard has become a poster-child for the right-to-die movement, and she is an ideal spokesperson: attractive, eloquent, with a tragic story (diagnosed on New Year’s Day, a year after her wedding) and all the right bonafides of medical courage (two surgeries, including a partial craniotomy). Despite that—or because of it—she has also become a lightning rod for critics of the movement, and they all seem to rest their case on the simple assertion that life has value.
If you were to Google “Brittany Maynard” on October 10, the third entry from the top (higher even than Maynard’s own CNN piece) was a piece by Matt Walsh for a website called The Blaze, titled “There is Nothing Brave About Suicide.”
“LIFE HAS VALUE,” Walsh writes. “If you deny this, you deny everything. There is no reason for justice, fairness, equity, compassion, or charity if human life has no value, or merely a value contingent upon whatever parameters we’ve arbitrarily asssigned.”
The thing is, no one disputes that life has value. It’s just that other things have value, too. Self-determination has value. Freedom from suffering has value. Dignity, to borrow terminology from the right-to-die/death-with-dignity movement, has value. And even death has value. It is death that makes our choices matter; it is death that makes our response to death a vital matter.[gn_pullquote align=”right”]Does our human agency stop at some invisible line, where suddenly all our efforts to master our experience yield to a passive submission to whatever winds blow our way?[/gn_pullquote]
“Life is to be lived like a cup we drink until the last drop,” Walsh says. But why? Why, if the last dregs are cold and bitter, must they be drunk? Why should nature—fickle, brutal, indifferent—be given the last word on death, when we are so insistent on trying to trump it in every other aspect of life? Does our human agency stop at some invisible line, where suddenly all our efforts to master our experience yield to a passive submission to whatever winds blow our way? Forestalling death as long as possible is not an act of spiritual valor; it is timidity, even cowardice.
Here’s Maynard’s plan for her last day on Earth: “I will die upstairs, in the bedroom that I share with my husband, with my mother and my husband by my side.” She will be conscious, in possession of her wits, not stripped of her capacity to recognize her loved ones. “I can’t even tell you the amount of relief that it provides me to know that I don’t have to die the way that it’s been described to me that my brain tumor would take me on its own.” How exactly is that the wrong choice? She is taking the reins from the brain tumor and deciding that she will make the call, that she will live not as a victim but as a fully fledged human being. That strikes me as an affirmation of life, not an abrogation of it.
Another Maynard critic with enough circulation to make it onto my radar (which is a blunt instrument, so it takes some doing), Katrina Trinko on the Daily Signal, also rested her case on the value of life. “It’s valuable always,” she writes. “No matter what.” Then she describes the long lingering dying process of her own grandmother, as she lost the capacity to walk, and see, and dress herself, and use the bathroom. “I don’t know why she was allowed to suffer like she did,” she says. “I’ll probably never know.”[gn_pullquote align=”right”]We insist on that suffering by turning our head from death, and claiming that living is always better than dying, and making sure our grandmas are pacemakered and IV’ed and feeding-tubed all the way to the bitter end.[/gn_pullquote]
I hate to be definitive in the face of a cosmic mystery like life and death, but here’s why she was allowed to suffer like she did: because we insist on that suffering. We insist on that suffering by turning our head from death, and claiming that living is always better than dying, and making sure our grandmas are pacemakered and IV’ed and feeding-tubed all the way to the bitter end. It is such an odd choice, such an unfortunate taboo. We have no problem sparing our pets from unnecessary suffering, but our grandparents and parents? Them, we want to drink the dregs.
The sad irony is that death seems most like an enemy when we’re fleeing it. Turn to face it and it becomes, if not a friend, at least a worthy counselor. As Emanuel wrote in his Atlantic piece, consciously confronting death “removes the fuzziness of trying to live as long as possible. Its specificity forces us to think about the end of our lives and engage with the deepest existential questions and ponder what we want to leave our children and grandchildren, our community, our fellow Americans, the world.”
Michel de Montaigne’s famous essay “To Philosophize is to Learn How to Die” should be required reading for everyone who will at some point die. Not because it’s morbid; not because it’s anti-life; not because it encourages readers to crave death. But because it is exactly the opposite—because it is realistic, and life-affirming, and encourages readers to step beyond their hard-wired fears and into a life worth living. “A man who has learned to die has unlearned how to be a slave,” he writes. “Knowing how to die gives us freedom from subjection and constraint.”
That is the freedom Maynard has embraced. She is a brave woman—not because she is “committing suicide,” but because she is refusing to commit an even greater sin: the sin of living by default, and letting life just do with her what it will. Yes, life has value. But so does a roaring heart.
Emanuel’s piece in The Atlantic: http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/
Linker’s piece at The Week: http://theweek.com/article/index/268589/should-you-hope-to-die-at-75-absolutely-not
Maynard’s piece at CNN.com: http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/
Walsh’s piece at The Blaze: http://www.theblaze.com/contributions/there-is-nothing-brave-about-suicide/
Trinko’s piece at The Daily Signal: http://dailysignal.com/2014/10/08/29-year-old-woman-chosen-die-thats-loss-us/
Montaigne’s essay: http://books.google.com/books?id=VCrII-QPaucC&pg=PT209&dq=%22to+philosophize+is+to+learn+how+to+die%22&hl=en&sa=X&ei=lTs7VLmICIT7yASttoHQAg&ved=0CB8Q6AEwAA#v=onepage&q=%22to%20philosophize%20is%20to%20learn%20how%20to%20die%22&f=false