Inside Story

Appointment with death

How best should we cope with our awareness of death — and a desire to control when it happens?

Nick Haslam Books 6 February 2023 1691 words

At the forefront: hearts planted in the lawn behind Parliament House in Sydney by Dying with Dignity NSW while a bill to legalise assisted dying was being debated in October 2021. Bianca De Marchi/AAP Image

Even in our darker moments, few of us are likely to agree with philosopher David Benatar that it would be preferable not to have existed. Living brings pain and suffering, Benatar reminds us, which eclipse pleasure and happiness. Non-existence nullifies pain — a good thing — and means no one is around to miss out on pleasure — no bad thing. Hence, as Benatar’s 2006 book title bleakly announces, it’s Better Never to Have Been.

Although they may not have reached these heights of nihilism, many people do wish their lives would end, or at least that they could be cut short if they became unbearable. With assisted dying increasingly in the news, Caitlin Mahar’s new book, The Good Death Through Time, presents an enlightening history of the desires of people suffering from terminal illness or planning for a dignified ending, and of the cultural shifts, religious values and medical advances that have shaped, supported or obstructed them.

Before acquiring its more familiar contemporary meaning about 150 years ago, euthanasia simply meant a good death. Dying was seen as a spiritual ordeal to be endured with Christian patience, and thus a test of courage and character. Much emphasis fell on what came after death — salvation or something much worse — rather than its attendant agonies. “For the faithful,” Mahar writes, “a good death was marked by the embrace or overcoming of suffering rather than its elimination.”

Just as well: doctors at the time had no power to alleviate pain. In fact, they believed it was beneficial to health, and were more apt to cause than cure it with their treatments. In any event, preparing the soul for death was judged more necessary than dulling the mind.

Some of this changed in the mid nineteenth century with the advent of opiates and other anaesthetics, prompting the earliest medicalisation of dying. Euthanasia came to refer to deaths eased by a physician’s care with the aid of narcotics. Pain was increasingly seen to lack redemptive qualities; reducing it might even help the dying to focus on spiritual matters. Mahar argues that this shift in attitudes reflected a more general rise in people’s dread of suffering and sensitivity to discomfort.

That rise, which William James characterised as a “strange moral transformation,” drove campaigns to reduce needless pain by outlawing vivisection, corporal punishment and blood sports. But it also provoked a backlash that foreshadowed present-day sneering at thin-skinned progressive “snowflakes.” A British critic of the voluntary euthanasia movement in 1906 ridiculed it as the home of pain-averse “literary dilettanti” and “neurotic intellectuals,” a charge later echoed by an opponent of euthanasia legislation who worried “we were getting too soft as a nation and too sensitive to pain.”

Mahar offers a compelling account of the rise of British voluntary euthanasia activism in the 1930s, a movement that originated within the medical profession and aimed to give doctors the power to accelerate lingering deaths using morphine and other narcotics in strictly limited circumstances. Despite having eminent supporters such as George Bernard Shaw and H.G. Wells, legislation failed after opponents raised concerns about the potential for abuse by relatives, slippery slopes, medical overreach, and the challenges of regulation.

The revelation that the Nazi regime euthanised well over 100,000 disabled people further damaged the voluntary euthanasia cause, reversing prior support within the medical community and undermining public support for the idea that some lives are “not worthy to be lived.” Mahar shows how eugenics-inspired advocacy for involuntary euthanasia of the intellectually disabled — advanced in Australia by University of Melbourne anatomy professor Richard Berry, whose name was permanently scrubbed from a campus building in 2016 — has tarnished the voluntary euthanasia movement.

The Good Death Through Time provides an authoritative examination of euthanasia debates, court cases and initiatives from the 1950s to the present. Mahar identifies shifts in the groups viewed as suitable for euthanasia, including people on life support or in unrelenting pain not linked to a terminal or incurable condition, as well as in the rationales offered for the practice. Although reducing suffering remains paramount and fear of pain may paradoxically have grown with medicine’s rising capacity to palliate it, voluntary euthanasia has been framed increasingly as a matter of rights, dignity and personal empowerment rather than alleviation of distress.

Australia has been near the forefront of legislative developments. Advocates for voluntary euthanasia argue that overly narrow eligibility requirements have led to unnecessarily bad deaths for those excluded. Disability activists, on the other hand, caution against broadened criteria, citing the Dutch experience of rising euthanasia among people with dementia or mental illness. Mahar concludes with a concise epilogue covering this recent context.

The Good Death Through Time is a lucid and well-documented guide to a challenging topic. Mahar provides a sympathetic but clear-eyed picture of euthanasia’s many protagonists and perspectives without forcing a single view onto the reader. The scholarship is global, but the focus on Australia and Britain adds to the book’s local relevance.

Mahar’s work is especially compelling as an account of the medical profession’s role in euthanasia, in all its meanings. The profession’s views on the desirability and scope of euthanasia have waxed and waned, its pharmacological tools enabling the practice while altering popular attitudes and increasingly pathologising pain. There is no better guide than this one to the wider context of current debates about assisted dying.

Philosopher Dean Rickles’s Life Is Short approaches death from a quite different angle, though he would agree with proponents of voluntary euthanasia that how we fashion our lives and deaths should be a profoundly personal choice. In re-visioning Seneca’s On the Shortness of Life, he wants to persuade us that although we may dread the end of life and entertain fantasies of eternal youth and immortality, it is life’s finitude that gives it significance.

“To have a meaningful life,” he writes, “death is necessary.” Only by having and recognising limits — “the very stuff of meaning” — can we make purposeful choices to create our selves and realise our futures, rather than being tossed around by life.

Life Is Short takes this idea and runs with it through eight brief but somewhat meandering chapters. Rickles suggests that the desire for immortality, or even just for a longer life, is often driven by a reluctance to foreclose future possibilities by making hard choices in the present. He dissects the difficulties individuals face in dealing with our future, notably temporal myopia — discounting the future relative to the present — and the less familiar but no less destructive favouring of the future at the present’s expense.

The key to overcoming these “diseases of time,” he suggests, is to develop a strong sense of connection with one’s future self rather than seeing it as a stranger. “[O]ur present self just is the future self of our past self! Treat every future time as equally as Now, because it will be Now later, and it will be your Now.”

How we should go about making a more meaningful life comes down to making it a project (“Project Me”), carving out a future by choosing and acting rather than leaving options forever open. Doing this requires us to overcome the sense that life is provisional and not yet quite real, which Rickles dubs “onedayism.” That process of overcoming involves understanding ourselves and our motives better. We must move beyond the childish feeling of being unbounded and invulnerable to a mature commitment to a purposeful life and work, dull as that may sound.

Despite his general breeziness and references to contemporary popular culture, Rickles’s intellectual influences have an oddly mid-twentieth-century flavour. Existentialist writers (Sartre, Camus, Heidegger, early Woody Allen) get guernseys, with their ruling image of solitary individuals creating heroically authentic selves against a backdrop of cosmic meaninglessness.

Carl Jung takes centrestage in the book’s second half; not the kooky, occult Jung of mandalas, the collective unconscious and flying saucers but the wise Jung of personal identity and the process of maturation. Rickles discusses at some length Jung’s ideas about individuation — the development of a coherent self through understanding our unconscious motivations — and how the archetypes of the present-oriented child (Puer) and the prudent elder (Senex) shape how we age.

What is noteworthy about this cluster of ideas is not just how much they have been generationally cast aside, but also how they portray our orientation towards life and death as fundamentally lonely and stoical. To Rickles, the authentic, unprovisional life is one in which individuals exercise their will by making resolute choices, pruning the branches of their tree of possibilities, and committing to a specific future.

There isn’t much room for other people in this vision of autonomous self-creation. They tend to figure primarily as the conformist horde who stand in the way of us becoming authentically ourselves by tying us down with their norms and expectations. Yes, each of us exists as a solo being with a unique beginning and end, but something is missing in an account of life’s meaning when relationships and social life are so apparently incidental.

It is well worth spending one of the last thousand or so Saturday afternoons we have left on Life Is Short, but in some ways it is an odd book. Contrary to its subtitle, it offers few concrete prescriptions for living a more meaningful life, so it is not a self-help book, however highbrow. Despite the amiable, self-disclosing persona of the author, its level of abstraction is too high for it to be accessible in a de Bottonian way, although Rickles sprinkles it with some memorable epigrams (“death anxiety is the ultimate FOMO”). Its intellectual style is too associative and wandering to be a philosophical treatise on the nature of life’s meaning.

All the same, as a meditation on a very big question — perhaps the biggest of them all — Life Is Short achieves its goal of making us think about the unthinkable. •

The Good Death Through Time
By Caitlin Mahar | Melbourne University Press | $35 | 256 pages

Life Is Short: An Appropriately Brief Guide to Making It More Meaningful
By Dean Rickles | Princeton University Press | $34.99 | 136 pages