Choice in Dying

Suddenly, I find myself reading more and more about religion, and, since I spent a lifetime in the church, and am trying to put this behind me, I need to explain to myself, sometimes, why I am doing so. For now, instead of trying to give an account of myself, as St. Paul would have said, for the faith that is in me, I write to oppose religion, and all, or pretty much all, that it stands for. (I’ll come back to that qualification in a later post, when I consider Philip Kitcher’s idea of religion as an orientation.) I oppose religion because I find that it diminishes — and cannot fail to diminish — us as persons.

I say, on the masthead of my blog, that its purpose is to argue “for the right to die, and against the religious obstruction of that right.” But this obstruction consists not only in religious opposition to the legalisation of assisted dying. Religious obstructionism goes much deeper than that, and an article in the Huffington Post is a good example of what I mean.

The article, “Treating the Body as a Sacred Home”, by Rev. Amy Ziettlow, a hospice chaplain, clearly exemplifies some of my concerns. Mind you, I do not object to people like Ziettlow treating the people in the hospice — or those receiving hospice care at  home — with dignity and consideration. Of course, this is the whole point of hospice care: to endeavour to make people’s last days as rich and rewarding as possible. But there’s something insidious about the way the good reverend seeks to do this, and this goes right to the heart of the religious obstruction of the right to die.

The problem can be seen in the following quote:

Day in and day out, hospice team members travel to local homes with the goal of assisting patients to feel at home in their bodies. For many of those we serve, their bodies may feel quite alien, uncomfortable, unwieldy, and painful. As they lose control of basic body functions, such as eating, toileting, bathing and breathing, the body can feel like a burdensome, run-down shack and not the sacred home that it is. I use the word “home” in its best possible connotations: a place of safety and security, of warmth and acceptance, of comfort and deep identity.

For many people who are dying, or who are suffering from lengthy degenerative processes, the body is often not a place of safety and security at all. It may be possible, as some research demonstrates, to restore those so afflicted to some sense of the integrity and dignity of their failing bodies, and, where this is possible, then we should do it. No one who supports assisted dying wants people to die before they are ready to die.

However, the claim that our bodies simply are a sacred home, tout court, is another thing altogether. It may seem perfectly harmless — simply an encouragement to those who have the care of the dying to treat them with respect for their dignity as persons – but it actually includes a (suppressed) prescription for the dying themselves. This body, which may perhaps seem increasingly foreign and disgusting to you as, one after another, its systems fail, and you become more and more dependent on others for everyday things that before you simply took for granted, is sacred, holy, and, however you feel about things, you have a duty to continue regarding this as a sacred home until the moment comes that you are released from it.

For example, in an article about assisted suicide, and the criteria necessary to qualify for assisted suicide (all of which is irrelevant to the immediate point I want to make), Felicia Ackerman takes Timothy Quill to task for his remark that “suicide would be appropriate for patients if they did not want to linger comatose, demented, or incontinent.” Her retort is simply:

Haven’t Dr. Quill and his ilk ever heard of Depends? To put the matter less flippantly, I think we need to question our society’s bigoted and superficial view of human dignity, which holds that the old, ill, and disabled have less human dignity than the young and the strong. Does Dr. Quill really want to endorse the view that human dignity resides in the bladder and the rectum? [from a paper published in the collection, Physician Assisted Suicide: Expanding the Debate, ed. Margaret P. Battin, Rosamond Rhodes and Anita Silvers, p. 151]

But Ms. Ackerman has the wrong end of the stick. It’s not that Quill thinks dignity resides in the bladder and the rectum; it’s simply that people who are incontinent, and are losing control over other bodily functions, very often undergo an existential crisis. It’s not what we feel about other people that counts; it’s what they feel. And if someone feels that incontinence, or needing to be “toiletted” by nurse’s aids, and other forms of dependence lack dignity, then they do, at least for them. It may be possible to convince them that they don’t, but you wouldn’t convince me, and I suspect there are lots of other folks you won’t be able to convince either.

So getting all hypothetical about the constituents of dignity doesn’t really help. If it feels undignified to me, and I find my condition of dependence repugnant, then that’s the way I feel, regardless of Ms. Ackerman or Rev. Ziettlow. And I don’t want to be told that I must find my body, which has been reduced to this, to be a sacred home, when it’s just not possible for me to see it in this way; and I don’t want people like Ackerman or Ziettlow to play their religious shell game with me, and tell me that I must simply give up the conceptions of a lifetime and find my dignity in something else. I want to be free to decide when I’ve had enough, and I want to be free to go when I choose.

Ronald Dworkin says something very important in this connexion. This has got nothing to do with general conceptions of what constitutes human dignity. It has to do with individuals and what they value, how they see their lives, and what they can see as consistent with their lives as they have lived them. The question of euthanasia, Dworkin says (and he says this about abortion as well, but we can leave that to the side here), has to do with “the intrinsic, cosmic importance of human life itself.” People are divided on the question of assisted dying, not, he says,

… because some people have contempt for values that others cherish, but, on the contrary, because the values in question are at the center of everyone’s lives, and no one can treat them as trivial enough to accept other people’s orders about what they mean. [Life's Dominion, 217]

That is, if I find being “toiletted” — having my faeces “mined” out of me (as Elizabeth used to call it when it was done to her, wearing a sleeping mask with her iPod cranked up as high as it would go) by a nurse’s aid — if I find this undignified, then that’s the way I find it, no matter how sacred a home Ziettlow thinks I should consider my body to be. And I don’t want her or anyone else to run interference here. This is my life, not hers, and I don’t want to be told what is or is not dignified or undignified.

None of this is to say that people should not be treated with respect and dignity, no matter what their condition or stage of life. But it is to say that religious conceptions of the sacredness of the body are only applicable to those who find this language helpful, and it is, as Dworkin says on the same page, “a devastating, odious form of tyranny” to make “someone die in a way that others approve, but he feels is a horrifying contradiction of his life.” It is the implicit tyranny of Rev. Ziettlow’s remarks that I find so objectionable, because religious conceptions just are the kind of thing that people believe it is appropriate to impose on others, and that is, to a large degree — aside, of course, from the ineradicable epistemological problems of all religious beliefs — the most objectionable thing about religion. Religion believes itself in the possession of absolute knowledge, applicable to all people, always, and everywhere. That’s why I write about religion, because it is an affront to human dignity and a continuing threat to human freedom.