A Point of View: The biggest decision


A personal essay on a particularly controversial issue by the writer Will Self, arguing that we should accept the right of people nearing the end of their lives to take matters into their own hands if they wish.

This may seem rather shocking to you but I am expecting to kill myself.

Really I am, and if you'll hear me out I hope to at least nudge society in the direction of considering suicide acceptable when - and this is the important point - the alternative is a slow painful death from a terminal illness.

Why? Well, the facts are pretty persuasive when it comes to the business of British dying. We're living longer and longer, while our deaths are becoming commensurately more protracted.

Such is the brilliance of contemporary medical science, at least in our privileged realm, that we can be kept breathing long past the point where our existence is anything save miserable - miserable for us, miserable for our loved ones, and miserable for those who have been appointed by either by the state or a private health plan to minister unto us.

Many, I'm sure, will disagree, having had positive experiences of care and kindness in hearth and home and hospice, but these experiences are far from universal.

There was a time, in the not so distant past, when either sepsis or infectious disease - or the very act of parturition itself - did for most of us considerably in advance of the biblically mandated "three score and ten". But nowadays the majority can reasonably expect to live long enough for senility to set in, and sclerosis or sarcoma to finish us off.

It's often said that there's an epidemic of cancer, or heart disease or Alzheimer's in our society. But what there really is an epidemic of old age itself, all these pathologies being merely its inevitable sequels.

What I am emphatically not proposing is that any given person of whatever age, or in any particular physical or psychic state, should kill themselves. I have friends in their 90s, who may be debilitated and depressed at times, but who nonetheless enjoy life intensely.

Often it seems to me that these aged ones have endured long enough that they are not so much hanging on to life as caressing it gently, in the awareness that this, like all bodily experiences, is, of necessity, transitory.

But what I do emphatically believe is that those who feel their suffering at the end of their days is intolerable should have the self-love needed to let go of their lives.

Of course, for people of some religious persuasions, the notion that self-love entails suicide is anathema. For them all human life is inherently sacred, no matter that the body which lives this life is effectively mindless, or wracked by pains still transmitted by stubbornly vigorous nerves.

It's for this reason that in our society - one governed by Judaeo-Christian moral precepts - the suicidal individual was traditionally deemed felo de se (literally: "a felon of himself").

Nowadays, while we may take a rather more secular view of these matters - neither prosecuting those who, as it were, botch the job, nor quarantining for eternity the cadavers of ones who got away - nonetheless, the taboo against killing yourself remains so strong that few can dare to contemplate it, even in extremis.

And there are so many of us in extremis. As our population ages, our hospitals, care homes and hospices are full of people for whom the expression "quality of life" has purely an ironic application.

There is one thing and one thing alone, that gives the lives of many of the terminally ill what little quality they do have, and that's diacetylmorphine. At least, that's what the medical profession term the drug. To the general population it is better known as heroin, and it was called this because in trials conducted by the pharmaceutical company Bayer, those who took it said they felt "heroic".

That was almost a century ago, but the ascription remains apt, for now so many of us play out the final tragic act of our lives in this narcotised state.

Image caption Diacetylmorphine - heroin - is used to reduce pain for the terminally ill

Doctors and nurses will tell us that they can calibrate the dosage effectively enough for the moribund to experience no pain and yet remain lucid, but from what I've seen, palliative care at this late stage largely consists in rendering us oblivious of everything - and in particular our own imminent demise.

Both my mother and my father died of cancer while heavily sedated. In my mother's case, the nursing staff made no secret of the fact that they were upping her medication while withdrawing her nutrition, with a view to smoothing the path to her end.

My father died at his home, but was visited four or five times a day by medics bearing barbed gifts. On the morning after he died, the first task I had was to gather up all the pain-killing medication in the house - morphine in oral solution and pill form - and return it to the hospital.

I absolutely understand the desire to ward off death at any price. For those who are without any belief in transcendence, there is nothing beyond this life, and so they cleave to it for all they're worth. I tell myself that when things get bad enough, I'll make a dignified exit, but somehow I too worry that things won't ever get quite bad enough until they're excruciating and I'm incapable of acting.

That's why I believe a change in social attitudes would be a great boon. I've observed what might be termed a "creeping normalcy" in the existence of the terminally ill - with each successive stage of greater incapacity, indignity and discomfort somehow managing to be incorporated into the daily go-round.

Besides, few of us really understand how to end our lives painlessly and effectively - this is just another crucial bodily matter that we want to leave, along with all the rest, to the professionals. And this is why the whole debate about assisted dying is really a shadow play, behind which lurks a still darker and more discomfiting dilemma.

Of course there are those with terrible conditions - locked-in syndrome, various forms of paralysis - who may wish to die, but be quite unable to do so without help, but for the vast majority of us suicide would be possible as a lone activity for some time after we knew that we were incontrovertibly dying.

But instead of stating this boldly and clearly, we collude with the medical profession who, at an unconscious level, are always only too pleased to increase the ambit of their own expertise, and ask of our legislators that suicide be rendered simply another medical procedure.

It's not, though. Rather, the decision to take one's own life could be, I would argue, part of affirming personal dignity, helping us to reach acceptance, and even gain some serenity - especially when the alternative is a long, painful decline through terminal illness.

Yet as things stand, our impotence in the face of our extinction means that a vast amount of medical resources are expended in the last few weeks of people's lives purely in order to render our deaths insensible and insensate.

When I see politicians campaigning relentlessly on their defence of the National Health Service, I often think that this is the unacknowledged subtext: vote for me, and I'll make sure you cease upon the midnight with no pain.

I don't say any of these things idly. Like many in middle age, my last few years have been heavily marked by an increasing awareness of both my own mortality and that of those who I love. Nor do I wish to offend religious sensibilities, or upset anyone who is either terminally ill themselves, or caring for someone who is.

While not a Christian myself, I still concur absolutely with the sonorous words of the committal service for the dead: "In the midst of life we are in death."

It's because of this that we should all keep constantly in mind that we cannot hope to understand how to have a good life, unless we also ready ourselves for a good death.

If you would like more information on this topic, the following websites may help: BBC Health: Support for terminal illness, National Council for Palliative Care and Dying Matters.

If you have been affected by these issues, you could talk to your GP or someone at the Samaritans.

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