The Way We Die Now (21 page)

The US state of Oregon enacted the Death with Dignity Act in 1997, which allows terminally ill people to obtain prescriptions for lethal doses of barbiturates, which they administer themselves. Nearly twenty years after the act became law, only three in every 1,000 people dying in Oregon avail themselves of this freedom. One third of those given a lethal prescription never use it. Twenty of 460 dying people regurgitated the drug, and one patient took a record 104 hours to die. ‘The doctors we talked to said it was likely she just had a very strong heart’, remarked George Eighmey, executive director of Compassion, a voluntary group which ‘supports and monitors’ Oregonians given these prescriptions. Another patient woke up after being asleep for 65 hours; according to Eighmey, he woke up ‘because he had taken a laxative to mask the bitter taste of the legal drug, which prevented his body from absorbing the drug quickly enough.’ He died, we are told, two weeks later, unassisted.

Some opponents of assisted suicide argue that vulnerable groups, such as the poor, the uneducated, and people with chronic physical or mental disability might be susceptible to this kind of death. A 2007 study examined the experience in Oregon and the Netherlands, and found no evidence for this claim. The only group with ‘a heightened risk’ was people with AIDS. I am not remotely surprised by the findings of this study. The passion for control is rare among the ‘vulnerable’.

The doctor in me is vehemently opposed to assisted suicide, but another part of me is (slightly) attracted to the idea of having the freedom to end one’s own life. Perhaps if I wasn’t a doctor, I might even be a supporter of assisted suicide. I am wary, however, of the notion of ‘death-on-demand’ as a glib riposte to the inevitable miseries of old age. The modern gospel of the ‘compression of morbidity’ is partly to blame. This concept was popularized by Dr James F. Fries, Professor of Medicine at Stanford University Medical School, who first wrote about his theory in 1980. Put simply, the ‘compression of morbidity’ teaches that as longevity increases, old age will be a period – increasingly longer – of active life and good health, followed by a short, relatively painless, final illness. American baby-boomers, bombarded with images of jogging octogenarians, have invested heavily in this concept, and are desperate for it to be true. Unfortunately, it isn’t. Study after study has shown that rising longevity is accompanied by increased disability, social isolation and loss of independence. Half of all Americans spend their last year in a nursing home. Is the demand for assisted suicide partly fuelled by disappointment that the ‘compression of morbidity’ is a fairy-tale, that old age is not always an unbroken run of golden years?

I have described the two extremes of control – ‘kill me’ and ‘don’t let me die’ – but both are delusions. In the end, nature will decide.

A long-held (and almost completely unchallenged) assertion of philosophy is that it prepares one to meet death with equanimity. Socrates and Seneca taught that we should not fear death, that we can overcome the dread of it by keeping it constantly in our thoughts. I have never been persuaded by this. The great popularizer of this idea was Montaigne. Michel de Montaigne (1533–92) was a French nobleman who, at the age of thirty-eight, withdrew from public life and spent the remaining twenty years of his life reading, thinking and writing what he called ‘essays’. He is usually credited with inventing this literary form. His essays were like nothing that had ever been written before: highly personal, speculative, uninhibited, discursive and inspired by his reading of the great classical authors. His parents had engaged a Latin tutor for Montaigne, who spoke the language fluently before he could converse in his native French. He was thus deeply influenced by the writings and examples of Cicero, Seneca and Marcus Aurelius.

The young Montaigne had a busy career as a magistrate, civil servant and diplomat. He was obsessed by death: as a young man, he lost his friend and soulmate, Étienne de la Boétie (who died of plague), and six years later his younger brother Arnaud died after a freak accident (a brain haemorrhage caused by a blow to the head from a tennis ball). Of his six children, only one survived into adulthood. Montaigne resolved to adopt the Stoic approach to death; his famous essay ‘To philosophize is to learn how to die’ borrowed its title from Cicero, who in turn, borrowed it from Socrates. The Stoics taught that we should face the inevitable with courage, resignation and lack of fuss. Fate cannot be controlled, but one’s attitude to events, including death, can: ‘At every moment let us picture it in our imagination in all its aspects. At the stumbling of a horse, the fall of a tile, the slightest pin prick, let us promptly chew on this: Well, what if it were death itself?’

But Montaigne was forced to re-examine his beliefs after a dramatic incident which occurred when he was thirty-six. He was thrown from his horse, and sustained serious injuries. Lying in a semi-conscious state, Montaigne was surprised to find himself experiencing no fear or pain. He was convinced that he would die yet felt completely at peace: ‘in truth not only free from distress but mingled with that sweet feeling that people have who let themselves slide into sleep’. Miraculously, Montaigne survived and had a slow and painful recovery. This event completely changed his attitude to death: ‘If you don’t know how to die, don’t worry; Nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you; don’t bother your head about it.’ Sarah Bakewell, in her biography of Montaigne,
How to Live
(2010) wrote: ‘“Don’t worry about death” became his most fundamental, most liberating answer to the question of how to live. It made it possible to do just that:
live.
’

Do philosophers, and those writers (such as Tolstoy) who write about death, die any better than their less contemplative brethren? My rather banal conclusion is this: some philosophers die well, some die badly; they appear to have no particular advantage over non- philosophers.

Montaigne maintained, purely on the basis of his own near-death experience, that dying is easy, and convinced himself for the remainder of his life that death was not to be feared. This was a neat psychological trick, but if accounts of his demise are accurate, it was not at all easy, although he did it bravely. He died of quinsy, or peritonsillar abscess, at the age of fifty-nine. He had previously expressed the wish that he would die while ‘planting cabbages’. It was not to be. He died slowly and painfully, over several days, propped up in bed. He struggled for breath, and his entire body was grotesquely swollen. In one of his essays, Montaigne had written that the most horrible death would be to have one’s tongue cut out, to be without the power of speech. His illness did just that.

His was the typical public death described by Philippe Ariès: Montaigne’s family, servants and priest were in attendance. Having written his will, Montaigne, although not an especially devout man, had a last mass said in his room. He died during this mass, probably of suffocation, as the abscess slowly closed off his windpipe. This was precisely the kind of death he had hoped to avoid:

...the cries of mothers, wives, and children; the visits of astounded and afflicted friends; the attendance of pale and blubbering servants; a dark room, set round with burning tapers; our beds environed with physicians and divines; in sum, nothing but ghostliness and horror round about us; we seem dead and buried already...

The painter Joseph-Nicolas Robert-Fleury depicted Montaigne’s death in
Les derniers moments de Montaigne
(1853). The canvas shows those very ‘terrible ceremonies and preparations’, right down to the dark room and the pale and blubbering servants. Montaigne has left us many well-polished phrases about not fearing death, but his philosophizing did not prevent him from having the type of death he expressly wished to avoid.

Montaigne tells us little of practical value about dying, because dying in sixteenth-century France was so different to what we experience now. Dying in old age was unusual in Montaigne’s day, but now it is the norm.

Some philosophers, such as Hume and Wittgenstein, do indeed die a ‘philosopher’s death’. Others, like Albert Camus (1913-60), died in character: he was killed in a car crash, having ditched plans to make the journey by train. The unused train ticket was found in his coat-pocket. He had once remarked that he couldn’t imagine a more meaningless death than dying in a car accident. ‘So Camus died in a car with a train ticket in his pocket,’ wrote Michael Foley in
The Age of Absurdity
, ‘an absurdist parable on the consequences of accepting someone else’s route.’

David Hume (1711–76), the great Scottish Enlightenment philosopher and historian, was, by universal consent, the most even-tempered and agreeable of men. Jules Evans, in
Philosophy for Life
(2012), recounts the story of his death:

In his sixties, after a long and distinguished career as an essayist, historian and philosopher, Hume fell ill with a disorder of the bowels that was probably cancer. His friend, the philosopher Adam Smith, tells us that Hume initially fought the disease. But the symptoms returned, and ‘from that moment he gave up all thoughts of recovery, but submitted with the utmost cheerfulness, and the most perfect complacency and resignation’ to his death.

Hume’s final illness lasted long enough – sixteen months – for him to write a brief autobiography,
My Own Life
:

I have suffered very little pain from my disorder; and what is more strange, have, notwithstanding the great decline of my person, never suffered a moment’s abatement of my spirits; insomuch, that were I to name the period of my life, which I should most choose to pass over again, I might be tempted to point to this later period.

Hume was an atheist and believed that death meant extinction. He was not, however, an evangelical unbeliever in the Richard Dawkins mode; indeed, like Gibbon, he thought that one should maintain the religious proprieties, particularly when dealing with women and servants. Thomas Boswell visited him near the end, and was perplexed by Hume’s equanimity: ‘I asked him if the thought of annihilation never gave him any uneasiness. He said not the least, no more than the thought that he had not been, as Lucretius observes.’

The bioethicist Franklin G. Miller contrasted Hume’s death with that of Christopher Hitchens. They were of a similar age when they died (Hume was sixty-five and Hitchens sixty-two) and had a similar interval between the onset of sickness and death (sixteen months and nineteen months respectively). Both believed that death meant oblivion. Because medicine in Hume’s day had so little to offer, he spent this sixteen months writing his autobiography, and ‘was exposed to none of the rigors and distressing side-effects of disease-fighting interventions’. Hitchens’s nineteen months, as we have seen, were spent in ‘Tumortown’. ‘It is much more difficult today’, concluded Miller, ‘to achieve the tranquillity of Hume in facing death from cancer.’

Hume’s calm deportment in the face of death is matched only by Ludwig Wittgenstein (1889-1951). In
The Book of Dead Philosophers
(2008), Simon Critchley tells the story of his final months:

After he had been diagnosed with terminal cancer, news that he apparently greeted with much relief, Wittgenstein moved in with Dr and Mrs Bevan... In the remaining two months of his life, he wrote the entire second half of the manuscript that was published as
On Certainty
... He had developed a friendship with Mrs Bevan; they would go to the pub together every evening at six o’clock where she would drink port and Wittgenstein would empty his glass into the aspidistra plant. She presented him with an electric blanket on his birthday and said, ‘Many happy returns.’ Wittgenstein replied, staring back at her, ‘There will be no returns.’ Mrs Bevan stayed with Wittgenstein during the last night and when she told him that his friends would be visiting the next day, he said to her, ‘Tell them I’ve had a wonderful life.’

Ernest Becker was visited in hospital before his death by the philosopher Sam Keen:

The first words Ernest Becker said to me when I walked into his hospital room were: ‘You are catching me in extremis. This is a test of everything I’ve written about death. And I’ve got a chance to show how one dies, the attitude one takes. Whether one does it in a dignified, manly way; what kind of thoughts one surrounds it with; how one accepts his death...’

Montaigne’s hero, Seneca (4
BC
–
AD
65), was that rare entity, a vastly wealthy Stoic philosopher. He fell foul of his former pupil, the emperor Nero, and was ordered to take his own life. He and his wife Paulina resolved to die together and used the traditional Roman method of cutting their veins and soaking in a bath. This didn’t work, because the veins stopped bleeding. Seneca eventually died from suffocation in a steam bath. The whole episode was grisly, messy and protracted; hardly the dignified exit of a Stoic. The game and willing Paulina survived – Nero had sent orders forbidding her death, so her wounds were bandaged. She went on to live for many more years. Is there a lesson here? Perhaps if Arthur Koestler’s wife Cynthia had read about Paulina, she might not have been so enthusiastic about the death-pact with her husband. Even Seneca, with all his wisdom, experience and wealth, couldn’t carry off the classical Stoic death. His botched demise was marked more by farce than nobility.