Ethics

In the 2009 post-apocalyptic movie, The Road, based on a critically-acclaimed novel by Cormac Macarthy, a vagabond character played by Robert Duvall is asked if he ever thought about giving it up and dying, and he replies that, No, in these times we cant afford luxuries. In this film the protagonist, played by Viggo Mortensen, and his son set out on a long, grim and grueling journey in the hope of meeting a band of survivors of the world-destruction caused by some unspecified cataclysm. In the bleak, desolate times they belong to, life does not seem to have much of a meaning. On their journey the father and son could encounter many situations in which death would be vastly more preferable to life. The father keeps a gun loaded with two bullets, one for himself and one for the son (Berardinelli 2009). In such a scenario as this movie presents, we can see compelling reasons for both a) continuing life at any cost, enduring whatever pain and suffering it may bring, for thats what the human spirit amounts to and as well for b) ending it all, because that could be the best rational choice in a host of imaginable situations. And we must remember that man is a rational animal.

In general, human existence is such that wherever we stand the road ahead forks in two directions, and perhaps above all to be human means to choose. The question of choice rarely gets as complicated and involved as in matters of life and death. Four hundred years ago, Shakespeare made Hamlet utter his immortal words (no pun intended), To be or not to be  that is the question. And that continues to be the question, more so today than ever, even as we have become so much more proficient technologically in prolonging life spans of common people by wide margins. Albert Camus, the French existentialist, said that the question of suicide is the most basic philosophical question (self-knowledge.org)

There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest  whether or not the world has three dimensions, whether the mind has nine or twelve categories  comes afterwards. These are games one must first answer the questions of suicide.

This has indeed been the great existential dilemma since man has emerged as a conscious free-willed entity, whether human awareness crystallized tens of thousands of years or only a couple of thousand years ago. In our own times, though, the question has assumed huge proportions and a much more immediate relevance, with a plethora of legal and social implications.

When we consider this issue, on the face of it it would look as if it is a simple matter and everyone should have the right to die in warranted circumstances. But when we begin to look at it a little more closely, the abyss opens, and we cannot be sure of our orientation any more. The nature of this problem can be succinctly illustrated through a simple, relatable example. Over a decade ago, a neighbor of mine, then a boy of 13, met with a gruesome accident when he was hit by a car as he was riding a bicycle. His body was virtually smashed, the doctors did not really think he had any chance of survival, and advised his parents to let them terminate his life. However, his mother was very adamant that they should do everything they could in treating him. The boy survived, came out of coma, was discharged from the hospital after undergoing several surgeries over a span of a few months. For years his mother had to take care of him as if he was an infant, for he was totally paralyzed and had to be fed through a tube. Today, he is a grown up young man although still bedridden and communicating through sign language, he can relate and talk with others perfectly normally, he has a wide variety of intellectual interests, a great sense of humor, and an irrepressible zest for life. It is a delight to be in his company. Back then, as a friend of his, I too thought it would be very good if he just died or if the doctors let him die, for I hated to see him living the life of a severely crippled person, but more than that the thought of the kind of perpetual ordeal his mother would have to undergo in looking after him was very appalling. But now when I see him, I feel like perhaps it was all worth it, the guy is indeed a kind of living miracle. The whole family, the mother and the son, the father and even the sister are a testament to human courage and endurance.

So the question arises, how justified would have been the doctors, and many friends and relatives including me, if the mother took our advice in the aftermath of the accident and let the boy die The issue is inherently so complicated that even with the aid of so much hindsight it is difficult to answer this. The mother is a PhD. and had to sacrifice her career because of her son, but that is nothing when we consider the incredible degree of physical and mental anguish that the boy and the mother would have gone through all those years of mind-numbingly slow recovery, surmounting each little hurdle one at a time, a process which nonetheless occurred rather fast speaking in relative terms. The most important factor to consider here is that how could it have been if the patient never really improved and went on vegetating for decades. That would have been a living hell for both the mother and the boy. Sadly, in the real world there could be any number of cases like that where things did not improve beyond a point, it is just that in this particular case the people have been rather fortunate. We may think that the mother listened to her inner voice and took the right decision. But this is only a tenuous explanation, we cannot depend on intuition and inner voices of the people to show us the path of wisdom every time. And moreover, today it is no more a question of isolated instances here and there, we have to contemplate on the issue of euthanasia at a collective level as applicable to many kinds of sick and suffering people, especially elderly ones.

Of course when it comes to making the decision of terminating a human life, even if purportedly on the grounds of compassion, each case tends to be unique and it is difficult to have any kind of general guidelines but considering the matter from a perspective can give us insights which can help in the process of decision making. In fact a part of the dilemma here essentially arises from the scalability concerns from an individual case to the collective setting. In cases of old and terminally ill patients, particularly in instances where people might be experiencing excruciating pain, there is usually a strong argument in favor of letting a person die a quick and dignified death. This stands very much to reason, and relatively few people would make serious objections to it per se. But suppose we change the parameters of the case just a little bit, for example if the patient happens to be relatively young or even just a child, and although considered terminally ill by todays evaluative standards, even if he were to survive just a few years new emerging technologies could cure his disease and make him perfectly normal. Today, both the patient and his family may be willing to go for the option of euthanasia, but if implemented, some time later on it may lead to much regret and may even appear like some sort of homicide.

Just like a confession made during police interrogation need not mean much and is usually not valid in the court of law in order to grant conviction, the willingness of the patient himself or herself to end his or her own life need not have a decisive validity. Personally, in the course of our lives we must have on several occasions felt like ending it all would be the best option, even if it be only for trivial reasons when we look at it objectively or in hindsight. It is a different thing that most people do not act on their momentary impulses. Similarly, it may be that in a state of severe depression and turmoil induced by some grave illness, the patient is hankering for death, with his closest relatives backing him  but still it may not be wise to let him end his life just like that. The patient may soon pass through it and live to realize his folly and may even be thankful to the doctors for not acceding to his wishes.

At the same time, let us suppose I am a patient going through some interminable agony, I am nonetheless in full possession of my faculties and want the doctors to end my life in a decent, painless way.  And if the doctors deny me that, I could be stupefied by the total ridiculousness of it. I could feel myself to be a clown in a freak show run by the doctors. Even for outside observers it might appear very inhumane the doctors might even appear as sadistic persons thriving on other peoples pain. Euthanasia could indeed be the most humane choice in a wide variety of situations, but the whole problem comes in determining the appropriateness of the situations. An octogenarian or a nonagenarian patient suffering from a serious illness could be an ideal candidate for euthanasia, but even if we make a move or two from the ideal case, we encounter all sorts of complications.

If we grant legal validity for carrying out euthanasia in just some particular cases and special circumstances, it would be very difficult or impossible to draw the line from there on. This is where the problem of scalability comes, because even if euthanasia was valid in certain specific instances, legally sanctioning those instances would create a trend which could soon lead to gross abuses, either willfully or unknowingly. Even in our ideal case of a seriously ill elderly patient, it may be that his own children or grandchildren want him to die, and they may subtly coerce and convince him, just in order to get rid of him. This may not amount to such a great crime in the particular, isolated instances, but if it catches up, it would lead to a slippery slope, causing the whole moral edifice of our society to tumble down it.

But of course, that there are such strong pros and cons need not mean that we should remain immobilized and do nothing about it. There is much that needs to be done. Only, in order to make judicious choices, we need to examine the whole matter at a greater depth and from a broader perspective. Socrates said, An unexamined life is not worth living  similarly perhaps an unexamined death is not worth dying either.