Thursday 9 September 2010

Euthanasia, antibiotics and Terry Pratchett

The matter of euthanasia has been 'in the news' lately in England, because of the advocacy of Terry Pratchett.

(Sorry, but I really cannot call him 'Sir' Terry. Sir has by now become a title overwhelmingly associated with a public career of political correctness and bureaucratic dishonesty, and has utterly lost its old romantic connotations of Arthurian knights in armour fighting evil and rescuing maidens in distress).

I can't think of another living novelist whose work I like and enjoy more than Terry Pratchett - especially his books featuring witches (e.g. Granny Weatherwax and Tiffany Aching).

But there is something I find terribly dismaying about TP's campaign to create 'tribunals' for assisted death:


As is well-known, TP has recently been diagnosed with a slowly-progressive but irreversible dementing illness - and he has expressed an understandable desire to avoid a prolonged decline into helpless dependency before his eventual death.

Terry Pratchett is a prominent atheist (although his best novels implicitly contradict his abstract opinions concerning the nature of the universe, since they are saturated with transcendental meaning).

Therefore TP's discussion of euthanasia is a clear statement of a humanist world view and its implications. Seeing this spelled-out so starkly, and from an author whom I like and respect, I find an uncomfortable, somewhat distressing experience. It has been on my mind for many months now.

TP's tone is the secular modernistic one that regards the value of a life as purely an hedonic matter - the outcome of a quantitative comparison of pleasant versus unpleasant feelings.

Life's value is implicitly assumed to derive from a surplus of good feelings (pleasure, gratification and independance) over bad feelings (misery, pain and dependance); and TP's argument is that when the good feelings have disappeared or the balance towards the bad has gone too far, then we should be assisted in killing ourselves if and when we wish (with abuses supposedly being prevented by the proposed bureaucratic tribinal).


TP wants more people to have the possibility of a dignified death, a 'good' death. But it seems to me that the concept of a good death is meaningless unless life itself is seen as more than a matter of balancing subjective positives against subjective negatives.

Therefore, any discussion of the desirability of euthanasia *must* begin with a clear statement of the nature of human existence and the purpose of life. Because the meaning of death can only be understood in a context of the meaning of life.

I know it is meant as a joke - but the idea that a perfect finish to life would be to "die peacefully with Thomas Tallis on my iPod" is horrific. This embodies the secular modern idea that life is *essentially* a matter of maintaining a state of pleasant distraction from awareness of reality (especially the reality of death).


But on the other hand, I also find the views of many people who publicly oppose euthanasia to be disturbingly incomplete. TP is describing real and big problems about modern death.

Modern medicine, modern culture, while valuing life no more highly than as a source of pleasure; yet recklessly prolongs this biologically conceptualized existence in vast numbers of humans, using a range of artificial means such as medication and biological support.

The situation is now one in which many people (and an increasing proportion of people) end their lives by enduring many *years* of a twilight, degenerating existence of heavy and increasing-dependency.

In other words, we are nowadays in an extremely un-natural situation. It is this modern and un-natural situation which has led to widespread demands for euthanasia.

Simply to state that euthanasia/ assisted suicide/ assisted death is unacceptable is correct so far as it goes, but does not help this situation. Yet I believe that this situation can indeed be helped, that death can again (on average) be made 'more natural'.


Throughout history, death has seldom been dignified or pleasant for humans. The main causes of death in later life have been infectious diseases, starvation, predation/ poisoning and (especially for men) violence and accidents.

The single most important reason why modern people survive for so much longer than in the past is antibiotics. These (and the related antiviral and anti-fungal drugs; also a range of hygienic practices involving antiseptics and disinfectants) mean that humans can survive for many months or years even when very sick, e.g. suffering from advanced cancer or advanced degenerative diseases (such as dementia, Parkinson's disease, strokes and heart disease).

In the past, elderly and/or sick people would (sooner-rather-than-later) rapidly be 'carried away' by overwhelming infectious disease, and this would usually happen over the space of a few hours up to a few days.

Death from overwhelming infection is not likely to be dignified - indeed it is quite likely to involve delirium (acute confusion, disorientation, malaise; maybe fear and paranoia). However, pain, fear and discomfort can usually effectively be treated with opiates - and death is likely to come quickly.

The commonest cause of death among the sick and old was probably pneumonia (which was nicknamed 'the old man's friend'), and other causes may have been bladder/ urinary tract infections, blood-poisoning, gastrointestinal infections and skin infections.

This is because ill people, bedridden or immobile people, people without the ability to care for themselves - are naturally vulnerable to a wide range of infections. Without antibiotics etc. they would soon die.

So it is almost certain that without antibiotics it would be very uncommon for old, decrepit, and chronically sick people to persist for many years in a twilight state of dependant semi-life.


Of course there will always be specific and exceptional circumstances in which people are afflicted by prolonged and awful deaths, and these need to be dealt with on an individual basis.

But as a general rule, my advice to Terry Pratchett and others is as follows:

If you are chronically ill or old and want to avoid a prolonged twilight existence of increasing dependency but regard the idea of assisted suicide/ assisted death/ euthanasia with abhorrence; then there are two main things which you should consider.

1. The first and most important is completely to avoid using antibiotics, antivirals, antifungals, antiseptics and the like.

Under ‘natural’ conditions, germs are going to be the commonest cause of death in ill humans, and infection will cut short prolonged sickness and helplessness.

Since everyone will die sooner or later of something or another, we need to remember that preventing one kind of death now, merely means ensuring another kind of death later - and perhaps a much nastier death.

2. Do not use any heroic life-saving measures such as cardioversion/ defibrilliation, ventilation or intensive therapy.

Best is to avoid hospital, hospices and the intensive involvement of health professionals where possible - because if you fall into the hands of health professionals then one or another of them will - sooner or later, for good or bad reason - initiate a course of action such as antibiotics, resuscitation or intensive therapy which it will be difficult/ impossible to reverse once begun.


Anonymous said...

I very much appreciate this post.

I personally feel that euthanasia is one of life's "necessities"; objectors to euthanasia, in my view, usually have a bad argument - they agree that prologued and deep suffering is a bad thing but in their eyes the negativity of killing out-weighs the negativity of prolonged, deep suffering and so they believe that euthanasia should be illegal; this in my view is selfish - The negative feelings of objectors regarding killings is more important than the suffering of sick people.

Anonymous said...

Refusing standard treatment which could save your life (antibiotics, etc.) does not seem to me to be essentially different from having oneself unplugged from life support -- and the latter is generally considered a form of euthanasia.

Bruce Charlton said...

@wmjas - "does not seem to me to be essentially different from having oneself unplugged from life support".

Really? It seems *very* different to me - especially as refusing antibiotics is a long-term strategy with a stochastic and unpredictable effect; while being unplugged from life support is an acute action resulting in almost certain and nearly instant death.