In the mid-1970s, we were introduced to the notion of the “medical nemesis” by Austrian philosopher Ivan Illich. He warned us that doctors may do more harm than good, and that some diseases — which he labeled iatrogenic — were caused, not cured, by medical interventions.
This doctrine has been widely accepted — we all know about the dangers of overprescribing antibiotics, about the risks of overzealous or misinterpreted scans, about the creeping medicalization of childbirth — but its application to old age and death is what interests me.
One of Illich’s arguments was that despite its apparent successes, medicine was not notably increasing life expectancy. Alas, he was wrong. Artificially prolonged old age is the new iatrogenic malady.
We cannot switch on the news without being told we will live longer, work longer and survive on diminishing pensions or overpriced annuities. Newspaper columnists tell us we are selfish and that the young are suffering from our claiming an unfair share of state support. They begrudge us our bus passes, one of the few well-earned consolations of age.
As we move into our unwanted final decade, we will — entirely predictably — become increasingly lonelier, more likely to suffer from dementia and ever more expensive to maintain.
It would be unfair to blame doctors or health professionals for our longevity, which may be attributed to causes other than surgical ingenuity and pharmacological innovations and deadly life-support machines, but it is not surprising that many of us feel gravely disappointed by the help and relief on offer to us at the end of life.
We look in vain for compassion, dignity and even common sense. Despite what we are told, we look in vain for adequate pain relief. Medical professionals seem far more interested in keeping barely viable premature “miracle” babies with a poor long-term prognosis alive than in offering reassurance to the growing and aging multitudes who long to depart peacefully. They keep the babies alive because it is challenging and very few people dare argue that it is not a good thing to do. They keep us alive because they are forbidden to give us what we want and need, and they are too frightened to question the law. There is something wrong there.
Do not blame us if we are cluttering up the system. What we want and need is simple. We want a change in the law concerning assisted dying and voluntary euthanasia and, if need be, help dying with dignity.
The groundswell of opinion in favor of change is unmistakable. How often do you hear phrases like: “You wouldn’t let your dog suffer like that?”
Three-quarters of the population backed former British secretary of state for justice Charles Falconer’s assisted dying bill on its first reading in the UK parliament. The bill would allow people who are terminally ill to receive the help they need to die, if that is what they choose. So can we have what we want? No. The politicians will not let us, the bishops will not let us, the health professionals are not allowed to let us — it is grotesque.
Those suffering from incurable diseases need to be able to choose without penalty the help that they are at the moment being denied. The elderly need to be able to plan ahead clearly and to make their own choices about when their lives are no longer worth living. There seems to be some conspiracy to stop us thinking about the end-game we all will play. So we shuffle on, until it is too late to make any decisions and we become helpless pawns in the politics of deferral, and utterly dependent on the humiliating procedures that for all our rational life we so wished to avoid.
It is my hope that in my lifetime, the law will change, taking with it the fears that add so much terror to death. How wonderful it would be if we knew that we would not be obliged to contemplate the bodily and mental decay that threatens us all. That we could opt out and make our quietus, not with a bare bodkin or a plastic bag, or by jumping off the top of a multi-story car park, but with a nice glass of whisky and a pleasing pill — and so good night. How the heart would lift with joy at the good news. I do not go for Martin Amis’ suicide booths, but I am with Will Self all the way about the right to die when and how we want. When it is time to go, let us just go.
At the moment, it is not that easy.
My husband, Michael Holroyd, fondly believes that as the longest-serving patron of the Dignity in Dying campaigning organization, he will be allowed to die in peace, but no, the doctors — in mortal fear of parliament, the law, the press and the UK General Medical Council — will be slavishly working to rule and obeying orders and striving officiously to keep him alive as they observe their archaic Hippocratic oath.
It will be just like it was in the old days, when Simone de Beauvoir described her mother’s death in the ironically titled A Very Easy Death. If a woman of her intellect and clout could not prevent her mother from being hacked about by surgeons on her deathbed, what hope have we?
The best new year’s gift an aging population could receive is the right to die.
As philosopher Joseph Raz wrote: “The right to life protects people from the time and manner of their death being determined by others, and the right to euthanasia grants each person the power to choose themselves that time and manner.”
The right to die is the right to live.
Margaret Drabble is a novelist, biographer and critic.
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