No doubt you have heard of “advance directives” – guidelines for your carers, guardians or doctors on what do to in the event that you are not competent to instruct them. Right-to-die associations often promote them as a way of avoiding life with dementia.
But what if the people with the power to “pull the plug” refuse? Advance directives are not currently legally enforceable in most jurisdictions.
Two bioethicists, Margaret Battin and Brent M. Kious, writing in The Hastings Center Report, an agenda-setting bioethics journal, have proposed a solution: an implant which automatically triggers the release of a lethal drug at some stage after the onset of dementia. It works like this: 10-9-8-7-6-5-4-3-2-1-you’re dead! Quite straightforward.
Anyone competing in the Weird Methods of Assisted Suicide Tournament has to contend with the World Number 1, Dr Philip Nitschke. The Australian activist is the inventor of the Exit Bay, the CoGen carbon monoxide device, the Peaceful Pill, the nitrogen suicide bag, and the Sarco self-sealing coffin. Battin and Kious have gone game, set and match with Nitschke. Demented people cannot use his devices; they could use the “advance directive implant”.
But not yet. Their scenario is merely hypothetical at the moment. As Dr Nitschke would have told them, designing a foolproof suicide device is not child’s play. Any fool can commit suicide; the trick is doing it peacefully – “to die of a rose in aromatic pain”, as the poet put it. It’s not easy for a demented person.
There is a precedent – Norplant. This is a matchstick-sized rod which is injected under the skin where it releases contraceptive hormones gradually. The ADI would have more functionality; it would be reversible and programmable and would cause death instantaneously. It would probably be implanted at the onset of dementia and programmed to activate according to the prognosis for the disease.
The bioethicists’ proposal reminds me of Logan’s Run, a 1976 sci-fi film. Sadly, it has not stood the test of time. “Terminally silly” and “aggressively tedious” are words used by some of its harsher critics. However, its central conceit is memorable: in a future civilisation everyone dies on their 30th birthday. In the palms of their hands they all have a “life-clock” crystal which begins blinking as they approach the “Last Day.”
The authors acknowledge that the pre-publication responses to their idea included “Yuk”, “Gross”, and “that causes me fear, disgust”.
OK, but the “yuck factor” works both ways, they say – just look at a patient with Alzheimer’s. Or read, they suggest, Philip Larkin’s gut-wrenching poem, “Heads in the Women’s Ward”.
Their nomination of Larkin as the poet laureate of assisted suicide gives away their game. Larkin, who died in 1985, was an excellent poet, but he was also the kind of guy who saw a cloud in every silver lining; a gloomy, death-obsessed, womanising curmudgeon whom the BBC called “England’s most miserable genius”. Why did they alight upon Larkin? Because he was incapable of joy.
And this is the lens through which Battin and Kious view the frailties of old age. No wonder they believe assisted suicide is a good idea. “For some, a life that ends in profound dementia is perhaps the worst fate one can realistically foresee,” they write.
“Even if our laws were liberalized dramatically to allow MAID by advance directive during dementia, applying those laws would remain controversial and would continue to impose great burdens on those left behind—on family members, friends, nurses, and, perhaps most acutely, on physicians called upon to act. The development of means to enable persons in the early stages of dementia to choose, while competent, the timing of their own deaths without the subsequent intervention of anyone else would go a long way to ameliorating this situation: they can get the better parts of dementia if they wish but avoid the worse parts they reasonably fear.”
In fact, they conclude, “Perhaps the greatest advantage of ADIs is that they would reduce the distress that living and dying with dementia imposes on others.”
In other words, the ADI would put them out of our misery. Silently, painlessly. All the relatives need do is sign the condolences book and listen to the executor read out the will. They don’t even have to sit at their dying grandmother’s bedside and pretend that they are grieving as a doctor gives her a lethal injection.
What amazes me is that this technological fantasy was published in one of the world’s leading bioethics journals. It doesn’t inspire much confidence in bioethicists.
I’m sure that the authors’ intentions are good. But they are intoxicated with a twisted sense of pity. Graham Greene wrote in The Ministry of Fear, a novel about a man who killed his wife rather than let her suffer: “Pity is cruel. Pity destroys. Love isn’t safe when pity’s prowling round.” Exactly.