LIVE BY DESIGN | What do you think is a good death?

The Greek word, euthanasia is made up from eu, meaning good, and thanatos, meaning death. What would that look like for you?
Conversely, what do you consider a “bad” death?

I ask because I got a call from Cape Talk asking me to comment on the situation of a 28-year-old Dutch woman, Zoraya Ter Beek, who submitted her application for assisted dying. She expects her plans will come to fruition this May. Zoraya is relatively young. From a physical assessment, medical point of view she is healthy and does not have any disease. So why is she applying for assisted dying? When asked she will tell you she has debilitating depression, autism, and a borderline personality disorder. She says her psychiatrist told her: “There’s nothing more we can do for you. It is never going to get any better.”
“But she is so young!” “But there is nothing physically wrong with her!” You can hear the voices of surprise and some of outrage.
It is true Zoraya’s body is young. Indeed, she doesn’t have a dread disease with a limited life expectancy. But for most of us living a good life isn’t about having all our body parts in working order – especially for the elderly, it is more about our mental state of well-being that is the source of our joy and zest for living?

That’s what is so thought-provoking about Zoraya’s situation. Just as physical well-being can be compromised and death can come at any age – so our mental well-being can also be compromised at any age. Yes, it is easier to identify unbearable suffering due to diagnosed physical illnesses and it is so much more difficult to accept that mental unwellness, less tangible, less visible, also produces unbearable suffering – which unfortunately may have no end in sight.
The question arising is why have lawmakers worldwide created a hierarchy of suffering? Why should physical suffering be treated as meriting relief through access to assisted dying whereas the same rights mostly do not apply to the person who is suffering mentally? The Netherlands and Belgium have become the forerunners in considering mental well-being as equal to physical well-being.

I’ve received calls recently from people who are at their wits’ end.

The one person is in the initial stages of Alzheimer’s. He’s in a state of suffering and anxiety because he does not want to live a life in which his body is alive but he can no longer consciously engage with loved ones in the manner to which he’s accustomed. He is vexed, agitated, and wants to advocate for assisted dying for people who have Alzheimer’s. His fear of not dying whilst he is still a decision maker is destroying his pleasure of enjoying what conscious life remains for him. Those around him who love him support his wish for an exit.

The other person lives with her middle-aged sister who is depressed. Every day she drinks, and numbs her mental anguish, and she regularly threatens that she will hang herself. She has tried two unsuccessful overdoses to date.

I understand that lawmakers like tidily defined boundaries, such as the dread disease physical illness (such as cancer) and the length of life expectancy (six months). But life is not tidy. Life is messy. Boundaries blur. Anorexia is not a dread disease, nor is arthritis, but some countries are considering these diseases to be included in the qualifying categories as they are seriously limiting in terms of quality of life.

Cape Talk interviewer Abs (Absalom Kushi) asks, “What are the concerns of those who oppose the legalisation of assisted dying?” It is a relevant question with several answers. Three are top of mind for me: institutional capacity, the psychology of the caring professionals, the vulnerable, as well as religion

If society accepts the right for a person who is suffering to die a good death and wants the medical profession to assist the implementation of such legislation, as with termination of pregnancy legislation, then what capacity building is required? I personally think that one of the biggest challenges to the way we engage with death is the psychological challenge for so many in the medical profession. The training received by medics and nurses working in hospitals is focused on saving and prolonging lives whereas the holistic interpretation of the Hippocratic Oath advocates that the caring profession should be “savers of life and easers of death.”

And what needs to be in place to safeguard the vulnerable: the mentally vulnerable, the physically challenged and the elderly? In the UK, during the Covid-19 pandemic, there were accusations that the elderly in old age homes did not receive exacting standards of preventative care as, possibly, some staff viewed them as “dispensable” members of society. There is a fear that the vulnerable might become pressured to request assisted dying by relatives who don’t want to incur the ongoing expenses.

There’s also the objection to accelerating the advent of death – that death is in the hands of God to decide. Nancy Duff, professor of Christian Ethics at Princeton Theological Seminary offered this question as her response when she addressed a congregation in Johannesburg’s St Columba’s presbyterian church in 2015: “My question regarding assisted death as a Christian is: when death as the enemy brings intolerable suffering that dying, left to its own timetable, will not soon resolve and medical intervention cannot alleviate, why is choosing to hasten one’s death thought to fall outside the will of God?”

The statistics from countries that have passed assisted dying legislation show that as few as 0.02 percent of the population might apply for the right to die. It’s a minuscule number. But I’m reminded that the hallmark of the quality of a democracy is how well it safeguards the rights and dignity of a minority.

Your opinion? Please share. Mapi and I are glad to facilitate this discussion further.