I did not ask to be born. I never signed up for any of this. If I had, I would look more like Paul Newman and less like Paul Giamatti. In fact, if I had been asked and fully informed of the consequences, I may well have declined.
Instead, in May of 1954, my proto-consciousness was dragged out of eternal oblivion, if not against my will, then certainly without my informed consent. Born to a family of modest means with three siblings who preceded my birth, it is not entirely clear that my parents even wanted another child. They were simply young, fertile and Catholic.
Whether my parents had the moral right to initiate my life without my consent is beyond the scope of this essay, but it is a question worthy of consideration. For now, I want to focus on the life they did create and who should determine how and when it ends.
I will begin with a spoiler alert: You are going to die. That’s right, it’s not negotiable. Life, it turns out, is a terminal illness. We acquire it at birth and it is one hundred percent fatal. You are going to die and so will everyone you know. The only questions are when and how.
Given that immutable fact, how do you want to die? Have you ever thought about it? Is it even a choice? If not, should it be? As I rapidly approach my own “use by” date, I have given the matter a lot of thought and I have come to some conclusions.
I did not know Robin Williams, or Kate Spade, or Anthony Bourdain. I do not know why each of these intelligent and immensely talented people chose to end their lives, nor would I presume to speculate on their reasons. I do, however, respect and accept their decisions because I believe they were exclusively their decisions to make, and that is actually my point.
Renaissance philosopher and essayist, Michel de Montaigne observed, “life is slavery if the freedom to die is wanting.” I agree. I can think of no more inalienable (unalienable) right that a conscious, competent, fully informed adult has than to determine the time and circumstances of his or her own death. It is, or should be, a fundamental human right. At the very least, I believe it should be a recognized right of every American.
During my three-score plus years on this planet I was lucky enough to find love and smart enough to recognize it when I did. I raised two intelligent and independent children who are successful in their chosen fields. I scaled the Rockies and cast flies to wild trout under brilliant blue skies. I hiked the Grand Canyon (five times) and experienced the spiritual essence of nature’s grandeur to my core. I saw magnificent art in Italy, ate fabulous food in Spain, drank amazing wine in France, and met wonderful people in Australia, New Zealand and everywhere else I visited. I taught thirty years of students to be better health care providers and better citizens, and I contributed, albeit perhaps modestly, to knowledge in my own little corner of scholarship.
To quote the great philosopher, Joe Walsh, “life’s been good to me so far.” I am especially grateful that my career has provided me with the opportunity to live an examined life and to read, write and reflect on its meaning and its value. In summary, I have done the things I wanted to do; said the things I wanted to say; and answered the questions I sought to answer, at least to my own satisfaction.
Isaac Asimov observed, “Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” Indeed. While my forties were the ‘new thirties’ and my fifties were the ‘new forties,’ my sixties have turned out to be the same old sixties they have always been. Each successive trip around the sun now finds me a little slower, a little weaker, and a little shorter of breath. My body is trying to tell me something and it definitely has my attention.
To be clear, my life is still rewarding and I have no immediate plans to end it. That said, if (when) circumstances change and I calculate the net present value of all future days to be negative, I feel it is exclusively my right to determine the time and circumstances of its end. It is, after all, my life. If nothing else, that is exclusively mine.
Furthermore, I feel that a civilized society would assist me to end my life in a manner that demonstrates at least the same consideration and compassion we extend to our pets. It is indefensible that most of us will die worse than our pets and, in many cases, even worse than the food we eat.
I think suicide has been given a bad rap, and I am not entirely sure why. It was considered an honorable end to the ancients. There is no prohibition to suicide that I can find in the bible, nor is it prohibited in the Ten Commandments, unless you want to make the disingenuous argument that it constitutes self-murder. Indeed, in Romans 4:15, Paul writes “where there is no law, there is no transgression.” Thus, where there is no commandment, there is no sin. Whence, then, the prejudice against suicide?
For a conscious, competent, fully informed person, the ending of one’s life is merely to recognize the inevitability of our own mortality and to take agency over it. Instead of avoiding the topic, we should be talking openly and honestly about it with those for whom we care and who care for us. We should be talking about our wishes for our final exit and who should make the decisions related to it. We should be respecting each person’s right to dignity and self-determination. So then, how do we do it?
In the Netherlands, assisted death advocate Philip Nitschke (aka “the Elon Musk of assisted suicide”) has created his Sarco machine to “demedicalize” death. Still in prototype as of this writing, Sarco is a futuristic looking pod approximately the size of a coffin, albeit a really cool looking one. Once sealed inside, the occupant simply presses a button and the pod fills with nitrogen gas. Loss of consciousness occurs in about 1 minute, and death follows approximately 5 minutes later. Brilliant! The only thing I would add is a Netflix subscription so I could doze off while watching a favorite movie . . . and a minibar would be a nice touch, too.
Rational suicide – and yes, there is such a thing – is about respecting individual liberty and freedom. In that sense, it is exquisitely and essentially American.
Note: For more on this topic see:
Rupp MT. “Dying Better.” J Am Pharm Assoc, 2018;58:250-252.