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Who Has the Right to Die?
At a time of increasing suicides and widespread misery, can self-determined death activists provide us with a path forward?
By James Anderson
James Anderson is from Illinois but now resides in Riverside, California. He works as a freelance writer and is a member of the Industrial Workers of the World Freelance Journalists Union (IWW FJU). He previously taught college courses as an adjunct professor. You can read and subscribe to his newsletter at waywards.substack.com.
Although the author hopes to encourage open dialogue about the difficult, stigmatized subject matter discussed in this article, he encourages discretion as regards reading and sharing the reported essay. If you are thinking about ending your life, you can speak with people who want to help. The National Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK (8255). You can also access the Lifeline Chat to connect with a crisis counselor online, 24/7. The author does not necessarily or explicitly endorse the positions of anyone quoted in the piece. Rather, the essay represents an effort to report on, and an attempt to understand, the perspectives and philosophies of those with relevant experience so as to highlight oft-neglected considerations and break through unproductive taboos.
The late Australian writer Annah Faulkner, author of the award-winning debut novel, The Beloved, and of the 2015 work of fiction, Last Day in the Dynamite Factory, composed a literary “suicide note” in anticipation of her last day in this corporeal realm, imploring society to honor her right to die by decriminalizing those who would dare assist her while she transitions and by legalizing a lethal drug like nembutal, commonly used to put pets to sleep when they’re suffering.
The Recommendations for Reporting on Suicide caution against sharing contents of a suicide note. The precise rationale for the guideline isn’t explicitly spelled out, but presumably the fear is that doing so will valorize the act and possibly encourage others to take similar action. And most of us would rather people live and enjoy life. But it’s not uncommon for a writer to intentionally disregard the generally sensible recommendations when there appear to be justifiable reasons for doing so.
Sometimes that’s because suicide is used as a form of protest. An indelible example: monk Thích Quảng Đức's self-immolation in protest of U.S.-backed South Vietnamese persecution of Buddhists in 1963, captured in a widely viewed photo taken by AP journalist Malcolm Brown. For different reasons but in a similar vein, Huey P. Newton coined the term “revolutionary suicide,” thereby creating, “a neoteric phrase in which the word ‘revolutionary’ transforms the word ‘suicide’ into an idea that has different dimensions and meanings, applicable to a new and complex situation.” For Newton, the concept did not suggest despair. “On the contrary,” he wrote, “it conveys an awareness of reality in combination with the possibility of hope—reality because the revolutionary must always be prepared to face death, and hope because it symbolizes a resolute determination to bring about change. Above all, it demands that the revolutionary see his death and his life as one piece.”
The last decade or so has seen a resurgence in protest via suicide. Tunisian street vendor Mohamed Bouazizi set himself on fire in December 2010, sparking the wider Arab Spring uprising. New York cab driver Douglas Schifter concluded his life in front of City Hall in 2018 after authoring a scathing Facebook post railing against politicians and Wall Street for backing app-based ride-hailing companies driving him and others in the taxi business into ruin. But they have highlighted dire social conditions and a capitalist economy pushing people to the depths, and to deaths, of despair. In a grim way, they’ve demonstrated a last-ditch effort at recovering a sense of agency, albeit individually and with an act that forecloses the possibility of doing so again.
Whether those acts conjure the spirit of “revolutionary suicide,” I cannot say. Nevertheless, we’d be wrong to overlook the gratifying, fleeting feeling elicited by finally regaining the ability to intervene in the world one is about to exit. It’s at our own peril that we discount the appeal of dramatically drawing attention to public problems when collective action is absent, underdeveloped or ineffective. When prospects for shared struggle appear as alienating or toxic as the arrangements and institutions existing organizations putatively seek to transform, reappropriating your human body, sacrificing it for a good greater than yourself, can reflect a dying effort to reconnect with and affirm humanity.
These kinds of elective deaths indict not only issues and structures negating human life; they’re also often indictments of our hitherto inadequate responses to existential crises and to systemic assaults on individuality that make suicide a morbidly appealing political message. That’s not to imply any person or organization is uniquely culpable. Instead, the loss of life here points to the success of an insidious worldview serving to individualize social problems irresolvable without communal life and the coordinated direct action it affords. Without a web of solidarities and the medium for meaningful self-determination those relations weave, political suicides become an unfortunately attractive substitute for meaningful living en route to dying with a modicum of dignity.
In the social media message he posted just prior to taking his life, Schifter, the aforementioned taxi driver, excoriated his industry’s conversion into a gig economy by corporate-owned ride-sharing platforms. “I worked 100-120 consecutive hours almost every week for the past fourteen plus years,” he wrote. “When the industry started in 1981, I averaged 40-50 hours. I cannot survive any longer with working 120 hours! I am not a Slave and I refuse to be one.” A spate of self-imposed deaths among taxi drivers ensued later that year, and NYC cabbies coordinated hunger strikes in 2021 that won debt relief measures. It’s not clear if Schifter’s suicide provided impetus for either or both.
Suicide prevention advocates often warn about “copycat suicides” and emphasize the risk of additional loss of life that might happen as a result of publicizing self-inflicted deaths. In writing about the self-immolation of Wynn Bruce, a climate activist from Colorado who set himself on fire outside the Supreme Court on Earth Day this year, Eleanor Cummins at The New Republic claimed the pressing challenge associated with covering suicide-as-remonstrance is, “to interrogate suffering without furthering it. To discuss but not sanction. To listen, without compromising on our shared belief in the value of life. When it comes to self-immolation, such subtlety can feel impossible. But this balancing act is more important than ever, as climate change stacks the deck with despair.”
Perhaps the balanced coverage Cummins invoked could contribute to a rapprochement between suicide prevention and honest evaluation of the systemic factors that compel abject refusal to continue living. The circumspect coverage Cummins envisions might also underscore how the budding movement to prevent premature and unnecessary loss of life could link up with movements geared toward changing or displacing the forces that provoke a surfeit of suicides. Writing about and reporting on elective deaths spurred by existing institutions and enacted by individuals who ostensibly desire to denounce those structures, while rejecting a world in which shitty life prospects predominate, arguably demands solidarity with the latter as well as the former.
Likewise, upholding the “shared belief in the value of life” by way of the balancing act Cummins endorsed has to entail grappling with what makes life valuable. The prevalence of political suicides suggests a dearth of relations of resistance capable of steeling, fortifying and at least partially defending people, including those who might be driven to consider desperate political measures, from the onslaught of anguish, suppression of individual autonomy and deprivation of substantive say over one’s life currently baked into society. To “interrogate suffering without furthering it” with respect to those deaths entreats us to consider why communal experiences through which personal agency can flourish are conspicuously missing.
To refrain from furthering suffering suggests moving from mere interrogation to revaluing conditions affording those experiences, which means abandoning paternalistic presuppositions about other people’s pain and how much they can endure. We might have to entertain the possibility that “the value of life” derives in part from the value inherent in the freedom to decide when and how to halt torment and hasten death, with appropriate support. In interrogating suffering, I think we’re obliged to question whether adults are in select cases (or, some claim, in the overwhelming majority of situations) best positioned to assess their own anguish and to make the ultimate decision about extinguishing the individual life that allows for it. Maybe all that means cultivating communities that render political suicides superfluous while still doing justice to the broader movement for dignified and voluntary assisted death—an idea explored below.
As Faulkner’s case makes clear, end-of-life notes can function as interventions intended to expand the scope of social justice and promote a “transvaluation of values”(to repurpose the Nietzschean notion) when it comes to living a good life and dying a decent death. “Calm, constructive conversations around self-compassionate, elective deaths are ridiculously overdue, yet so many people reel back in horror. “Why? Death is not the enemy. Fear and ignorance are our enemies,” Faulkner wrote. “Massive efforts go into keeping people alive, yet not a single, compassionate way allows them to die by choice.” She echoed Socrates, who prior to being sentenced to death and drinking poisonous hemlock, referred to “fear of death” as “the pretence of wisdom, and not real wisdom,” and who suggested the culmination of life which, in fear, Athenians of antiquity took “to be the greatest evil, may not be the greatest good.”
Should “our shared belief in the value of life” encompass commitment to the value inherent in providing compassionate choices to expedite the ineluctable expiration of our individual lives, as Faulkner invited us to consider? On the surface, the values seem dichotomous. Digging deeper, one wonders if it’s possible they’re better understood dialectically.
Barry Price, Ph.D., president of the Hemlock Society of San Diego, a Southern California-based chapter of a larger non-profit organization that educates people about end-of-life choices and endorses campaigns to help improve access to humane, self-determined death, said he got involved in advocacy after decades of witnessing people die. Some passed peacefully, others only after enduring tremendous and prolonged torment. A long-time dog lover, Price said he couldn’t comprehend why we end the agony of pets who are in constant, debilitating pain but do not extend the same courtesy to our fellow human beings. Faulkner echoed the indignant incomprehension in her call for legalization of nembutal and decriminalization of voluntary assisted dying (VAD). Neither Price nor the Hemlock Society ever encourage suicide. Rather, they inform people about legislation, like California’s End of Life Option Act, which legalized physician-assisted dying for terminally ill adults in the Golden State who have an anticipated six months or less to live—progress for elective death advocacy, perhaps, but also woefully inadequate to address suffering, some contend.
Price said plenty of people who reach out to him about prospective end-of-life options endure incessant distress and crippling disease years before they become terminally ill. Not long ago, he got a call from a bedridden man in his late eighties who was going blind, facing memory loss and dealing with chronic blood flow problems, which prompted doctors to discuss amputation of his appendages to prevent gangrene. The man, Price said, “didn't want to live through this process of finger chopping and other kinds of things that he saw as torture.” Incurable illness can leave individuals in “terrible, debilitated and humiliating conditions, in some cases for literally years and years and years before the person dies,” which is why, he explained, the Hemlock Society believes those who are expected to live more than six months should be able and empowered to end their life when pain becomes unbearable.
Kay Scurr, a member of Exit International, an international non-profit organization committed to the belief “that every adult of sound mind has the right to implement plans for the end of their life so that their death is reliable, peaceful and at a time of their choosing,” penned a piece about Faulkner’s final days. In the article, Scurr repudiated the social disparities and stigmas that make dignified dying possible for some while denying that opportunity or right to others. “Keeping people uninformed about one’s end of life is more about controlling our society: we are shackled with conditions, rules and regulations,” she lamented. “Of course there are the elite who have access to the best drugs and know-how but the silent majority will suffer on in ignorance, and in silence.”
Scurr, who coordinates Exit’s chapter in Tasmania, told me that for several years she knew Rodney Syme, the Melbourne-based doctor who, prior to his death last fall, supported VAD. Syme sparked controversy and risked criminal prosecution by providing end-of-life drugs for patients experiencing excruciating, unending pain. “He was able to get access to those drugs,” she said. “He thought it wasn't right that he could get them for himself and family but the average person couldn't get them.”
Those power differentials give some the ability to make decisions about how and when to end life, with social and interpersonal support, while systematically depriving others of that opportunity. But what’s more, the disparities in agency that preclude self-determined death also indicate shared problems other social movements have sought (and seek) to address. They thus undermine—and elucidate—shared values. The implication seems to be that collective action ought to confer experience in reasserting autonomy. Opposition to that autonomy, to an institutionally imposed inability for a person to participate in decisions that affect and are most meaningful to that individual, can be located in the same value underpinning the principle and tradition of participatory democracy and the progenitor movement for Participatory Economics.
The same sort of precept appears to inform belief in bodily autonomy, which undergirds various forms of political theory and practice. This includes the issue of and struggle over choice as it pertains to decisions about one’s body, foregrounded in public discourse around the same time Faulkner put together her final, stirring words. According to a leaked majority opinion authored by Justice Samuel Alito that surfaced less than two months after Faulkner’s letter, the United States Supreme Court has voted to strike down the landmark Roe v. Wade decision. Since 1973, that USSC ruling protected a woman’s right to choose to have an abortion without undue government restriction. Not so coincidentally, in his leaked opinion, Alito invoked the Washington v. Glucksberg Supreme Court case. “Thus in Glucksberg, which held that the Due Process clause does not confer a right to assisted suicide, the Court surveyed more than 700 years of ‘Anglo-American common law tradition,’ 521, U.S. at 710, and made clear that a fundamental right must be ‘objectively, deeply rooted in this Nation’s history and tradition,’ id., at 720-721,” as Alito would have it. Years before, when Chief Justice Rehnquist delivered the opinion of the court in Glucksberg, he also cited Roe and claimed end-of-life assistance “is not a fundamental liberty” protected by the constitution, as the “asserted right has no place in our Nation's traditions, given the country's consistent, almost universal, and continuing rejection of the right, even for terminally ill, mentally competent adults.” Noam Chomsky has noted this “ultra-reactionary judicial doctrine” rooted in “British common law, which held that a woman is property,” tethers rights to many historical precedents now outmoded or even universally condemned. That those in the abortion rights and end-of-life movements have acted outside the confines of the law and its regressive interpretations shouldn’t surprise.
In her final letter to the world, Faulkner indirectly highlighted these separate yet intersectional struggles in admonishing the one-dimensional view of life and death that elides the inevitable termination of the former with the latter. “Society deems life sacrosanct (I’m not talking about abortion—that’s another conversation altogether),” the late Aussie author wrote, “its right enshrined in locked-and-bolted law, but the right to death—the most inevitable part of life, is denied—both as a choice and, increasingly, as a natural process.”
Scurr, a retired nurse who bore five children and who also had two abortions, said she sees similarities in pro-choice advocacy between the protracted movement for abortion rights and the less celebrated end-of-life movement. “If we follow your road with this abortion thing we’re just backpedaling the whole way. And yes, absolute parallels, without a doubt,” Scurr, who’s still based in Australia, said before adding: “But bear in mind human nature. And humans, we will never ever stop. We will never give up. And I tell you what, I don't want to go to jail or anything but I will not stop what I'm doing.” Police in Australia have been investigating her in relation to Faulkner’s death, she said, although Scurr only offers advice and emotional support. She never assists individuals in ending their lives.
Mixael Laufer, PhD, a member of the Four Thieves Vinegar Collective, a collaborative effort among coordinated anarchist biohackers who publicize do-it-yourself (DIY) methods for often producing over-priced or hard-to-obtain medication, agreed that the parallels between the philosophies animating the dignity in dying and the abortion rights movements aren’t always understood.
Four Thieves gained popularity in 2016 after publishing instructions on how to make an ‘EpiPencil,’ a low-cost alternative to the ‘EpiPen’ manufactured by the pharmaceutical company Mylan, which jacked up prices of the patented medical device used to self-inject epinephrine, typically to treat anaphylaxis. Laufer obtained a level of media attention for Four Thieves and open source medicine again when he recorded a video describing a DIY method for manufacturing abortion medication, a move reminiscent of the Chicago-based Jane Collective, a cadre of women in the sixties and early seventies who aided more than 11,000 persons in accessing abortion before Roe became law. “The real goal of Four Thieves is to offer tools by which people can increase the space of their choices” and to furnish the ideas and strategies people “can implement to be participatory in their own health,” Laufer explained.
His analysis of what he called the “poorly understood” political subterfuge fueling the abortion rights debate echoes Scurr’s criticism of the politics of social control undermining the end-of-life movement. “You look at the discourse surrounding abortion,” he said. “I think a lot of people analyze it incorrectly as being a two-sided issue. It's not. There are three interested parties.”
The two interested parties known to most people include those desiring medical/bodily autonomy and what they deem to be basic human right, and on what looks to be the “other side,” Laufer said, there’s a second “group of people through a misinterpretation of certain ancient doctrines [who] have decided [aborting a pregnancy ] is something that they should not allow other people to do because it's somehow a moral transgression.” The discourse focuses on those two camps duking it out as another influential brigade operates just below the surface. “There's a third group, and [the] third group is people who are seeking political power, recognizing that that second group is very determined, very well organized, rather resource rich, and in a very pragmatic way [they] have decided to align themselves with that [second] group because they know it will garner them more power.” Laufer cites the example of Ronald Reagan, who adopted a pro-choice position early on in his political career only to make the pragmatic decision to change his stance on the issue as a tactic to appeal to an active and vocal evangelical base. Faux concern for the religious beliefs of that base has been conducive to pushing through other political objectives, as seen with Reagan’s notoriously successful union-busting and his “war on drugs” that targeted poor and Black communities, feeding the prison-industrial complex.
Again echoing Scurr’s comments about the over-policing of efforts to allow for elective death, Laufer said the extent to which law enforcement authorities (e.g. Interpol) seem to be investigating and in some cases prosecuting people trying to die in peace on their terms prima facie indicates pressure coming from circles able to exert a lot of it in rather indiscreet fashion. Mutual aid among movements emphasizing autonomy, along with recollection of the knowledge that the good of the individual and collective are inextricably linked, remains an elusive-yet-attractive antidote to the repression and paternalism actively thwarting the various attempts to engender the common good.
Laufer acknowledged barriers to solidarity and inter-movement communalism, however, like the significant resources, time and energies involved in maintaining precarious ground gained through tireless work in respective, niche areas. But he also mentioned work his collective is doing that could catalyze political partnerships and coalitions, such as the nascent collaboration between Four Thieves and the Exit International director, Philip Nitschke, PhD, MBBS. “In a very pragmatic sense, Philip has asked us specifically if we would develop a protocol for people to be able to manufacture a ‘death with dignity’ drug at home,” Laufer said.
He also mentioned having lost people he cared about to suicide. Laufer said he’s “grappled with the cognitive dissonance” that can accompany such loss when you allow “for the possibility that maybe that was the best decision for them, and that there's no way that you can really know.” The tension heightens when the suicidal act remains “totally incomprehensible,” as he put it.
Four Thieves planned to release the ‘death with dignity’ drug over the summer, but with other projects in the works for an upcoming lecture tour Laufer is about to embark upon, there’s no definite ETA for it now. “We've managed to put together the beginnings of it, at least,” he said. “There is a chemical procedure for manufacturing a targeted drug that looks appropriate for the use, but trying to tool it for automation is a little trickier. So that's going to take some more time, unfortunately.”
Illustrative of the intersections in social movements, Nitschke met Laufer through the abortion rights network in the Netherlands, where the Australian native and public face of Exit International now resides. Nitschke, author of “The Peaceful Pill Handbook,” a self-help book on the subject of VAD that’s been banned in Australia, also sees the development of open source DIY technologies to be one of the keys to unlocking heretofore restricted personal agency, consequently opening doors for more mutual aid of the sort that might have comforted Faulker as she transitioned. “The distribution of information about how to get things which are currently not legislated against a whole lot easier to access opens up a whole stack of personal freedoms and choices in this issue and certainly opens up this idea that people can indeed be present [with someone when/if they opt to hasten death], because no one's going to be knowing what's going on,” Nitschke said.
For his part, Nitschke got involved in this line of work back in the nineties. He helped get a piece of legislation passed in 1997—an Australian law that enabled doctors to help terminally ill persons end their lives, per patient request. It only lasted eight months before the federal government overturned it. Like existing legislation in states like California and Oregon, Nitschke takes the overturned legislation in Australia, and the more recent dignity in dying laws there that set a plethora of conditions for people to meet, to be inadequate. “They’re all medicalized laws,” he said; they empower medical professionals to determine if someone is sick enough to be eligible. Way back, Nitschke said he encountered people with compelling “social reasons” for wanting to die sooner rather than later. Asking if people should be required to satisfy someone else’s criteria for sufficient suffering to qualify for assistance in dying prompted a change in perspective. “So our philosophy changed,” Nitschke said. “I set up Exit. Our philosophy has always been that it's a right, not a medical privilege, for the very sick, and there's no adjudication.”
To his credit, some would say, Nitschke isn’t opposed to suicide prevention on principle. Non-coercive suicide prevention efforts aimed at persuading individuals to seriously consider life and that make counseling and other social support available need not infringe upon what those in his organization venerate as a human right. In corresponding fashion, offering an array of alternatives to, or collectively endeavoring to bring them about for, someone debating an abortion need not negate a woman’s right to choose.
Nitschke also believes a person must have an adequate amount of “mental capacity” to make a sound, sober decision about dying, though he added that’s a rather “nebulous quality” currently open to interpretation, poor and dogmatic ones included. “We spend a lot of time worrying about this idea of how the hell do you assess mental capacity because there are plenty out there within the medical profession who try to argue that anyone who wants to die can't have mental capacity by definition—ipso facto a person who wants to die is psychiatrically ill.” Nitschke rejects those arguments, which he sees as circular. “In general, speaking of a person's functioning in society, there's an assumption [the functional person has] mental capacity. If you go out and steal something and get dragged in front of a law court, you're going to have trouble arguing that you didn't have mental capacity. There’ll be an assumption, if you're functioning, you got it, and if you’ve got it, and you’re an adult, that is you’re over the age that knows about the permanence of death, then I would argue that you should have the ability to take this step.”
He sees mental illness and mental capacity as interconnected, but he doesn’t believe the former necessarily implies loss of the latter. For example, he said, someone can become so depressed they lose their abilities to think clearly and rationally. “The question is, do you lose mental capacity if you’ve got depression? And the answer is no, you can be depressed and have mental capacity. The question is [then], is the depression bad enough for you to have lost … this rather ethereal, hard-to-determine quality?” Much to the psychiatric profession’s chagrin, Nitschke said, he and colleagues are working on an artificial intelligence system to help evaluate this. “But if we accept there is such a thing as mental capacity, we have to also acknowledge that psychiatric disease per se does not deprive you of mental capacity. It’s the severity of the psychiatric illness or the nature of the psychiatric illness involved.”
Avenues as well as existing and emergent technologies to facilitate inter-movement fellowship notwithstanding, divisions within the end-of-life movement itself point to other unresolved political disputes that keep much-needed dialogue at bay, obstructing unity in diversity.
Peg Sandeen, CEO of Death with Dignity, an Oregon-based organization engaged in end-of-life advocacy and policy reform, said she doesn’t see the euthanasia legislation enacted in European countries to be politically feasible in the U.S. “We don't have a health care system yet that provides health care to everybody. We have a mental health system that is in tatters. And I'm a social worker,” Sandeen said. “I feel pretty safe saying that. Death with Dignity is not the answer to those problems. And so I cannot imagine that we would go on a path like Europe has or like Canada has in a health care system that is such the mess that we have. It’s not going to happen, and I wouldn't support it happening just because I want people to get the care they need. I want people to get the mental health care they need. I want people to get the health care they need. So I don't see the United States going in that direction at all.”
Having worked to help get legislation passed in several states, and having worked in the dying space as well as the mental health space and the HIV care space, Sandeen stresses what she sees as a pertinent distinction. “There is something markedly different between a patient who is interested in death with dignity, and someone who is suicidal,” she said. “They look different. They feel different. They present different clinically. The American Association of Suicidology issued their their statement in 2017, distinguishing between suicide and medical aid and dying. … Our opponents suggest that there's not very much of a line at all, and I think there's a huge gap between what is traditionally considered suicide and death with dignity.”
Death with Dignity opponents have also weaponized the term “suicide,” she said. Polls suggest a majority of people support the policies her organization champions, but popular support falls if it’s phrased in terms of suicide. Use of the word trigger “this death taboo in the United States,” she said. “We're not going to talk about dying, and we're going to scare people who are talking about dying and, you know, talking about suicide scares people. So unfortunately, because our opponents have weaponized the term suicide, it really has closed the door, I think, for productive conversations. And, for instance, one of the things that we do know is that, in a strange way, Death with Dignity can be suicide prevention.” That is, people with terminal illness who contemplate suicide can, if they live in a Death with Dignity state (e.g. California, Oregon, Colorado), talk to their physicians about it, and the doctors can help them get the symptoms they’re struggling with under control, Sandeen said.
Opposition to end-of-life advocacy in the U.S. not only makes passage of VAD legislation for terminally ill persons difficult; it also exacerbates schisms among those with like priorities. “There's a real division within the right-to-die movement between people who would support the idea of fundamental autonomy (and the ability to take this step themselves), and those who are passionately arguing for a legislative solution and have been using the political process to try and bring about legislative changes,” according to Nitschke. Those points of departure are not unlike the long-standing disagreements between champions of liberal-progressive politics who’ve lobbied for incremental changes, and those who eschew reformism that legitimizes the established political framework, opting instead for direct action outside the sanctioned parameters of a social order viewed by some in this latter cohort as currently anathema to exercising meaningful say over one's own life. “The main reason for the opposition comes about because people that are passionately involved in trying to affect the political process see the idea of some, if you like, anarchist approach to provision of free access to reliable end-of-life drugs as being counterproductive because it frightens the political process,” Nitschke said. Fear can undermine attempts to introduce and pass end-of-life bills, he said, which typically have to be tethered to severe restrictions and heavy safeguards to get through.
The debate intensified recently with the invention of the Sarco device, a 3D-printable pod developed by Nitschke to allow people a painless, even pleasant death via “happy hypoxia,” induced by release of gas into the futuristic-looking capsule upon activation by the person inside. His invention passed legal review in Switzerland. “They’re pretty impressive, the Swiss,” Nitschke said as he complemented the “de-medicalized legislation” for assisted dying in that confederated European country of 26 cantons. He sees the fledgling legislation in the US as a “good step” and “better than nothing,” but he also calls those bills states have enacted “beg and grovel laws” because of the conditions requiring people to be sick to make a choice he contends is a human right. Were the Sarco to proliferate, it could provide the means to circumvent a bureaucratic political process and diminish the authority legislators and the medical community exert over people’s decisions about concluding their lives on their own terms—a prospect for fuller freedoms, fraught with risk.
The tensions within the end-of-life movement and between right-to-die objectives and life-affirming suicide prevention discourse exist as unresolved contradictions in my own mind and personal approach to these matters. In trying to sort it all out, I found some solace in the work of Lydia Dugdale, MD. As a physician, Dugdale was tasked with resuscitating infirm patients so they could suffer on a little longer before succumbing to death. The experience made her critical of “medicalized dying” insofar as it callously disregards the inescapable and nonsensically ignores what’s obviously imminent. She’s onto something with her mission to revive the ars moriendi, the Latin phrase she borrowed for the translated title of her book, “The Lost Art of Dying: Reviving Forgotten Wisdom,” published in 2020. The ars moriendi, or “art of dying,” was traditionally based on literature and knowledge circulating before the fourteenth century. “A central premise was that in order to die well, you had to live well,” she wrote, “Part of living well meant anticipating and preparing for death within the context of your community over the course of a lifetime.”
Recuperating the “art of dying” means embracing community, she suggests, and Dugdale devotes a chapter to it in the book. The harbinger of death “can create an opportunity for reconciliation that might not otherwise be possible,” but as she argues in the book, that’s not the time to start forming a community. “Relationship building as well as the preparation for death were meant to take place over the course of a lifetime,” she explained. “Community helps us clarify our sense of self and what we value most. … Community can also encourage us to invest further in what we value.” If Socrates was right that an “unexamined life is not worth living,” then perhaps Dugdale is right to claim creating community constructs the conditions for a meaningful life, just as it does for a decent death. “Communities also aid in making sense of life’s big questions of meaning and purpose,” as she urges us to grasp. They’re a fount of untapped wisdom and perhaps the basis for destigmatizing contentious, controversial subject matter.
Communities are the precondition for the mutually affording exercise of individual and collective agency. The best ones broaden the horizon of possibility such that the freedom to both live and die with dignity, buoyed by the care of others, begins to displace whatever value might be realized by opting out of life for political reasons. They remind us that all deaths are political, as are the contexts in which they occur. Just maybe, they can help make politically motivated self-immolation and similarly desperate acts irrelevant by revealing the mutability of the circumstances in which they have previously occurred. They can then inform how, and with what values, we organize those contexts—provided the communities are characterized by a reverence for the value of autonomous choice in the most personal of matters. Minus that, suicide, be it overtly political or otherwise, remains too commonplace and a distressingly comprehensible response.
About a decade before she left this world and probably unbeknownst to her, Faulkner shared advice for crafting the kind of communities capable of vindicating that value and revivifying the “art of dying,” as it were. “Trust yourself,” she advised. “Stay true to who you are. Be courageous in love. Recognise it is not easy, passive or cheap but our greatest opportunity and ultimate gift.”