Assisted Dying, The Ultimate Act Of Self-Care
France's much discussed citizens' convention on assisted dying has just delivered its conclusions, including some proposals the government deems too ambitious. But the freedom to choose one's own death is the ultimate achievement of self-control, says French philosopher Gaspard Koenig.
PARIS — The citizens' convention on end-of-life issues has spoken in favor of "active assistance in dying" (assisted suicide or euthanasia), in line with recommendations from the National Ethics Committee and most recent surveys of public opinion. But French Health Minister François Braun has expressed reservations, and proposed a simple strengthening of palliative care.
None of this is likely to calm the democratic crisis over this complicated but crucial issue for society. Why gather 200 citizens for four months and mobilize dozens of experts and significant government resources, if the response is immediately to dismiss their ideas?
Braun is concerned that a law might "profoundly change our society and our relationship to death." Indeed! We remain imbued with Judeo-Christian heritage, which considers suicide a sin so severe as to prohibit burial.
As Saint Paul writes to the Corinthians, "The body is for the Lord, and the Lord for the body." To end one's life is to interfere with divine law. Let us remember that suicide remained illegal until the French Revolution; the bodies of those who defied the prohibition were often judged, hanged and their property confiscated.
This cultural subconscious resurfaces in debates on end-of-life issues, and it explains the intense opposition from people like French author Michel Houellebecq, who, despite having no religious fervor, asserts that a civilization where euthanasia is allowed would lose "the right to respect."
Another, equally respectable, civilization is possible — one that dates back to even older times, whose convictions are based on self-mastery rather than obedience to external injunctions: the Stoic ideal. For Epictetus, the former slave, and for Seneca, the wealthy patrician, voluntary death is the ultimate expression of human freedom.
If we must control what depends on us, and remain indifferent to the rest, then bidding farewell to the world represents the Stoic exercise par excellence: we cannot choose not to die, but we can choose to die well, consciously, rather than dissolve into the fog of "deep and continuous sedation," which is the only option allowed under the law today.
In his "Letters to Lucilius," Seneca writes, "To die earlier or later is indifferent; to die well or ill is not. To die well is to escape the danger of living badly." His disciple Michel de Montaigne found a more vivid expression: voluntary death gives us "the key to the fields" — to open the door to freedom. Armed with this key, we become invincible. The freedom to die also allows us to live a more free life.
Stoicism is the art of "self-care."
Why, then, not figure it out on our own? Why ask medical personnel to break the Hippocratic Oath? First, because they are not instructed to give death, but rather to end life in the name of the care owed to patients. Second, for very practical reasons: Seneca had tried to slit his own veins, but as the blood flowed poorly and his agony continued, he had to resort to the help of his friend and physician, Statius Annaeus, to administer a final poison.
Today, the trafficking of Nembutal, a lethal barbiturate supposed to guarantee a peaceful death, leads to the worst legal entanglements. Can we not simply be accompanied in these final moments like responsible citizens, rather than having to hide like criminals?
"The trafficking of Nembutal, a lethal barbiturate supposed to guarantee a peaceful death, leads to the worst legal entanglements."
A form of sovereignty
In addition to this choice of civilization, there are more utilitarian arguments. First, like any prohibition, the current status quo generates hypocrisies, injustices and suffering, to the point of imposing exile as a means in order for one to die in a country where it is made possible. Charles Biétry, a journalist who suffered from Charcot's disease, recently said that he had made arrangements to end his life in Switzerland.
Secondly, like any legalization, active assistance in dying would allow for finer regulation that deals with the eligibility of patients (adults with serious and incurable illnesses, for example), the collection of consent (interviews, advance directives) and the question of self-administration of the product, which marks the boundary between euthanasia and assisted suicide — always preferable to exercise one's free choice.
Foucault wrote that Stoicism is the art of "self-care." Through the practice of sobriety, the discipline of emotions and the mastery of one's destiny, one gains a form of sovereignty over oneself, and becomes able to participate in political society. It's a philosophy of freedom, in life as in death, which corresponds well to a secularized society in search of moral direction.
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