Pub: Sydney Morning Herald

Pubdate: 21-May-2008

Edition: First

Section: News and Features

Subsection: Opinion

Page: 15

Wordcount: 774

The pain in denying choice

Elizabeth Farrelly

Almodovar’s film Volver, which sounds gynaecological and like all his films centres on women but actually means “to return”, opens with a grave-polishing scene in which Augustina tends her own tomb. Augustina is dying – then again, who isn’t? – but the point of this wonderful, surreal scene, and of the film, is the under-recognised entanglement of life and death.

Other traditions do death differently. Some, from Chinese to Mexican, include cemetery feasts where the living and the dead, in general merriment, break bread. Thirteenth- and 14th-century Europe, where grotesque and violent death was commonplace, rediscovered the tradition of ars moriendi, a literary form delineating the art of dying well. Thus arose a new genre, the vado mori (not a black metal band), and a new visual motif, the danse macabre, where characters light-of-foot partnered their own deaths throughout life.

Film, from Bergman’s The Seventh Seal to Ang Lee’s Lust, Caution, habitually flirts with the love-death entwinement, and recent psychology suggests death visualisation actually makes us happier. But mostly we prefer death at arm’s-length. So adept are we, indeed, at maintaining this fantasy that generally it is death, not immortality, that seems the delusion.

But life is still fatal. And the same modern miracles that make violent death rare also mean more of us will linger longer; living faster, dying slower. So more of us will eventually face the moment when not death itself but engagement in the manner of our dying becomes the defining creative act. The trick is to grasp this while you still can.

But what does it mean, and what does it take, to choreograph and enact one’s own death? What is the play between the living and the dying, the motive and the act, the principle and the law? Rodney Syme’s wise and lucid book, A Good Death, may revive the old debate.

Syme is a urological surgeon from a “Christian-humanist” background in the Melbourne establishment; hardly the “doctor death” of media beat-ups. Yet his book argues persuasively for legalising what he calls “physician-assisted dying.”

Syme rejects the word euthanasia as a “mongrel term” that spans everything from “what the Nazis did” to the putting-down of animals, and conjures a white-coated scientist with a large syringe. Physician-assisted dying may not be lyrically blessed but it does capture both the servant role of the medic, here, and the active, present-continuous verb.

Syme’s conversion came in 1974 after he watched a patient with secondary cancer of the spine die in extreme pain, resembling un-anesthetised dental work, but virtually impossible to relieve. “I knew,” he says, “in the same situation I would have ended my life rather than suffer that pain. And as a doctor I could do it.” Why, he wondered, should his patients be less privileged? To watch someone you love die in pain is to know the urge to end it.

What you can’t know, perhaps ever, is whether that urge is on their behalf, or yours; and the more compassionate the bond, the murkier this becomes. So even without the money-motive, moral clarity may be unachievable. Equally, the refusal to hasten death may itself be moral cowardice.

Most doctors are approached, at some point in their career, to assist a death. A 2007 study showed 35 per cent of Victorian doctors had in fact “administered medication, at the patient’s request, with the purpose of hastening death”.

But access, even to understanding, is far from assured. As the philosopher Mary Warnock points out, doctors already make life-or-death decisions, from IVF to withholding treatment for, say, pneumonia. “Even if one believes life is a gift from God,” argues Warnock, “it does not necessarily follow that death must also come from the hand of God.”

And it’s not just physical suffering. Often, notes Syme, “it’s not death … [but] the manner of their dying that causes [people] extreme suffering, both psychological and existential”. The terror that even brave people feel when, swallowed by the medical system and reluctant to incriminate others, they become too weak or incapacitated to opt out, can be excruciating and is often at least as distressing as the deterioration itself.

Indeed, just providing people with the means to end life often relieves their suffering so dramatically that they choose not to. But either way, argues Syme, the provision of those means is good palliative medicine.

Most of us have this choice, all the time. Religious and emotional scruples aside, we could, if necessary, press the ejector button. We don’t, on the whole, precisely, in part, because we could.