Before taking the course, my knowledge and understanding of death were limited to the common understanding of this notion. As a matter of fact, our way of thinking in many respects depends on the society we live in. In a religious community, one may think of death as a transition to a new life; in atheistic world, it will mean the end of biological activity. But in all societies, death represents the greatest mystery. In fact, I have never thought of death as a complex phenomenon, partly due to a subconscious unwillingness to think about it at all. As Lewis Aiken puts it, “human beings realize the inevitability of death, but they often find it difficult to apply this understanding to themselves” (Aiken, 2001, p. 30). Still, as a human being, I realized that I am mortal, and this thought urged me to look further into the concept of death. In this paper I will explain my understanding of death after having taken this course.
The first thing I would like to note is not just “the loss of integrative unity of the organism as a whole” (Joffe, 2007, p.119). The whole organic world is characterized by a universal antithesis of life and death. Living is understood by people - though the mystery of life is still not clear - in the presence of dead as radically different from the latter in order, structure, rhythm and orderliness. Every living organism inevitably carries the possibility (due to external factors) and the need (due to internal factors) of its “exterminability”. At the beginning of every life, the embryo already has its end programmed. Lifeless world is inanimate, because nothing and nobody dies in it; there is only eternal change and evolvement. Life is living, because there are no individual organisms in it that would not be doomed to destruction. Life - death - new life – that is the trinity, which characterizes the cycle and rhythm of the whole organic nature in the unity of continuity and discontinuity.
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Another important moment for me is that man is a part of nature, which is subject not only to biological but also social laws. By engaging in certain social relations, man is the first and only creature (others are not yet known) who possesses the opportunity to develop his attitude to the world and himself, distancing himself from blind necessity, which prevails in the rest of nature. The living matter has a tendency to death and destruction, while man has an attitude to death, or, to be more precise, a specific human existence that manifests itself in the quest for its understanding; therefore, death becomes the subject of worries and thoughts for people, which are expressed as a tendency to solve the mystery of it. Man lives and knows that he lives; this is what distinguishes him from the rest of nature. However, along with a conscious attitude to life, the ability to comprehend it in a spiritual experience inevitably brings the idea of death to the foreground, as the life’s necessary conclusion. Therefore, the fear of death is a spiritual phenomenon, and it describes man as a creature endowed with consciousness.
Man is a creature that faces death throughout the entire life, and not only in his last hour. Man is the only creature capable of suicide, not death but suicide, as a possible position in relation to life and its content (meaninglessness, hopelessness, etc.). Only man has the ability to accept or give up life depending on the conformity of ideas about its meaning, since the determination to live is related to taking responsibility. And only man can consciously agree to die to defend homeland, or performing some other feat. It is no accident that Albert Camus began The Myth of Sisyphus (1941) with the idea that “is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy” (Camus, 1941). And the beginning of Hamlet’s famous soliloquy “To be or not to be - that is the question” emphasizes the fact that this question is the most important issue that people have to solve.
Death is the natural ending of all life. But only a creature endowed with consciousness, i.e. a human being, is capable of accepting death as a final opportunity, or as the finale of life. On the one hand, death is the natural end of every living being, an inevitable fact in the natural order of phenomena. On the other hand, death is a phenomenon that characterizes the specifically human image of being as an integral component of human life. According to Southard, death “has as its corollary in the human psyche a drive towards hope, and in many ways the story of religious belief is the story of the search for balance between death and hope” (Southhard, 1991, p.11).
Death is a mystery, not a problem. Death itself - if we were to consider it as an event of an individual life - cannot be the subject of knowledge and awareness due to being the fact of consciousness itself. Consciousness by its very nature cannot state either its beginning or its end. Man does not know when he is going to die. As a matter of fact, no one can survive a conscious death, because it is assumed that this is the end of a spiritual life. Death in this sense is unknowable, and we are dealing more with its symbol. However, since ancient times, people have thought about death, trying to understand and comprehend it. By trying to find the reason behind these attempts, we will be able to understand the human nature and its specific position in the world.
Death is the end of life, the denial of it as a supreme value. Therefore, death is a value, since it like life contains some fundamental sense, which gives the true values their true meaning. Death is the universal equivalent of all the values in life, if a particular individual prefers death to life.
The meaning of our existence is more or less revealed in deeds and behavior. However, each act of behavior, either successful or otherwise, reveals it only partly and incompletely. The only category that covers the full meaning of a person’s life is death. Death is meaningless only when life is empty, vain, and failed. The thought of death should awaken the idea of life, its meaning, sense, and value. People should live in such a manner that death could not catch a person unprepared. Being prepared to death means that a person will have no regrets about the life he has lived or years he has wasted. Death should be an event that explicitly reveals the final fullness of life, a moment crowned with the maximum possible completeness of each specific moment of time. If a person dies at the peak of his fame, i.e. at the height of the fullness of life, nothing which can happen after that can spoil his life.
The notion of death has always been connected with notions of grief and loss. It is possible to say that the dead do not die completely. This paradox is explained if we consider the existence of a social community between the living and the dead. In contrast to the physical existence of the individual, his social and public existence does not end with biological death. Even after death, man retains his place in the relations between people. It is manifested in the feeling of grief among relatives, this person’s prestige, status, etc. The deceased person continues to fulfill a certain role, the expression of which may include the design of his tomb, a place in the cemetery, a monument, memorial plaques, etc. In some cases, such a “life” can relieve the pain of loss, while in others it can make it even harder.
Euthanasia and Assisted Suicide
My attitude to these two concepts before taking the course was generally negative. I saw no difference between them, and used to consider them as an act of murder. After the course, I understood the difference between them and started to consider them differently.
First of all, both these concepts deal with the notion of suicide, which was briefly mentioned in the first part of this paper. I also would like to emphasize that only few people decided to ask for help in suicide or to kill themselves on their own. Usually, people live their lives the way they can or the way they see it normal to live. However, when a person has been dying for a long time, suffering and being tormented by physical and mental pain, it is difficult to escape the thought that this person should die faster and easier. Even people who sincerely believe in God have difficulties in accepting this suffering with humility. The idea of killing a dying patient by a doctor at patient’s request is as old as medicine itself. Doctors have always publicly refused to perform euthanasia, and always - like all the people witnessing the terrible and humiliating sufferings - pondered it. However, there have been recorded cases of doctors performing euthanasia. But only few doctors believe that euthanasia should exist as an opportunity for each patient.
In theory, there are two types of euthanasia, such as passive euthanasia (the intentional termination of medical therapy) and active euthanasia (giving medicines or performing other actions, which result in a quick and painless death). Some consider assisted suicide (providing the patient at his request with means to painlessly end his life) as a part of active euthanasia. However, I differentiate between these notions. I think, suicide is a conscious act of an individual. I cannot blame a doctor for helping his patient to die, with his consent previously expressed. Euthanasia, on the other hand, involves doctor’s or relative’s decision. For example, it is performed on irreversibly comatose patients. In this case, death comes not as a conscious and voluntary decision, but as other person’s will, which is unacceptable. According to the American Medical Association, “euthanasia and assisted suicide differ in the degree of physician participation. Euthanasia entails a physician performing the immediate life-ending action (e.g., administering a lethal injection). Assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/ or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient is intending to commit suicide)” (AMA, 1992, p. 2).
Euthanasia is a highly debatable question. No matter what our attitude is, the fact remains that euthanasia is the killing of one human by another human, or a physician, in this case. Even killing a hopelessly sick person at his own request contradicts the very essence of a doctor and an average health worker. The vocation to which they devote their lives is all about fighting death, not helping it.
There is an opinion that if a doctor, for any reason, takes the life of another person, his diploma should be immediately cancelled, because this doctor has turned into a killer. We should not forget that doctors are people, and people can succumb to temptation. If a doctor is able to kill a person in his interest, then, having the right to kill legally, he can possibly use this right for his own advantage. Sooner or later, people will stop trusting their lives to doctors, and thus society will lose medicine. The question about the hopelessness of the patient is not easy, either. Strictly speaking, this category mainly includes old and sick people, as they will all inevitably die within a few years. Should they also be denied treatment? A murder is never humane. It is always a murder. And humanism is called humanism because it helps people to survive and not die. And the society - if it wants to be humane - should not force this duty on the doctor, because it is contrary to the nature of his activities.
It is believed that euthanasia is the product of compassion. Suffering in itself causes sympathy, e.g. killing a dog writhing in pain or finishing off the one doomed to death. Can one be refused this act of mercy? In fact, even Christians sometimes feel convinced to alleviate the suffering of others. But this pity in itself is ambiguous. Of course, very often the pain is unbearable, but it is often even more unbearable for those who are around the patient. By relieving the patient from pain, they often eliminate the pain within themselves. Is the patient’s freedom of choice respected in this case? This is purely human: it is always more difficult to see the patient suffering, rather than help him pass away in a dignified and painless manner.
But in the case of assisted suicide, the situation is different. If we consider the human right of taking control over one’s life, then assisted suicide is simply a means of exercising that right. An important issue here is placing the responsibility for taking life on another person, viz. a doctor.
Any healthcare worker strives to alleviate the suffering of the patient by fighting for health and life. However, the situation in which these components begin to contradict each other, that is when preservation of life will inevitably lead to severe pain and suffering, becomes a formidable moral challenge. In the eyes of many people, suicide is an unworthy act, the evidence of weakness, and even taking the rights which belong only to God. I cannot agree with this opinion. The right to die is the same as the right to live. It is a property of a free individual. Besides, if we consider religions, it is not prohibited in most of them. There is no explicit prohibition, for instance, in the Bible. Besides, people do not usually blame those who kill themselves to avoid agony.
I believe that assisted suicide should not be prohibited, because, first of all, it is the inherent right of any human being. Besides, there are cases when it is absolutely necessary. People should not condemn a patient who suffers from unbearable pain for having hope in the so-called miracle cure. Of course, people should not give up hope, either. No doubt, a very experienced doctor can understand where this fine line is. Euthanasia, on the other hand, is a debatable question. I cannot say that I have a solid opinion on it. But I do think, that no relative or doctor can decide for the patient. If the patient cannot express his desire to die, euthanasia will turn into murder.