The Important Difference Between Assisted Suicide and Euthanasia
This is the second of a two-part article, which examines the right to die on our own terms. This is a personal reflection based on a real-life example of a close family member. It examines the legal, social and historical aspects of assisted suicide in Switzerland.
[This article was originally published on Fair Observer.]
In the previous piece, I examined the historical roots and social aspects of the practice of assisted suicide in Switzerland. Unlike other European nations, Switzerland allows citizens the option to end their lives. Many take this option. Both parents of my partner chose assisted suicide to end their lives.
It should be noted that, in Swiss law, there’s an important distinction between assisted suicide and euthanasia. Assisted suicide is a privilege enacted by proxy. If the person, who expressly wants to end his/her life, cannot do it themselves, they can get help from an organization. These organizations train volunteers who can access the necessary medication to put an end to the person’s suffering. This person who has chosen to end his/her life then takes this medication voluntarily without any assistance.
In contrast to assisted suicide, Swiss law considers euthanasia a particular kind of murder. There is a specific case in which a Swiss doctor has been brought to trial on charges of euthanasia while practicing assisted suicide. The court acquitted the doctor because the patient had not only asked to be delivered of her suffering various months if not years earlier, but also at a later stage her neurological disease had spread too far, and she could only barely move one foot at the set date; hence the doctor held the glass and gave her the drink when she moved her foot as a sign. The judges considered that it would have been cruel to deny her a dignified death simply because, on that day, she could not move her arm, and this after years of battling her illness.
One day A-L felt ready.
As a family we made a rendezvous, and on a set day, early in the morning, the lady who had interviewed everyone, came to the house. She asked when and how this would happen. We all gathered in the grandmother’s room and greeted each other. The volunteer explained that she was preparing the beverage and took a glass of water where she put the medication. Then she offered a piece of chocolate and an antiemetic pill to chew so the medication wouldn’t taste too sour nor would it be rejected.
When A-L felt ready, she took the glass from the volunteer’s hand and looked around the room. I don’t remember what she said exactly, but she feebly waved her other hand and drank a few sips.
A few minutes later, she closed her eyes, and her breathing became shallow and slowed down.
She passed peacefully on the morning of August 11, 2020 in her bed, surrounded by her daughter, the daughter’s partner, her partner, myself, and the volunteer from Exit.
The “accompagnatrice” called the police and the funeral home, which she had previously warned. When our children, 9, 12 and 22 years old at the time, came back home after spending the night at their older sister’s house, the police had already interviewed us and taken all the essential documents. The corpse had been taken to the morgue.
Most people present at her departure felt relief, even if there was indeed some sadness. Peace and serenity remained floating around for a while, with a sense of “je ne sais quoi.” We organized a ceremony according to her wishes and the local law about a week later in the city’s cemetery. She had chosen classical music and cremation just like her husband who went through the assisted suicide process before her. After the ceremony, we all had an aperitivo with a glass of white wine, which A-L had enjoyed throughout her life.
Is assisted suicide a form of negligent humanism?
According to the French ex-Dominican friar, now an Orthodox theologian and author Jean-Yves Leloup, (Ars Moriendi, 1986 and Les Livres des morts, Tibétain, Egyptien, Chrétien, 2009), there are four main ways to approach death.
The first one, in Buddhism and the Qohélet in the Jewish library, considers suffering, illness and death more or less as illusions. All three phenomena pertain to the self.
The second attitude, found in Hinduism and a few other traditions, considers pleasure, suffering, illness, and death as epiphenomena in a chain of causes and effects. They are all a part of a larger cosmic cycle.
The third attitude, which interests us here, says Leloup in his introduction, “is found in various forms of atheist humanism, traditional or contemporary, a familiar attitude in the West; in this context, suffering, illness, and death are a scandalous thing, one must preserve oneself and deliver oneself at all costs, death is the end, it’s considered as absolutely mortal, it is the interruption of biophysical or neurophysiological functions; there is nothing else than this aleatory interrelation of atoms and the ‘no-rules’ game of our synapses.”
Finally, the fourth attitude comes from monotheistic religions, which consider suffering and death as passages, a time of trial to which and from which one can give and take meaning and learning.
Leloup’s book is fascinating because it shines the light on a number of relatively less known traditions. The book contains a collection of translations of the Bardo and the Egyptian Book of the Dead.
Yet this book is still Christian in its ethos. Life is sacred as expounded both by the Catholic Church and the Evengelicals. These Christian institutions have deep theological differences but are united in their opposition of abortion and assisted suicide. Hence, Leloup’s description of “atheist humanism” as an anguished knee-jerk reaction to a scandal (death and suffering) appears extreme.
Leloup’s characterization of assisted suicide as negligent humanism is judgmental. Others have also opposed this practice. In fact, many atheist or agnostic authors consider it wrong on other grounds. As a devout Christian, Leloup implies that there can neither be ethics outside of religious beliefs, nor spirituality outside of institutionalized religion.
Leloup forgets that we can care for our community and living space without the narrative construction of submitting to a higher power. He overlooks a key question entirely: do we really need a religious framework to care for each other? Communities and groups have developed a variety of ways to cope with grief and fear of death and not all of these implicate an organized religion.
The ancient Stoics, whom Leloup also quotes, say, “As long as we are alive we can’t speak about it, and when we’re dead we won’t be here to speak about it,” steer away completely from speaking about death. There were philosophers in India, China and elsewhere who also did the same. Charvaka and Xunzi did not dwell too much on death and had a radically different view of life than that of monotheistic Abrahamic traditions. How can we say with certainty as to who is right and who is wrong?
What is death after all, and how about bereavement and grieving?
Speaking of death, we can’t forget to mention the influential Philippe Ariès. A French historian, with an atypical background, Ariès dedicated a large part of his life to the study of attitudes toward death in the history of the Western World. He examined death not as a physical or physiological fact but as a significant sociological phenomenon heavily charged with symbolic meaning.
Ariès’s work reads the social, physiological and psychological mutations that occurred in Western society from the Middle Ages to the 20th century. He claims that there isn’t a radical rupture between the more ancient attitude that viewed death as a part of life and more recent attitudes. In not so distant times, in fact until around World War I, death was accepted socially as a collective destiny to be addressed by the community and people were prepared for it.
Slowly — along the centuries — the process of isolation of the individual gathered pace, at least in western Judeo-Christian societies. The modern attitude that associates death with solitude, fear and even shame came later.
It might be hard to believe today that death was accepted and even ennobled for many centuries. Now it is hidden and feared, which can, in part, explain what Leloup tried to convey in his moralizing argument. In the leisure world and in cinema, brutal death is now made into an exciting spectacle, and even depersonalized. This shift, according to Ariès, happened slowly, over centuries.
Ariès explains and demonstrates that the persistence of post-death and bereavement rituals over a very long time make it difficult for any historian to chronicle changes in attitudes about death. The relatively new practice of assisted suicide brings “disturbance” to the traditional order. This phenomenon might be a symptom of things changing at a much larger scale than any religious tradition has countenanced.
A personal reflection on watching assisted suicide
If you have made it this far into the article, you might want to know my personal opinion on assisted suicide. I am agnostic on this phenomenon.
In the most literal sense, we cannot know nor prove that a god or any other “supreme being” does or does not exist. Therefore, I suspend cognition (a-gnosis). This argument is also usually transferred to the domain of belief by believers and theologians, which for me is clearly distinct from knowledge. However, both domains, belief and knowledge, can be studied through a constructivist — where people experience the world and reflect upon those experiences to create knowledge — lens.
The whole discussion on the existence or non-existence of a god, or gods, from this perspective, reveals itself as probably not much more than an interesting intellectual exercise. It does not help me with daily life. For me, the theological intellectual exercise about god per se is a waste of time and energy.
Don’t get me wrong, I don’t shun spirituality nor disrespect religions. I simply believe that too often religions don’t really help. Instead, they complicate things and increase suffering. If we want to take care of people and the things around us, we need a pragmatic approach. This pragmatism, which I expressed on some occasions, has been decried alternately as “not grateful” or anti-religious and, at other times, similar to the Buddha’s attitude because in his speeches, he never really mentions the existence of gods or a god.
The pain of ill people and the loneliness of the elderly are real phenomena that we have to address. The pain and suffering of their close ones, family and friends, and lovers are also real phenomena. Let’s take care of these phenomena, let us care for the living, the suffering and the bereaving. Let us not make the pain go on forever on the grounds that destiny, god, or any other entity that is supposedly telling us what to do or not to do. We have no idea, and no way to know what lies beyond.
Let me finish with a mourning chant from southern Italy from a precious anthropological document by Cecilia Mangini. Here women cry and scream and shake out all their suffering at the death of a young man, who was only 16 years old. These songs express pain, grief, and hope at many levels. Later, the men carry out the coffin and accompany it to the cemetery for burial.
Farewell A-L.
