SUNDAY, 13 APRIL 2025

Modern medicine has led to a huge decrease in mortality from acute disease at the cost of an explosion in cases of chronic, disabling illness, at least in the developed world, so there has been a slow and steady rise in public debate about assisted suicide, including that which is currently happening in the UK surrounding a Bill in parliament. I read an article this week about this subject, Is There A Duty to Die?, written by John Hardwig (available on JSTOR and easily googled), and it was its focus on duty which I personally found most interesting. Debates about assisted suicide tend to concentrate on the rights of the individual to end a life that belongs to him or her alone, but Hardwig’s paper focuses mostly instead on responsibilities to family and friends and society at large. I see this as a welcome corrective to a lot of current thinking.

I’m not saying that the standard, rights-based arguments for assisted suicide aren’t valid, but sometimes they seem to stem from the highly individualistic mindset of modern society, as if the person making the decision exists in a kind of vacuum set apart from the rest of the world. I imagine that the person considering this option of taking their own life does feel terribly alone and suffers from an aching sense of isolation as the debate unfolds inside his or her own heart and mind. But these decisions will have repercussions for everyone involved, and especially those who are fighting to take care of debilitatingly ill loved ones, and who are struggling to do so, emotionally, practically, and often financially. The thinking behind Hardwig’s paper is that the person contemplating assisted suicide has a duty to weigh its effects on everyone concerned, so, in a perfect world, these matters should be spoken about openly and decisions should be collective rather than individual.

No man is an island, as the famous quote goes. I see myself as a perfect example of the essential truth of this statement. In many ways my lifestyle is as close to that of a hermit as it could get without my going up a mountain and contemplating my navel. I live alone here in Gozo without a single local friend; my closest human contact is with the people who run the restaurant where I often go to lunch. Such friendships as I have are all online or happen via phone. And yet even someone like me who lives alone and whose parents and siblings are long dead has a web of people who would be affected if I decided to end my life. Yes, I’m sure it would be less painful for them to overcome any grief they might feel because I’m not a constant part of their everyday lives. We don’t speak on the phone every day, I’m not waiting in the house when they get home, I’m not chatting with them over meals together, my clothes aren’t hanging in the wardrobe, my books aren’t cluttering up the room. So it would be easier for them to forget me, and that would be a blessing in my opinion. But even the death of someone as socially isolated as I am would send ripples through the water for a while.

When we turn to the more common situation of someone living as part of a family or with a spouse, those ripples become tsunamis, so ideally any decision should be a collective one in which all close parties are involved. I say ‘ideally’, because when we are in the depths of pain and despair, we often have no energy left to consider anyone else; of necessity we become selfish and close ourselves off. But hopefully, in the calm at the centre of the storm, the thinking of the person considering suicide becomes quite clear and turns to their responsibilities towards those people they love, and they see themselves as part of something larger, something that will live on even if they as an individual are no longer there to share it. This is asking a lot of any human being, but perhaps this overcoming of self is possible with support and kindness and courage.

It might be argued that a rational decision is impossible in these extreme conditions and all that open discussions will do is set off conflict and negative emotions, and that of guilt in particular. But guilt is inevitable in these situations; it will certainly come following a suicide if these issues have never been discussed. You can’t have love without guilt because no one is perfect and we often hurt each other, even more so the people who have the deepest place in our hearts. The only people who don’t feel guilt are sociopaths who have no genuine feelings for others and see them as merely a means to an end. The painful difficulties of speaking openly shouldn’t be used as a reason for not speaking at all.

The truth is we don’t like to speak about these things because they make us uncomfortable and indeed do risk setting off all kinds of negative feelings. If someone does raise these issues, the conversation is often labelled ‘morbid’ and shut down, for in the modern world, there is almost no public acknowledgement of death. I remember many years ago I was on holiday in a little town in the Peloponnese, and one day there was a funeral procession through the streets. I don’t mean to sound disrespectful if I say that the corpse was like an ageing rock star being taken on a kind of farewell tour of the town and everything stood still as people had their chance to pay their last respects (and I felt pretty sure this was not a local dignitary who had passed away – it was just an ordinary coffin in an ordinary hearse without any of the pomp of an official event). Even in my own childhood in the UK, if someone died in my street the neighbours pulled shut their curtains for a day as a public gesture to honour the deceased. If I compare that to what happens in the UK nowadays, where death is handed over to professionals who make it as discreet and invisible as they possibly can, we can see that death, like so many other things, has become privatised in modern life.

This returns me to the argument at the heart of Hardwig’s piece: we can never actually be isolated units. Yet in public spaces today, we often are effectively alone: sealed off in our cars as we drive down the street, chatting on our smartphones as we walk, listening to music on our headphones. We have become molecules in an empty space which occasionally bump into each other, and thoughts of death are an unwelcome disruption of this atomised, semi-public existence. Acknowledging the reality and commonality of death is a way of connecting back with everyone else and putting shared meaning back into our lives. The line which stood out for me in Hardwig’s paper was, ‘We can conquer death only by finding meaning in it.’ I totally agree. But we tend to see it instead as an unwelcome reminder of our meaninglessness and flee from it as quickly as we can.

Many people will strongly disagree with Hardwig’s thesis and argue that an ethics which is based on one’s duties to loved ones is just as dangerous as one based on individual rights because both turn life and death into something which is negotiable and sacrifices the sanctity of life. This argument is most commonly advanced by Christians: that it is a sin to end a life which is given to us by God. My thoughts on this are twofold. First, the western world is no longer monolithically Christian and Christians must learn to live in a world where they co-exist with others of different faiths and none: they can believe what they want, of course, but they can no longer expect their chosen faith to dictate the wider rules of our society. Second, we can’t pick and choose when something is deemed sacred: an absolutist core is built into the concept and life is either sacred or it isn’t. Yet there are many occasions when this is conveniently fudged: in wars, including religious battles; in heroic sacrifices like that of Captain Oates, which is mentioned by Hardwig; in execution as a form of punishment for heinous crimes.

Another reason why assisted suicide should be a collective decision by the person in consultation with closest family and friends is that it removes a lot of burden from the shoulders of medical practitioners. At the moment, they are often the de facto decision-makers in a process which is deemed to be scientific and objective but I suspect frequently isn’t. For instance, the practice of triage in deciding who gets treatment and who is effectively left to die is a reality according to medical practitioners, even if we don’t care to admit it. Of course, doctors must remain a central part of any legal system which allows assisted suicide as a safeguard against its misuse, but their burden should be shared and the process in which this happens should be honest and transparent.

I’d like to detour slightly here in order to briefly mention the dangers of idealising the biological family. Many families are dysfunctional and I’m intending a broader concept of the term to refer to any group of people who love and support each other. Most commonly this is based on blood ties but need not be. In most cases, though, we will be talking of parents and children and siblings, and also in most cases, I hope and I believe, there will be bonds of affection and love, and these bonds need to be supported by systems that bring out all that is most noble in human beings.

Hardwig’s contention that there are situations in which someone might choose to die in order to cease being a terrible burden on those they love and who love them in return may sound harsh and uncaring towards a person who is already suffering horribly. And I can understand the argument that legal assisted suicide could be another perilous step towards a utilitarian society in which human relationships become even more instrumentalist. But this is where modern technology has brought us, and we can no longer close our eyes and block our ears: this issue is going to grow increasingly important as populations age and chronic health conditions become pandemic.

I would add as a final thought – and as my opinion – that Hardwig’s focus on responsibilities rather than rights is part of a more general needed realignment of the balance between them. Of course we must still fight for our rights, especially at this moment in history when many of those in power seem to want to strip us of them, but, to adapt a famous example, we must not only ask what our loved ones and our communities can do for us, but what we can do for our loved ones and communities. With rights come responsibilities, and a society must reflect that fact if it wants to remain in good health.