Monday, September 21, 2020

Who really wants to die? Part V: The absence of suicidal desire amongst the survivors of catastrophic injury.

Gordon Friesen

A fundamental truth

Cutting directly to the chase: survivors of catastrophic injury (such as those suffering from paralysis due to spinal cord injury), have no greater desire to die than anybody else. There is, therefore, no rationale for facilitating access to assisted death on their account.

In crude figures: only somewhat less than one percent of the victims of spinal chord injuries will despair, renounce, and end their lives during the first crucial five years of recovery (and after that time, their specific suicide rates become statistically identical to those of the general population). That is, of course, a huge number of individual suicides (and roughly twenty times the normal expectation). But it remains, none-the-less, only one percent of the whole.

These facts may come as a surprise to many. But such is the incontrovertible truth.

Once again, as with celebrity suicide, and with the general euthanasia rates observed around the world: we see that the “service” of euthanasia has been grossly oversold in proportion to the scale of voluntary organic demand on the part of its’ intended clientele. And even more importantly, this demand has been energetically misrepresented over the years, by suggesting that certain specific categories of ill and disabled individuals, including (especially) major injury survivors, people with AIDS or persons experiencing progressive neurological decline, and those diagnosed with terminal cancer, do indeed wish to die, when, by the dispassionate measure of statistical evidence: such is clearly not the case.

To what, then, do we owe this false, dangerous, and all too popular misconception?

At the heart of pro-euthanasia messaging: the ideal notion of “suffering”

Fully -- and confidently -- imbued with the early twentieth century spirit of progressive scientific utilitarianism, the Voluntary Euthanasia Society (UK) was formed in 1935 (four years before the onset of war), dedicated to the following principle: 

“incurable sufferers should have the right to choose a Merciful Death”
Ten years later, however, when the Second World War had ended the fascist dream of a “new social order” (and faced at Nuremberg with the appalling evidence of what can really happen when the medical profession is instrumentalized in the pursuit of utilitarian public policy), support for euthanasia virtually disappeared.

As a result, those few creative and powerful personalities who, for whatever reason, remained deeply attached to this ideology, found themselves in a similar situation to that of anti-euthanasia activists today, which is to say, firmly on the back foot and comprehensively obliged to reinvent their goals and methods.

In this extremity (and at the price of a deep fracturing within the Society itself), the immediate goal of access to euthanasia was abandoned; and what was left of the movement transitioned (in the post-fascist period) to a more modest set of objectives, beginning with the first and most basic patient prerogative on the road to full access euthanasia: the right to refuse treatment.

Refusal of treatment, and the original slippery slope

Today, of course this principle is universally accepted. We should, however, frankly realize that refusal of treatment has crucial suicidal implications: that by accepting refusal of treatment we are also deemed to have credited the idea that suicide need not be, by definition, a wrongful act; that we do not have an unconditional duty to prevent suicide; that suicide is not necessarily “bad”; that suicide can, in fact, be “good”; and ultimately, that we might be morally required to provide assistance in suicide. In other words, from the first formal acceptance of “refusal of treatment” (and with far greater effect from the later refusal of “care”), the road became clearly laid out -- through the logical falling of successive legal dominoes -- to that situation in which we find ourselves today.

For clearly: categorical interdictions can not be (formally) breached without inviting far-reaching consequences.

A required moral consensus on the desirability of (at least) some suicides

Perhaps the most brilliant and effective aspect of the strategy outlined above lies in this fact: that the entire collective and utilitarian justification for euthanasia -- previously quite obvious but now unavowable -- had been displaced by this one remaining principle of unfettered individual choice.

And yet there still remained a crucial obstacle to this plan. We must understand, I believe, how difficult it was for people, at that time, to openly promote the idea of suicidal choice. It was not enough, three quarters of a century ago, to simply fall back (as one might today) on the sovereign personal right of capricious subjective desire. Those who wished to enable suicide, assisted suicide, and ultimately euthanasia itself, faced the very real challenge of convincing a democratic majority that suicide can be (and is in fact), objectively “good” (in specific instances).

In practical terms, of course, this would mean convincing the common man that there were situations in which, he -- or anyone else -- would naturally wish to die. And to achieve this goal, euthansia promoters began with a truly ingenious linguistic tool, for soliciting agreement with their underlying thesis. This involved a minute, almost invisible change, introducing the notion, no longer of merely “incurable” suffering, but that of a suffering which was incurable and “unbearable”! For in this case, IF we accept at the outset that there is (in fact) such a thing as “unbearable suffering”, THEN by definition, anybody so afflicted would automatically wish to die, and the argument is carried without further demonstration.

The only task remaining, therefore, was to sow this treacherous conceptual seed in collective consciousness (appealing, also, to pre-existing popular prejudice), by presenting ideal images of people “suffering” in seemingly “unbearable” circumstances. Unfortunately, as we shall see, this challenge was actually undertaken with great success over a period of fifty years (in spite of clear statistical proof to the contrary), by mere literary representations of fictional suffering, involving notably (among others) the paralysed survivors of spinal cord injury.

An outstandingly successful instance of fictional misrepresentation: spinal cord injury

As early as 1972, a television drama championing the right to die, intitled “Whose Life is it Anyway”, by author Brian Clark (1932 - ), appeared in UK (once again), which was subsequently brought out on the stage (London 1978, Broadway 1979) and was ultimately produced as a Hollywood film starring Richard Dreyfuss (MGM 1981).

The subject of this film concerned the suicidal desires of a young man (Dreyfuss) who was rendered quadriplegic in a car accident. The point of the film however -- it’s purpose -- was to convince the average sympathetic spectator, that a life of paralysis is objectively unworthy of living; or at least, that if he or she were to find themselves in such a case, that they would not wish to live. The fundamental goal, therefore, lies in soliciting the spectator’s agreement with that essential euthanistic premise identified above: that there do indeed exist extraordinary instances of “suffering” which are objectively “unbearable” (and for which the act of suicide -- and indeed of homicide also -- must be postulated as a positive “good”).

Unfortunately however – incidentally and unforgivably -- it was also grossly (and falsely) intimated through this fictional imagery, that the typical paralysed survivors of spinal cord injury are indeed “suffering” in that mythically “unbearable” fashion so artfully evoked, and naturally desire death in consequence!

Never mind that this is a bald-faced lie. Never mind that ninety-nine percent of catastrophic injury survivors will show no more suicidal tendency than anybody else! People of the author’s ilk have no interest in such distractions: In fact, it would surprise me greatly to learn that Brian Clark actually cared if real spinal cord injuries wished to die. He might easily have discovered that they do not (And perhaps knew this perfectly well)!

Even the spinal cord issue, itself, (as choice of subject) was probably a mere happenstance. Apparently, Clark simply picked the worst infirmity he could think of (while still getting aesthetically photogenic shots). His one simple goal, for whatever reason, was to convince “normal” people that their “suffering” neighbors should be allowed to die. And if that demonstration depended on a completely fallacious description of reality, advanced unselfconsciously through a work of political fiction, then so be it.

A personal, indignant resentment, evoked at the view of this film

The reader may have detected a particularly warm tone in my treatment of this particular subject. And the reason for that “warmth”, is because, coincidentally, “Whose Life is it Anyway” appeared as a film only two years after I myself became paralysed in circumstances very similar to those depicted in the movie.

The terrible nature of such literary assault

Without the will to live, even the strongest man, in the most favorable circumstances, will soon disappear. For that is the inflexible rule of all life, which has governed evolution from the very start: Life must be desired; life must be nurtured; life must be defended; life must be striven after. Among humans, indeed, the capacity for adaptation is virtually limitless, and the will to live, therefore, is not a secondary, but the first and determining predictor of outcome: for almost any situation is livable to the person who desires life; but no situation will suffice for the one who does not.

Generally speaking, then: How could anyone fail to understand the mortal danger posed by such a work, to people at grips with these intimate and personal adjustments? In those first crucial four, or five years? In that first devastating year? How could anyone ignore the terrible implications of telling such people (at that most delicate of times), that their lives were (objectively) not worthy of life?

As concerns myself personally: forty years ago, my survival teetered on the knife’s edge. My life depended, quite simply, on the confidence required to make positive choices; and the suggestive force of Clark’s propaganda, with its nihilistic view of disabled life (whether wittingly or no) posed a direct threat to my existence.

I do not hesitate to affirm, therefore: that the production and distribution of this film (and the still very popular stage-play from which it sprang) were (and remain) acts of criminal assault upon real people; some of whom, sadly, will not succeed in repulsing this poisonous ideation.

And yet most happily: the human powers of recuperation (from psychic no less than from physical assault), are much greater than we might intuitively expect (and certainly much greater than the shameless pornographers of “unbearable” suffering would have us believe).

A more faithful portrait of real life

People who have lived through these sorts of difficult adaptations, and those also, who have been the intimate witnesses to such feats, naturally see them as unique, heroic, victories over misfortune. And they definitely are. But the superb level and intensity of the efforts made – and of the satisfaction achieved -- does not change their equally ordinary nature. It is simply a lie (albeit a nearly universally credited lie) that only a very few superior individuals can possibly overcome the challenges of catastrophic injury. In reality – and this is a truth which cannot possibly be over-stated: this kind of amazing adaptive power reveals itself as a standard characteristic of humanity. Especially where it is expected and embraced.

A conclusion of infantile simplicity

Once again, let us remember the main thesis of this present series of articles: that observed demand for euthanasia is wildly below what we would expect as a justification for the scale of the service offered (and for the sacrifices demanded of both typical patients and typical doctors) in the satisfaction of what little demand there is.

What is the reason for that? Why is this dishonest (and clearly false) nihilistic messaging (epitomized by the film “Whose Life is it Anyway”), still allowed to stand? Where are the ninety-nine other films logically required to faithfully portray observed proportional reality? Where are the popular commentators, eager to “set the record straight”?

Whatever answers might be found for these intriguing questions, something has clearly gone wrong with the scenario imagined seventy-five years ago by post-fascist euthanasia apologists suddenly recycled as apostles of personal choice: Doors to the “service” have been thrown wide open. Doctors are now instructed to be on the lookout and to recruit as many clients as possible. Yet to their enduring frustration (and, I believe, entirely predictably): As long as euthanasia depends on choice it can never prevail over the normal human instinct of survival. Or to recall the familiar Children’s Tale:

Then said the Little Red Hen:
“I have convinced the general population that “suffering” is worse than death;

I have changed the law to allow doctors to kill their patients;

I have transformed the public healthcare system along utilitarian lines in order to maximize access to euthanasia;

And now, who wishes to die?”

“Not I”, said the Pig.

“Not I”, said the Cow.

“Not I”, said the survivors of catastrophic injury...
How long will it take (and how much damage will be done to our medical establishment) before judges, administrators and opinion-makers realize that they are attempting to force a “product” upon us, for which there is no corresponding market organically expressed?

And how long will we – patients and taxpayers – allow this abuse of our trust?

This article is the fifth in a series of articles.


Ed said...

Our CCB zoom hearing starts Wednesday to allow St Mikes to end life support for our 59-year-old son. Even after undergoing severe brain damage during a botched medical procedure, our son continues tenaciously demonstrating an undeterred will to live. The ICU head has refused to accept his remarkable refusal to die. In fact, even before the 72-hour-rule of providing critical care expired, medical staff was telling us that his condition would not improve and asking whether our son would want to stay on life support. Admitted almost 2 years ago, our son has been staked to die from pretty well the outset. Instead of helping him through rehab, the hospital has been busy building a case to legally pull the plug hiring two lawyers from one of the largest firms in Canada against parents who will be using Zoom for the first time!

gordon friesen said...

HI Ed,

I fully support your efforts to defend your son.

Just because his "condition would not improve" is not, I submit, any reason to let him die (or kill him by euthanasia).

Is your son actually conscious and capable of expressing his desire to continue ?