The dying decision: choice, coercion and community

A Japanese drama about medical assistance in dying, Plan 75, reveals a lot about our relationlessness.

Sian Brookes

Sian Brookes is studying for a Doctorate at Aberdeen University. Her research focuses on developing a theological understanding of old age. She studied English and Theology at Cambridge University.

In a retirement home, a older person sings karaoke while the person behind waves a hand.

Chieko Baishô plays Michi.

Happinet.

“Being able to choose when my life will end provided me with peace of mind. With no feelings of doubt. She led a good life on her terms, people will say”.

In Chie Hayakawa’s 2023 dystopian drama Plan 75, these are the words of a silver-haired, wrinkled woman in a promotional video for the eponymous plan – a government scheme which offers all over 75-year-olds the option of a pain-free death at the time of their choosing.

And yet for Michi, an older lady toying with the decisions around Plan 75 it doesn’t really feel like it is her choice which matters at all. Whether it is the $1,000 grant offered as an incentive to die, the luxury amenities on offer at the Plan 75 facility promoted in leaflets and magazines, or the young person employed to gently guide the candidates towards their death (but whose real job it is to make sure they follow through with it), this is a world which has a clear agenda – to rid society of older people. Indeed, it is clear that this is a vision of a world which believes it is better for old people to die than to put financial burdens on the economy or their families, and this is a culture willing to subtly coerce individuals to accept and act on that belief.

Plan 75 reveals an interesting point at the heart of the MAID (Medical Assistance in Dying) debate. One of the primary reasons that MAID is so attractive is the ability to take back control of one’s life and death, yet what happens when that seeming control isn’t really within the individual’s own control at all? For Plan 75, what is marketed as giving control back to older people, is really just a twist on a more sinister political policy to pressure individuals to sacrifice their “burdensome” lives for the greater good. Of course, this is a common argument for rejection of assisted suicide. This is the dangerous ‘slippery slope’, where MAID begins as an option only for those who desperately need it to relieve intense physical suffering. Yet it quickly becomes a tool to remove people whose lives no longer seem worth living due to societal expectations and opinions, rather than any objective reality.

Do we ever truly choose to die totally independent of the expectations of those around us?

For many, this problem can be appeased through strict legal controls over MAID – as long as the powers that be are regulated, MAID is still OK. As long as it is the individual who maintains control over their own death (and not the state), the goal of personal autonomy is maintained and all is well. And yet this perspective fails to ask the question - is such control over our own death ever actually possible? Do we ever truly choose to die totally independent of the expectations of those around us? In a world which places so little value on old age, can older people really make choices unaffected by that (deeply flawed and inhumane) logic? And, indeed - the elephant in the room – no matter how much we try to control death, in the end is it not death that ultimately controls us? As fundamentally finite beings we can never escape it completely – it will always find us one way or another. Ultimately, we will all have to face the reality of death when it comes to us. Complete control and autonomy are never truly possible.

In light of this unveiling, the possibility that complete choice and autonomy around death isn’t really an attainable goal, what better options might we pursue?

Where previously we would find comfort and hope in being loved, known and held by others in our death, now all too often this isn’t the case.

One thing is clear in Plan 75, the isolation and loneliness of older people in a society that has rejected them is deeply problematic. The movie primarily follows the stories of Michi, who lives alone with no family and Yukio Okabe, an older man totally estranged from his remaining family. Both face life, and are facing death, alone. We live in a world where increasingly we are forced to face death alone. When our final days and hours rarely happen in the family home, surrounded by our loved ones, but in faceless institutions devoid of lifelong meaningful relationship the sense that we are no longer doing death together as a society is acute. Where previously we would find comfort and hope in being loved, known and held by others in our death, now all too often this isn’t the case.

At the same time, there is no doubt that our modern world is unceasingly committed to the ideal of individual personal agency and autonomy – “She led a good life on her terms”. As a myriad of philosophers and theologians have commented, belief in human autonomy has come to replace belief in God. And MAID is one area which reveals this to be the case most acutely. Where previously we would turn to God to find comfort in the face of our finitude, instead now we turn to ourselves – the last hope we find in the face of death is our individual ability to control it.

Death and health should be a corporate phenomenon – when one person is ill, all of society is ill.

The German theologian Eberhard Jüngel described death in this broken world as “the occurrence of complete relationlessness”. In fact, Jüngel suggests that as human beings we are first and foremost made up of our relationships – we are truly human not by how we self-define in isolation but how we relate – how we relate to the God who made us, and how we relate to other people. This need for relationship is found most acutely in the face of death. As Ashley Moyse points out in his book, Resourcing Hope for Ageing & Dying in a Broken World, death and health should be a corporate phenomenon – when one person is ill, all of society is ill. And so, as death increasingly becomes the journey of the individual – when we face death in isolation from others and in isolation from God no wonder we feel such a strong desire towards control, towards ending our lives prematurely, towards science to help us avoid any more pain than we can bear alone.

In Plan 75 we see glimmers of hope in the possibility of relationship. As Michi and Yukio find rare moments of human connection with a long-lost nephew, with a young person working for Plan 75, with another older person going through the same questions around mortality you can’t help but feel deeply uncomfortable with their choice to apply for the scheme. It is in the hints of love, physical touch, smiles exchanged, even a simple conversation shared between two people that suddenly MAID seems so disconnected with the hope that life still has to offer through relationship. Perhaps if we could imagine a world where death became no longer an occurrence of complete relationlessness, but a locus for relational dependence, for familial connection, for leaning on God and not ourselves, the need for MAID would feel a little less necessary. It would be a world with a little more hope.

Review

Belief

Culture

Film & TV

20 September 2024

4 min read

Kate Winslett delivers the performance of her life, in a film that doesn’t look away

The true quality of witness shines in Lee Miller’s biopic.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

Two war photographers creep along a shadowy corridor.

Kate Winslett and Andy Samberg in Lee.

Sky Cinema.

If we might indulge an absurd anachronism, I wonder what the American photojournalist Lee Miller would have done, had she been one of the women at the foot of the cross. To my mind, she would have held her nerve to record – on her German-made Rolleiflex camera held at her abdomen – not only the horror of the crucifixion of Jesus of Nazareth and the criminals beside him, but also the suffering of his mother and the other women who looked on.

I’ve had these ruminations since I watched Miller’s biopic, Lee, on its UK premiere. In passing, I should record that Kate Winslet delivers the performance of her life in the title role, because it’s in the quality of her interpretation that I’m led to consider the nature of what it means to witness, which is an act at the heart of humanity as well as central to the Christian faith.

Witnessing is what reporters, at their best, do if they are to honour their vocation. Especially war reporters. But the act of witnessing isn’t confined to journalists. The case for professional witness can be made for other jobs – police officers, aid workers, medics, lawyers all come to mind.

It’s just that this movie shows witness at its sharpest end. “Even when I wanted to look away, I knew I couldn’t,” says Lee Miller. That imperative, not to look away, is central to our human story and I would argue that this is because it’s central to my faith, which has at its centre a God who doesn’t look away.

That’s why Lee Miller made me think of the historical event of the crucifixion. The Church down the ages has been inclined to turn the cross into the Christ’s great victory – rather as reportage of the Second World War has concentrated on its conclusive victory rather than the horrors that Miller recorded.

Her magazine employer, Vogue, at first declined to publish her photos of the liberation of concentration camps Dachau and Buchenwald, in part because it detracted from the joy of that victory (though they were subsequently published in the US). If you will, Vogue looked away.

I’ve found that to go down this path with Miller, accompanied by faith, a kind of terrible road to Emmaus, delivers some unexpected reactions.

We’re called to refuse to look away from the grotesque horrors of the cross, to resist it becoming simply a jewellery symbol on a pendant, to acknowledge its centrality in man’s inhumanity to man and, ultimately, our God’s choice to share that experience. “Jesus Christ,” mutters Miller at the door of a room, possibly a gas chamber, stacked with skeletal corpses, before entering to take her photographs. Jesus Christ, indeed.

This is not to make a claim for Miller as a figure of faith. It is rather to make the claim that those of us of faith should be highly alert to where we might find the witness to it. Over the past week, I have to say I’ve found it in the work of Miller, not only in the hell of the camps, but in the shaven heads of collaborator women, the frightened children and even in that bath in Hitler’s Munich apartment.

In the last of those, there she is, naked, washing herself clean from the dirt of Dachau, which stains the bathmat from her boots in the foreground. Here is a witness to a spiritual defiance, the portrait of Hitler propped on the bath edge as she is cleansed. It’s not just that he hasn’t won, it’s that death itself hasn’t won.

I’ve found that to go down this path with Miller, accompanied by faith, a kind of terrible road to Emmaus, delivers some unexpected reactions. And they’re not the kind of reactions normally associated with faith.

The first is anger. It clearly accompanied Miller throughout her work: Anger at military discrimination against her womanhood; rage that Vogue censored her work. We could all do with being more angry at injustice, especially those of us of religious faith. Note that when American Vogue published her photos, they headlined them “Believe It!” True belief, arguably, is angry.

My second takeaway is the danger of real witness. Miller described her work as "a matter of getting out on a damn limb and sawing it off behind you". Discipleship can, maybe should, be like that.

The third is the cost of witness. Miller’s war left her with depression and what today would be called PTSD. Not looking away has its price. The cost of witness to disciples may not be as extreme as it was in the first century of its practice, but we should also be aware that it’s not a cosy lifestyle choice either.

For Miller, part of the price of her witness was alienation from her son, Antony. In the movie, though (spoiler alert), he discovers after her death how devoted to him she was. At a stretch I would say he was a son in whom she was well pleased.

That’s not to imbue her with something messianic. It is perhaps to say, with the poet Philip Larkin, that what will survive of us, especially those who have witnessed the worst of humanity and come through, is love.