Review
Assisted dying
Death & life
Film & TV
5 min read

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 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. 

Article
Comment
Grenfell disaster
Justice
Death & life
Politics
7 min read

Grenfell: a tale of two towers

The Inquiry offers an opportunity to change the way we treat each other

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A wrapping around the Grenfell Tower bears a giant green heart.
The Blowup on Unsplash.

Graham Tomlin was Bishop of Kensington at the time of the Grenfell Tower fire. This is the first of a short series of articles reflecting on this milestone in our national life. 

The Grenfell Inquiry report is brutal. None of the companies involved in the renovation of Grenfell Tower escape. Arconic, Kingspan, Rydon, Celotex, Exova and many others – all have a lot to answer for.  Listening to the statement by Sir Martin Moore-Bick and reading the report, words such as ‘failure’, ‘dishonesty’, ‘misleading’, and ‘defective’ sounded like a tolling bell throughout his account.   

This was a tragedy that was decades in the making. Reports came out, warnings were issued and routinely ignored. A government which led a campaign of de-regulation without looking at the consequences for safety, a local council that failed to plan ahead for such an event, a tenant management organisation that treated the tenants they were supposed to serve with disdain, all played their part. The construction industry fared even worse. A culture of unholy competition, ‘value engineering’ (another term for deception), cost-cutting, a scramble for market share all took precedence over the safety of the people who were going to live in the newly clad flats of Grenfell Tower.  

In the past, initial reports such as those on Bloody Sunday in Northern Ireland and on the Hillsborough disaster, were weak affairs, failing to listen to the voices of victims, too careful to preserve the status quo, only leading to further anger, and further reports which finally began to address the key issues. This report has not pulled its punches – perhaps because they kept the human side of the tragedy in mind throughout. 

In the early stages, in an inspired move, the Inquiry decided to offer an opportunity for bereaved family members to simply describe the people who died in the fire. It was intensely moving as the richness and colour of each person was described, celebrated and mourned. As a result, this Inquiry has never quite lost the human nature of this tragedy and I suspect that is why its results have been so hard-hitting. 

No blame for the victims - instead he demands a radical national repentance, a re-examination of deeper social and spiritual trends, and for a radical turnaround of attitude. 

Jesus and another tower 

Remembering the human scale of the disaster is vital, yet in itself, it does not lead to change. At one point in his public teaching, Jesus was asked about another disaster involving a tower which led to the tragic death of a large number of people. At some point during Jesus’ time in Jerusalem, it seems a tower collapsed in a part of the city called Siloam, killing 18 people. This tragedy clearly had a significant impact across the nation, and people started asking what it meant, and what it said about the society in which they lived.  

Jesus' words were harsh:

“Those who died when the tower in Siloam fell – do you think they were more guilty than all the others living in Jerusalem? I tell you, no! But unless you repent, you too will all perish.’”

No blame for the victims - instead he demands a radical national repentance, a re-examination of deeper social and spiritual trends, and a profound change of mindset. If they don’t, such disasters will continue to happen. When disaster strikes, it doesn’t say anything much about those caught up in it, but it does give us an opportunity to take a good look at ourselves.  

Jesus said that the two most basic commandments, the things we should set out to do every day of our lives, were to love God and to love our neighbour - who is deserving of love because they are first made and loved by God. The Grenfell story is an object lesson in what happens when those commandments get ignored. This is what happens when these commandments are superseded by other imperatives, such as to increase market share, to beat the competition or to safeguard the reputation of our own organisation.  

Grenfell was the result of a culture that has become so individualistic that we have lost sight of the fact that we are our brothers’ (and sisters’) keepers, that we have a responsibility for each other, and that we find purpose and meaning in loving our neighbours as we love ourselves, whoever they happen to be. I am sure that the employees of Arconic, Rydon, Kingspan and the Tenant Management Organisation of RBKC, would have done anything they could to ensure that they and their families enjoyed a safe and secure home. They simply failed to do that for those they were meant to serve through their work. They took care of themselves and their own. They lost sight of the people their work affected. They did not take care of their neighbour.

It is the individuals and institutions that have the resilience and flexibility to face up to failure, learn the lessons and to be open to change which ultimately excel. 

What happens now?  

Matthew Syed’s 2015 book Black Box Thinking looked at responses to catastrophic failure. He contrasted the approach of the medical profession with the aviation industry. Too often, he argued, when an error is made in the world of healthcare, the instinct is to cover up failure for fear of litigation or in order to protect reputations. As a result, he suggested, the same mistakes are often repeated, which means that thousands of people continue to die in hospitals every year due to preventable error. When a plane crashes, however, the ‘black box’ is recovered, data painstakingly analysed, and no stone is left unturned in order to determine the exact causes of the disaster to make sure that it never happens again. As a result, plane travel has become one of the safest means of transport we have.  

The companies and organisations that were meant to protect the residents of Grenfell failed in that duty. Yet the moral of Syed’s story is that failure is not something to be feared — but an opportunity to change. It is the individuals and institutions that have the resilience and flexibility to face up to failure, learn the lessons and to be open to change which ultimately excel. It is what the Christian church calls confession and repentance – the willingness to admit when we have got something wrong, bear the consequences, ask for forgiveness, resolve to learn from the error of our ways and to become a better person through it. Repentance is not wallowing in self-pity or hiding in a corner from the wagging finger of guilt; it is an invitation to honesty, to growth and to transformation.  

Those responsible will need to face justice. Yet if we allocate blame, punish the guilty, and then carry on as before, then there is no guarantee that something like this will not happen again. We might issue new types of building regulations, or safety measures in construction, but even that would not be enough. The kind of repentance that Jesus, and indeed the Grenfell Tower fire calls for is deeper - a radical look at the way we live together in our society.  

This involves all of us. As Andrew O’Hagan put it in a long article soon after the fire in the London Review of Books:

“In all the loosening of cares and controls and emergency services, it’s not just the current government but a succession of them that lie behind those deaths, and who, if not all of us, voted such vulnerability into existence? No one did well. If civic life is dead, with a 24-storey tombstone beside the Westway, it died in the times in which we too lived, and by the values we lived by. The point of a society, if we have one, is that when bad things happen, it’s everybody’s concern.” 

Grenfell is such an opportunity that we dare not let pass. If we carry on as normal, with our atomised individualism, our addiction to comfort, our spiritual poverty, our disregard for our neighbours, we would miss a huge opportunity to address some of the deeper issues in our life together, not to speak of refusing to heed the call of Jesus for true repentance.

In his statement in the House of Commons, Keir Starmer pledged a “profound shift in culture and behaviour.” I hope - and pray - this is what happens. Yet it will take more than changes to building regulation and for safety. It needs spiritual and not just political change, as I’ve argued here before. It would mean each of us looking at ourselves, and the cultures of the organisations of which we are a part (yes - including the church), and responding to the call to love God – to re-orient our lives around something, someone bigger and better than us – and to love our neighbours as much as we love ourselves. What if Grenfell sparked a fundamental change back to that more connected vision of who we are and what we are here for? Grenfell - and this report - is a shock to our system. Let us not waste it. 

 

Listen to Graham discuss Grenfell on BBC Radio 4's PM programme.