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.

Article

Culture

Film & TV

Psychology

4 September 2024

5 min read

Who’s missing from Inside Out’s internal family?

Where Riley’s writers could go next.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

Cartoon characters of emotions at a control desk.

Inside Riley's head.

Disney.

Once upon a time a man got angry. Then he got angry at himself for the fact that he got angry, which of course didn’t help. As the Buddhist monk Thich Nhat Hanh would say, “If we become angry at our anger, then we will have two angers at the same time.” Similarly, there was an occasion when he got really nervous that he might make a mess of giving a speech, and his nerves became so overwhelming that he delivered the speech badly. A self-fulfilling prophecy, one might say.

These are not my examples; they are examples given by psychologist Richard Schwartz in his introduction to Internal Family Systems (IFS). This therapy (sometimes also called “parts therapy”) is a form of self-analysis in which participants learn to resist supressing or controlling their difficult thoughts or emotions, the different “parts” of their inner world, and instead adopt a posture of curiosity towards each of them. This posture allows people to be in a beneficial relationship to their emotional lives, rather than being ruled by them.

Fundamentally, the relationship that emerges is one of compassion, understanding that our thoughts and emotions have a job to do, even the uncomfortable or shameful ones. So, anxiety, for example, guards us from committing social faux pas, whilst joy helps us to keep hold of a sense that life is ultimately worth the living, no matter how hard things get. Even sadness and grief, as much as we fear being overtaken by such emotions, have an important role to play, for example by helping us to define what things and people are most valuable and important to us.

For those who haven’t seen the Inside Out films, the writers cleverly take this idea of the “internal family” of emotions and create five relatable characters that embody them – Joy, Fear, Sadness, Anger and Disgust. In the first film, we see how these characters interact inside the head of a little girl called Riley. They are helping her to hang on to her sense of self despite the upheaval she experiences in her outside world, when her family relocate to a new city, and she must settle in to a new home and school. In the sequel, we rejoin Riley as she enters the turmoil of puberty, and the five initial characters are abruptly forced to work alongside some new arrivals – the “teenage” crew of emotions: Anxiety, Ennui, Envy, and… the biggie… Embarrassment.

This Self is transpersonal – it exceeds the boundaries of who we each are as an individual person and connects us to something large.

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When he first developed IFS in the 1980s, Richard Schwartz was, by his own confession, a committed atheist, with what he describes as “a distain for religion”. Schwartz writes of the frustration he felt at that time when several Christians got excited about IFS in its early stages of development. His peer, Robert Harris, even went so far as to publish a book that set out a Christian version of the therapy. Initially, Schwartz felt the biggie – embarrassment – that his therapy was being taken up by Christians. However, as time went on, and as much as Schwartz tried to push aside the spiritual dimension of IFS, he increasingly found that spirituality could not be eliminated from the picture:

“As I used the model with clients through the eighties and nineties, increasingly they began having what can only be described as spiritual experiences. These vicarious encounters with the mystical profoundly affected my own spirituality and I became interested in Buddhism, Hinduism, Taoism, shamanism, Kabala – everything but Christianity.”

Over time, Schwartz’s antipathy to the relationship between IFS and Christianity began to wane. He saw how much he had been working on the basis of prejudice, limiting his own exploration of Christian ideas in response to some unhelpful encounters he’d had with a few heavy-handed fundamentalists. He made deliberate moves to engage with Christian dialogue partners across the breadth of the tradition and began to see how congruent IFS was with the teaching of Jesus. The posture of curious compassion towards oppressive and uncomfortable emotions that Schwartz was encouraging his clients to adopt was mirrored perfectly in the attitude that Jesus advocated towards “enemies” in the outside world: do not judge, instead seek to engage them with kindness, and work towards their healing.

In recent decades, Schwartz has come to rethink IFS as an integration of psychology and spirituality, rather than as a form of psychotherapy. He speaks of “spirituality” as an innate essence at the core of each person, which he calls the “Self”, and acknowledges that many of his more religious students prefer to think of this essence as “the soul” or “Atman” (the eternal self within Hinduism). And, whilst he still describes himself as fundamentally agnostic and is wary of making his own definitive religious commitments, he has come to agree that this Self is transpersonal – it exceeds the boundaries of who we each are as an individual person and connects us to something larger.

Screenwriting for a popular audience of all-faiths-and-none, it is perhaps unsurprising that the makers of Inside Out have thus far eschewed the deep and fascinating spirituality of IFS. Riley’s “sense of self” is at the centre of both films, but the way it is depicted implies that it is something that only comes into being at birth and exists entirely to regulate Riley’s engagement with the outside world. So far, there has been no exploration of more existential questions such as faith and eternity. However, the concept of the film is so brilliant, and for a complex idea it is so well executed, that I am sure we can look forward to many more Inside Out films to come. If that is the case, then just as Schwartz found himself going on an unexpected journey of spiritual exploration, the writers of Riley’s may well find themselves doing the same. I, for one, look forward to finding out what Riley discovers.