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

Culture

Death & life

20 November 2023

5 min read

How the Victorians could help us to die well

Victorians welcomed the angel of death, rather than fearing it. Ian Bradley explores their changing attitudes towards death. Part of the How to Die Well series.

Ian Bradley

Ian Bradley is Emeritus Professor of Cultural and Spiritual History at the University of St Andrews.

A bronze statue of a resting angel sits atop a low stone grave.

A grave in a Dresden cemetery.

Veit Hammer on Unsplash.

When it comes to dying well, there is much that we can learn from our Victorian forebears. Experiencing death more frequently and directly than most of us do, they were not frightened by it but regarded it rather as part of the natural order and, thanks to the pervasive influence of the Christian faith, as the gateway to eternal life.

In his widely read epic poem, ‘In Memoriam’, inspired by the death of his close friend Arthur Hallam at the age of 22 and published in 1851, Alfred Tennyson posed the rhetorical question: ‘How fares it with the happy dead?’. It struck a deep chord with his readers, as did his answer that they are ‘the breathers of an ampler day for ever nobler ends’.

The Victorians thought, wrote, preached, and sang about death and what follows it far more than we do today. Novels were judged by the power and pathos of their death bed scenes. Ninety hymns in the 1889 edition of Hymns Ancient and Modern deal primarily with the experience of death and dying. By contrast, there is not a single hymn on this subject in its current successor, the 2013 Ancient & Modern: Hymns and Songs for Refreshing Worship. Death and heaven featured prominently in popular poems, none more so than those by Adelaide Procter, a devout Catholic and the second most read Victorian poet after Tennyson. For her, ‘the beautiful angel, Death, waiting at the portals of the skies’ is to be welcomed rather than dreaded. Her verses about a ‘lost chord’ that an organist realises he may only hear again in heaven, set to music by Arthur Sullivan, who also had no fear of death, became the best-selling song in Britain throughout the last quarter of the nineteenth century.

To our modern taste, such sentiments may seem maudlin and morbid. We have done our best to sweep death under the carpet and we think little about what may follow it.

For most Victorian Christians death was something to be looked forward to rather than dreaded. Frederick William Faber, who converted from Anglicanism to Roman Catholicism, was typical in his enthusiastic evocation of its joyful and liberating character:

O grave and pleasant cheer of death! How it softens our hearts and without pain kills the spirit of the world within our hearts! It draws us towards God, filling us with strength and banishing our fears, and sanctifying us by the pathos of its sweetness. When we are weary and hemmed in by life, close and hot and crowded, when we are in strife and self-dissatisfied, we have only to look out in our imagination over wood and hill, and sunny earth and starlit mountains, and the broad seas whose blue waters are jewelled with bright islands, and rest ourselves on the sweet thought of the diligent, ubiquitous benignity of death.

To our modern taste, such sentiments may seem maudlin and morbid. We have done our best to sweep death under the carpet and we think little about what may follow it. For the Victorians, by contrast, it was an ever-present reality, mostly happening at home rather than out of sight in a curtained-off hospital bed or care home, and directly affecting the young as well as the old. The average life expectancy of someone born in Britain in 1837, the year of Victoria’s accession, was just 39 years, less than half the current figure of 81. Infant mortality stood at 150 per 1,000 births and actually rose through the century, reaching 160 per 1,000 births in 1899 – the current level is just over three per 1,000.

It was in this context that Victorian clergy sought to dispel anxious fears about death and help people to die well by expounding the Christian doctrine of eternal life. There was a pastoral imperative to do so when seeking to minister to so many who were dying or grieving.

Their focus was on the promise of heaven rather than the fear of hell. There was still a continuing adherence within the churches to the doctrine of eternal punishment for the wicked in the aftermath of a final and terrible Day of Judgment. However, the latter half of the nineteenth century saw a marked decline of belief in hell, prompted partly by the impact of the new German school of biblical criticism which challenged Biblical literalism and by moral revulsion at the idea that a basically benevolent and good God could consign people who had not led particularly bad lives to eternal torment.

Increasing missionary endeavour and contact with those of other faiths, or of no faith, also made many Christians uneasy with the idea that a large proportion of the human race were condemned to everlasting punishment simply because they had never encountered the Christian Gospel.

As fear of hell subsided, so hope of heaven came to occupy a much more prominent place in Victorian thought and imagination. This can be clearly seen in the language of hymns. Heaven receives over 100 explicit mentions in the seminal 1889 edition of Hymns Ancient and Modern, and there are a further 43 references to Paradise. Hell is mentioned in just 15 of the 638 hymns and only in four of those is it conceived of primarily as a place of pain and punishment.

Hymns are, indeed, a good place to gain an insight into Victorian views of death and heaven. Two popular ones written at the very beginning of Victoria’s reign set the tone for those that followed. ‘I’m but a stranger here, heaven is my home’ by Thomas Taylor, a Bradford Congregational minister, and ‘There is a happy land, far, far away’ by Edinburgh schoolmaster Andrew Young, emphasize the idea of death as a home-coming and reinforce the conviction, increasingly common among Victorian clergy, that friends and family will be reunited in heaven.

As mortality rates rise in the wake of Covid and as a consequence of an ever-older population and death comes out of the closet, we are at last beginning to talk and think about it more. Through their poems and hymns, the Victorians can help us to be less fearful and to die well.

Ian's new book Breathers of an Ampler Day: Victorian Views of Heaven is published by Sacristy Press.