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
Creed
Death & life
Middle East
5 min read

How much is a human life worth?

Concerned by the conditional responses to deaths in the Israel-Hamas war, Ryan Gilfeather considers why we should value all human lives.

Ryan Gilfeather explores social issues through the lens of philosophy, theology, and history. He is a Research Associate at the Joseph Centre for Dignified Work.

A line of people, some old, some young, wait to cross a road.
Palestinian life near the Damascus Gate in Jerusalem, Israel, 2021.
Levi Meir Clancy on Unsplash

The horrors of recent weeks have bought a disturbing reality to the surface: human dignity, the unearned and basic worth of all people, is up for negotiation. As I write these words, a dire conflict rumbles on in Israel and Gaza; the latest horrifying flashpoint in an intractable and brutal conflict. A cacophony of voices in the West are espousing histories, interpretations and solutions. Many of them reveal an implicit sense that only certain lives have an inherent dignity.  

Some praised Hamas’ brutal attack as a just act of decolonisation. The lives lost were not to be mourned, because, in their words, these Israelis were fair game for violence because they are colonisers. They asked for it. They have given up their right to the preservation of life. Implicitly, these voices suggest that human dignity is conditional; their actions have taken away their inherent value.  

Just as troubling is the apathy as thousands of Palestinian men, women, and children in Gaza are slain in their homes. Many of our leaders are silent about this unimaginable loss of life, as if it does not represent a tragedy, and as if they are just the collateral damage of war. The implicit message is that human dignity has preconditions, that only certain kinds of people get to have it in the first place, and that these particular Palestinians do not.   

Why should our rational autonomy or other capacities mean that we have an unearned worth? 

It is, in some ways, unsurprising that human dignity is up for negotiation in this way. Secular discussions of human dignity often ground it in the human person.  

In the philosophical tradition, following Kant, many consider our inherent dignity to be grounded in our capacity to make choices, be autonomous, and exercise reason. In other words, the capabilities which separate us from animals give us all an unearned worth or status.  

Others will point to our sentience, our capacity for creativity, empathy and caring relationships, or our membership of the human species. Hence, our inherent dignity is grounded in something that we do or possess, over and above the rest of creation. The problem with this grounding is that it can, at times, seem arbitrary. Why should our rational autonomy or other capacities mean that we have an unearned worth? It is little surprise that dignity is so often overlooked in practice.  

To respect this dignity, we must allow each person to live out this gift. Each person must be allowed to be free to think and act, without having their life violated or cut short. 

In contrast, Christians root the dignity of every human person in something altogether outside of them: the unbreakable love of God. It is a cornerstone of Christian belief that God loves every person who has ever lived and will ever live, regardless of what we have done or will do. “Nothing can separate us from the love of God”, as St Paul put it. God’s love for us is so profound that he became human and died for our sins so that we might be reconciled to Him.  

Central also, is the belief that God is omniscient, he knows everything that can ever be known, and he does not make errors of judgement. For Him to love us without any conditions of who we are or what we do, is to affirm that we are all inherently worthy of love.  

Our inherent dignity, is, therefore, grounded in something far more fundamental than something we do. It is rooted in the love of the creator of the whole universe. If we believe in the Christian God, therefore, we also accept the supreme value of every person. 

God’s gift to all of us expands on this picture. Genesis, the first book of the Bible, tells us that God made all humans in His image.  In this, God gives us the gift of reflecting his goodness and love here on this earth. He has granted us the capacity to use our minds to think about God and abstract things, to live lives marked by His love, joy, peace, justice, and courage. He calls us to use these capacities to nurture and care for creation just as He does. Since God is infinitely valuable; those made in His image are too. Hence, this gift gives us an inherent dignity. To respect this dignity, we must allow each person to live out this gift. Each person must be allowed to be free to think and act, without having their life violated or cut short. Crucially, this gift is unconditional. No matter what we do, we can always turn back to God and accept his gift of reflecting His goodness. There are no preconditions for who God gives it to. He freely offers this gift to all.  

Returning to Western responses to Israel-Gaza, we see that the Christian vision of human dignity does not countenance celebration of or apathy toward this loss of life. Some people saw Israeli deaths as unworthy of grief because they believe their actions forfeit their right to life. They implicitly see human dignity as conditional. In contrast, Christians believe our inherent value is unconditional, God will never cease to love us and will never take away our ability to reflect His goodness. Indeed, the death of Palestinians has been met with apathy and silence by many in the West, much as human tragedies in the Middle East often are. Implicit to this response is the sense that human dignity has preconditions, it is only extended to certain groups, those who live similar lives to us. The Christian vision objects here. God’s gift has no preconditions, it is freely offered to all. All possess an inherent dignity. This is not to pre-judge the complex questions of how to deal with the heart of the Israel / Palestine conflict, but it is to say that as we do so, the value and dignity of every human life must be paramount in the decisions taken   In the midst of this darkness the Christian message offers hope: every death is a tragic loss beyond all imagination and measure because all are infinitely valuable in God’s sight.