Review

Assisted dying

Death & life

Film & TV

28 May 2023

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

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.

Explainer

Creed

Death & life

1 November 2023

7 min read

How Christianity transformed attitudes towards death

Once we buried bodies outside cities. Then we started burying loved ones inside them. This is why.

Andrew Davison

Andrew works at the intersection of theology, science and philosophy. He is Canon and Regius Professor of Divinity at Christ Church, Oxford.

Dozens of candles in cloured jars and holders litter the ground of a cemetry.

Commemorative candles at cemetery in Srebrniki, Gdańsk, Poland.

Ludomił Sawicki on Unsplash.

‘The last enemy that shall be destroyed is death.’

Seeing things two ways at the same time doesn’t mean ambivalence. Christianity has two things to say about death, and it says both forcefully. They particularly come to mind during November, as the season of the year when we remember the dead. In this month we get the modern secularised rituals of Hallowe’en, but we also get Remembrance Sunday, when we think of those who fell in war; and on 2 November, we have All Souls’ Day, when ‘the faithful departed’ are recalled, and in many traditions, prayed for.

Christianity’s two entwined attitudes to death are lament and hope. On the one hand, death is a shadow; on the other, a light has dawned that will banish that shadow. Both aspects are in that line from St Paul:

‘The last enemy that shall be destroyed is death.’

Death is our enemy; death is slated for destruction.

Whatever a popular funeral poem might claim, death is not ‘nothing at all’. That poem has been suggested a few times when I’ve been planning a funeral. It’s never stayed in the draft order of service longer than it’s taken me to ask the question ‘But do you really think that death is nothing at all?’

Unlike our benighted predecessors, ancient and mediaeval, don’t we now understand that death is natural, just part of being the sort of creatures we are?

I take the opposite approach to funerals. I do not treat death as ‘nothing at all’. I wear black vestments: I do not assume that mourners are ready, only a week or two into their bereavement, to skip to the bright hope of white as a liturgical colour. I make the liturgy solemn. I avoid circumlocutions like ‘he’s moved on’ or ‘she has passed’ (somehow popular at present). No: someone has died, and even if that came after a long illness or a long life, a death is a loss.

The idea of death as enemy, though – ‘the most fearful of bodily evils’ (Thomas Aquinas) – might look out of date in the twenty-first century. Unlike our benighted predecessors, ancient and mediaeval, don’t we now understand that death is natural, just part of being the sort of creatures we are?

It’s almost always a mistake to underestimate our forebears. They knew that we are animals, but also said that we are animals of an odd sort: we are ‘rational animals’. That left them with a conundrum (and here I continue to have Aquinas in mind). On the one hand, we are animals, and animals are mortal, so that makes death natural. On the other hand, Christianity also insists that death is a wrench, a disjunction, an affront.

Reconciliation for this tension rests on that odd status of the human being, as a rational animal. We are animals, but also the sort of self-aware animals who are made for a relationship with God: suited for it, called to it. One model for that relationship, remarkably, has been friendship, with Moses as an example: ‘So the Lord used to speak to Moses face to face, as one speaks to a friend.’ That sort of relationship, that sort of seeing God face to face, would confer immortality on our naturally mortal bodies (‘when we see him, we shall be like him, for we shall see him as he is’). Thus, both parts of the conundrum are true: as animals, we are naturally mortal, yet our animality is called to a destiny beyond its nature. Our tragedy is not that we are animals, but that we are rational animals foolish enough to turn from God, and from the light of immortality.

The message of the Incarnation and the hope of the resurrection turned something around for early Christians. They no longer found dead bodies frightening.

That’s the first half of our opening phrase: death is our enemy because, although mortal by nature, we were originally called to something beyond nature, but lost it. God was turned towards us, but we turned away. However, enmity, tragedy, and loss are not the whole story, and they are certainly not the end of the story. There is also death’s destruction. That’s what the life, death, and resurrection of Christ were about. If death is our enemy, then it’s a routed enemy, overcome, although not fully destroyed, until God recreates the world.

Christians can be so excited about the prospect of death’s destruction that they forget that this destruction is still a promise, and we still live under its sway. For now, the hope and the sadness lie woven together. That is why we read in the New Testament about ‘not grieving as others do who have no hope’. I don’t take that as a blanket injunction against grieving (death is still our enemy, after all), but as standing only against the kind of grief that has no hope (because death’s destruction is assured). Again, here are the two strands, woven together. We also see that two-sidedness in a funeral prayer used by Eastern Orthodox Christians (and at the funeral of the HM Queen Elizabeth II), the kontakion of the dead. Its final lines put place wrenching tears right next to the church’s great word of praise and celebration, ‘Alleluia’:

All we go down to the dust;

weeping o’er the grave we make our song:

Alleluia, alleluia, alleluia.

This duality in Christian attitudes to death shows up in how Christians treat the bodies of the dead. We probably take burial practices for granted, but the idea of treating the bodies of the dead with utmost care and dignity was a point that Christianity really belaboured. Christ, for instance, had given a list of six good deeds in the Parable of the Sheep and the Goats: feeding the hungry, giving drink to the thirsty, clothing the naked, sheltering travellers, visiting the sick, and visiting prisoners. It would be a bold decision to add to any list draw up by Christ, but the church did it, adding a seventh ‘act of corporeal mercy’: burying the dead.

Christianity is definitively the religion of the Incarnation: of God taking up human flesh. Bodies therefore matter. Talk of casting off the body, as if the body were just some old cloak that the soul has outgrown, is not something Christians say. We are bodily creatures, so Christian hope is for the resurrection of the body. (So also – I should add for completeness – is Christian doom also bodily. Those who die at enmity with God and the good, the faith insists, turning down the offer of reconciliation, face the consequences in the resurrected body.)

The message of the Incarnation and the hope of the resurrection turned something around for early Christians. They no longer found dead bodies frightening. In the ancient world, bodies were to be buried outside the city, cast out from the human community. Christians changed that, and started burying their loved ones inside the city. Bodies were to be treasured, not feared. The bodies of their heroes – those who excelled in virtue, and especially the martyrs – were brought right into their churches. Before long, no altar (the communion table) was quite proper unless it was built over the body of a martyr or other saint, or at the very least contained some part or relic.

Veneration of relics has not been so common in the Church of England (the church to which I belong) since the Reformation, nor in the wider Anglican Communion. Slowly, however, it has edged its way back. In 2002, the cathedral where I’m a canon, St Albans, received a shoulder blade of St Alban, England’s first martyr, the gift of one of the dozen remarkable Romanesque churches in Cologne. That bone gets considerable honour on the weekend closest to his feast day (22 June). Relics are also familiar in the church in Philadelphia where I currently celebrate the Eucharist once or twice per week. The altars are usually at least lightly decked with relics. During Eastertide, they groan under the weight of them, including some impressive whole-bone affairs. Only in Advent and Lent – penitential seasons – do the relics disappear to the sacristy, replaced with statues of the prophets in Advent.

It’s easy to grow accustomed to relics after a while. I should remind myself of their strangeness. Defying any trend in religious thought down the ages to denigrate the body in favour of the soul, here the body is holy, recognised as the site of God’s great works. Here, dead bodies are no longer to be feared. They are the most precious things the church owns, and threaten no contamination. Or, rather, if they suggest any contagion, it is a contagion of the good.

Care towards the bodies of the dead reflects both poles of Christian attitudes to death. On the one hand, Christians have preserved the bodies of the dead with great care because death is an affront. Death is the enemy that falls upon us all, even the most holy among us. Lamenting that loss, we keep bodies safe until it is reversed. And there is also the other side of the Christian attitude to death: alongside lament there is hope in death’s destruction.

Christianity, at its wisest, has not skipped through lamentation too quickly, but neither has it given lamentation the final word. Day-by-day funeral practice probably connects most clearly with the sadness, although the hope is woven through. The place of relics in many strands of Christianity (although by no means all), swings more towards an emphasis on death’s defeat. It rejoices in having among us, in all those slivers of bone, fragments poised towards Resurrection, when ‘death shall be no more’.