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

Addiction

Culture

Film & TV

11 April 2023

6 min read

Who’s by your side?

It’s tough to watch A Good Person. Its laser focus and tenderness prompts Lauren Windle to recall her experience of addiction and recovery.

Lauren Windle

Lauren Windle is an author, journalist, presenter and public speaker.

An old man accompanies a young woman into a wood-panelled hall, both look aprehensive.

Morgan Freeman and Florence Pugh in A Good Person

Metro-Goldwyn-Mayer.

I don’t watch films about addiction. When I first got clean and sober almost nine years ago, I soaked in any piece of content I could find on drugs, drug use and recovery. At the time it was just YouTube clips of Russell Brand and the occasional memoir of a starlet who turned to cocaine before discovering yoga. After going to a 10:30am showing of Amy Winehouse documentary film Amy and bawling through the entire film, I decided to call it quits. I don’t need to see horrific stories of desperation – I’ve lived one. I am not a casual observer of addiction narratives; I’ve got skin in the game.

In 2018 I went to see A Star Is Born thinking I was watching a rags-to-riches tale of an unlikely popstar. I quickly realised we weren’t there to witness the female protagonist’s ascent, so much as the male protagonist’s decent. I got back in my car and had to wait a quarter of an hour for the fit of hysterical tears to pass before I drove home. I had the same realisation watching A Good Person.

Going in I knew that I had signed up to a film with Morgan Freeman and Florence Pugh. I knew that Pugh’s character Allison “had it all” before a “dramatic accident changed everything”. The ground here sounded so well-trodden that I thought I may need my wellies to navigate it. I knew that there was some element of addiction, but I envisaged a reasonably light touch depiction of a few too many nights on the sauce.

I knew I was wrong when, about half an hour in, Allison lay on the cold bathroom floor to soothe her withdrawal from prescription opioids. She was sweating, shaking and breathless and from then on, it all felt distressingly familiar. The trajectory of her decline was too quick, too obvious, too accurate. As Allison bargained, manipulated and begged for drugs, I saw myself. As Allison looked directly into the mirror and said: ‘I hate you’ to her own glazed reflection, I saw myself. As Allison was dragged out of a stranger’s house party unable to stand up straight, I saw myself.

The hopelessness, the false starts, empty promises and rare moments of lucidity rang so true, that I would find it hard to believe writer Zach Braff hadn’t experienced his own similar hardship. Either that or the recovering addicts they hired to consult on the project deserve a bonus of investment banker proportions.

When Allison eventually reached out for help and asked a woman to sponsor her, the loving directness that came back was reminiscent of those I was given by my first sponsor. It was virtually word for word what I remember being told when I, nine days sober, made the same terrifying request. The experienced mentor told her: “Some beat it, some die.” And she’s right.

Any of my friends who went to an in-patient treatment centre were told to look around because in five years a decent number of their cohort would be dead. And they were always right. Some people give up and let the tide of addiction pull them under. They feel exactly as Allison did when she told Daniel (played by Morgan Freeman): “I’m not sure I have the will.” And when she confessed in a Narcotics Anonymous meeting that: “Without [the pills] I want to die.”

In the 2015 film Amy, the one that convinced me to stick to rom-coms, there’s a scene that stuck with me. Amy had been invited to perform at the Grammy’s but was denied a visa because of her well-documented drug use. It was arranged for her to live perform in London and it would be broadcast on big screens at the event. When the date came around she was in a stint of sobriety. She performed beautifully and won five Grammys. One of her friends burst into her dressing room to celebrate the momentous achievement but all Amy said was that it wasn’t as good without the drugs.

You learn to love the cage you built around yourself and stop dreaming of more, because you are blind to anything beyond the walls you’ve created.

Getting into addiction means silencing that feeling in your Spirit that says that something isn’t right and you should go home. It’s consistently pushing through when you get a pit of your stomach urge to cut and run. Because you want the drugs, so you know you’ll have to take the chaos they’re packaged in. At some point you stop remembering that you ever felt uncomfortable, and you start to think you enjoy where you are, what you’re doing and the people you’re doing it with. You get Stockholm syndrome and life before your captor is a distant memory. You learn to love the cage you built around yourself and stop dreaming of more, because you are blind to anything beyond the walls you’ve created. You’re not happy, but what other options do you have? You could trade the misery of addiction for the misery of abstinence, but either way you’ll be miserable so you might as well do it with the drugs.

Except, that’s not true. When we’re living our lives right, we’re living them in complete freedom. Slaves to no substance or behaviour with the freedom to say yes to what we want and, crucially, the freedom to say no. It’s the present Jesus gave us in the resurrection but so many of us, myself included, hand it back like it came with a gift receipt.

I wish I’d known the dreams that would be realised, the friendships forged and the profound moments I would experience on the other side of those first, excruciating months of sobriety.

What I wish I could have told Amy at the Grammy’s, Allison in that NA meeting and myself when I first said the words: “I think I’m addicted”, is that there’s so much more than what you can currently see. I wish I’d known the dreams that would be realised, the friendships forged and the profound moments I would experience on the other side of those first, excruciating months of sobriety. I would have wanted to know that in time my grip would loosen, my knuckles would go from white back to their fleshy hue and I would be able to breathe again. It wouldn’t feel like a compromise or half a life or as though something was missing, but I would feel more fulfilled and alive than any drug would ever allow me.

A Good Person demonstrates the chronic and repetitive condition of addiction with a laser sharp accuracy that, for someone with lived experience, could burn. But it’s also a tender reminder of the power of unlikely friendships forged from a mutual understanding of adversity. It made me think of the woman who scooped me up as I backed away from my first ever support group meeting and said: “You can sit next to me.” It made me grateful for the woman who mouthed “it’s going to be OK,” at me across the table as I sat there listening with tears rolling down my face. It reminded me of the awe I felt the first time I heard someone speak about the insomnia, shame and self-hatred of drug addiction, and I realised I wasn’t the only one. The film showed the transformative effect of consistent community in a way that I hope encourages people to turn up to one of those meetings like Allison and I did. I pray that it is the turning point in many people’s lives.

Should you go and watch it? Absolutely. Just don’t ask me to go with you.