Death With Aesthetics

Original Article

We don’t speak plainly in public discourse anymore. Rather, we equivocate and deploy euphemisms to sanitize our debates. Take the passing of Brittany Maynard by her own hand, which the media has repeatedly characterized as an act of “dignity.” To be sure, Maynard died with human dignity—but not because she committed suicide. Human dignity is intrinsic. Indeed, to accept the premise of suicide as death with dignity says—or at least strongly implies—that patients who expire naturally die with indignity.

When we look more deeply at arguments in favor of legalizing assisted suicide, we see that the assisted suicide discussion is really more about what I will call the aesthetics of dying than it is about potential pain. This is no small matter. Nor is it in the least a frivolous concern. Worries about lost looks or, perhaps, how the sick room might smell can be devastating to those approaching the end of life.

Indeed, our self-esteem—and perhaps more important, how we perceive that others view us—can materially impact our mental and emotional states as we approach the end of life. (For example, I used to be a hospice volunteer. One of my patients became so distraught by his changed appearance that he covered all the mirrors in his home.)

Maynard’s evocative explanation for eschewing hospice in favor of suicide illustrates how potent aesthetic fears (if you will) can be:

I considered passing away in hospice care at my San Francisco Bay-area home. But even with palliative medication, I could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind.
Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind. I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.

It is worth noting that Maynard fixated on a worst-case scenario. Indeed, many with brain cancer die peacefully, their symptoms well managed and their pain controlled.

Along this same line, she told Elite Daily:

Not only do I want to save myself from that fate [of suffering and decline], but I love my family too much to make them carry the memories of my deterioration for the rest of their lives.

Yes, Maynard was worried about suffering. Who wouldn’t be? But she seemed even more intent on not forcing her family to suffer by witnessing her loss of beauty, vitality, and capacity.

This is how the assisted-suicide movement hurts the very people it claims to champion. During my years working with hospice, I was struck by how my patients would focus intently my face when we first met. I soon realized they were seeking assurance of acceptance. For sick, disabled, disfigured, and dying people, our faces can be like mirrors: If they sense that we think they are less than “we” are, it can crush the spirit. Yet, isn’t this the very message conveyed when we validate suicide as the “dignified” way to die?

I saw the impact of such advocacy with my last hospice patient, Robert Salamanca, who died of Lou Gehrig’s disease. This was in the late 1990s, when a case was before the Supreme Court (unsuccessfully) seeking the legalization of assisted suicide.

As with Maynard, the media went into a feeding frenzy, presenting emotional and highly publicized profiles of ALS patients who wanted “to die with dignity.” These programs made Bob’s burden much harder to carry. “They are trying to drive me from the well-lit boulevards into the dark alley!” he told me angrily after watching such a feature on Nightline.

Bob was so incensed by these attitudes that he wrote a column—typing it one letter at a time, using the only finger he could still control—for the San Francisco Chronicle. From “I Don’t Want a Choice to Die,” which ran on February 19, 1997:

Euthanasia advocates believe they are doing people like me a favor. They are not. The negative emotions toward the terminally ill and disabled generated by their advocacy is actually at the expense of the “dying” and their families and friends. We often feel disheartened and without self-assurance because of a false picture of what it is like to die created by these enthusiasts who prey on the misinformed.

Supporting assisted suicide, Bob insisted, disrespected his dignity by denying the value of his life:

Many pro-euthanasia groups “showcase” people with ALS. They portray us as feeble, unintelligible and dying by slow suffocation. This is absolutely false, and I protest their efforts vehemently. . . . We are not people just waiting for someone to help us end our misery, but to the contrary, we are people reaching out to love—to be loved—wanting to feel life at its best.

He concluded:

In my view, the pro-euthanasia followers’ posture is a great threat to the foundation upon which all life is based, and that is hope. I exhort everyone: Life is worth living, and life is worth receiving. I know. I live it every day.

Bob died peacefully—with dignity—in his sleep. I was honored to give his eulogy.

There is no question that Maynard’s perspective is integral to the assisted-suicide debate. But Salamanca’s should be, too. Ultimately, his view accords more with the true meaning of human dignity and the intrinsic value of all our lives.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.