The Good Death Through Time
The first exhibition at Hobart’s Museum of Old and New Art featured a collaboration between the Melbourne sculptor Greg Taylor and the pro-euthanasia activist Dr Philip Nitschke.
The homely installation My Beautiful Chair featured a Persian rug, a comfy sofa and – on a glass coffee table – a replica of Nitschke’s “deliverance machine”. Visitors were invited to sit and answer questions designed to assess if they genuinely wanted to end their life. When euthanasia was legal from 1996-97 in the Northern Territory, four people used a similar machine – which could administer a shot of Nembutal – to end their lives. As a work of art, it was extremely confronting.
Few subjects are capable of arousing stronger emotions than euthanasia – literally “the good death”. But as Caitlin Mahar shows in The Good Death Through Time, the definition of a good death as well as attitudes towards dying, pain and suffering have changed significantly, even radically, over the past hundred years or so. The debate doesn’t simply boil down to secular progressives versus religious conservatives. Among the most passionate objectors to euthanasia in Australia are Aboriginal people, whose experience of medical mistreatment and government programs to “breed out the Black race” have instilled fear that it could be used for genocidal purposes.
When the word “euthanasia” was coined in ancient Greece, it referred to “good death” as in having lived to a comfortable old age or, conversely, dying heroically in battle. Later,
Christianity reframed the “good death” as a preparation for the afterlife: suffering and pain were seen as spiritually elevating. Religious pastors, not doctors, attended the deathbed.
By the 19th century, medicine – which now focused on alleviating pain as well as curing disease – saw doctors attend to the dying with opiates. A “radical view”, as Mahar puts it, was taking hold “that pain might be a physical aberration with no purpose” and that removing it did not disrupt the natural or spiritual order. This led, however, to a new ethical dilemma: what if, in the palliation of pain, the physician risked hastening the end of life – violating the sworn duty to preserve it?
In 1930, in England, Professor Richard Berry, much taken with the nascent science of eugenics and charged with care for children and adults with intellectual disabilities at an institution, proposed to put “the more chronic mental derelicts out of their and our misery in a National Lethal Chamber”. In their demands for care and desire to reproduce, he contended, the “feeble-minded” posed nothing less than a “threat to civilisation itself ”. His ideas, repugnant to contemporary sensibilities, sparked discussion and found celebrity adherents in George Bernard Shaw, H.G. Wells and D.H. Lawrence, among others.
Berry’s “lethal chamber” proposition further muddied the discussions around euthanasia, already complicated by arguments about whether doctors should ever become killers, and the role that the law ought to play in the matter. Then along came the Nazis, who built industrial-scale lethal chambers and consigned to them the mentally and physically disabled, those suffering incurable diseases and elderly Germans, as well as some nine million homosexuals, Jews and Romani. Euthanasia and eugenics retreated from the public conversation under a cloud of shame for decades.
In the 1970s, Karen Ann Quinlan, a 21-year-old American who had slipped into a “vegetative state” after taking Valium with alcohol, reinvigorated the debate in America, Australia and elsewhere. Her parents, devout Catholics, had asked for her breathing tube to be removed, on the principle that while death wasn’t to be hastened, neither was it to be artificially prevented – there existed a “right to die”. She lived in a coma for another 10 years.
Older Christian beliefs around the sanctity of suffering, common in Victorian times, seemed pointlessly cruel. The growing palliative care movement centred on relieving suffering and improving the quality of life for the terminally ill. A new field of philosophy known as bioethics also turned its attention to ideas around death, suffering and euthanasia, with sometimes controversial results. When the philosopher Peter Singer suggested that children or others with intellectual or other disabilities be euthanised on the basis that, in Singer’s words, a life “so full of misery” was perhaps “not to be worth living” – an echo of some of Professor Berry’s ideas – he incited a “storm of protest”. The pro-euthanasia movement has in recent years moved towards patient empowerment and personal choice, exemplified by what Nitschke calls “dying with dignity”. Disability advocates, like many Aboriginal people, remain deeply wary.
The complex history of the “good death” is woven from legal, philosophical, scientific, theological and social strands. Mahar does an admirable job of making it cohere. She observes the paradox that “Just as we have become more anxious about our health as we have become healthier, so as methods for assuaging pain have improved, we appear to have become more fearful of suffering”. By the late 20th century, people had grown more “terrified by what might precede death rather than what might follow it”.
The Good Death Through Time could have benefited from a broadening of perspective to consider attitudes towards death, dying and euthanasia in non
Christian, non-western traditions such as Buddhism, Hinduism and Islam. Mahar does acknowledge that “there is no final or consummate vision of the good death”: the one that holds sway in places such as Australia is “not natural or universal but the product of specific – predominantly white, middle class, ableist – cultural and historical milieus”.
Wanting to double-check something while writing this review, I googled Nembutal. The first search result directed me to Lifeline Australia.
Melbourne University Press, 256pp, $35 Lifeline 13 11 14