Dignity in Death – Using a comparative literary analysis to advocate for terminally ill patients’ “right to die”

Dignity in Death

Jake Mitchell

Centennial College

Abstract

This essay analyzes the way that Norman Cousins contrasts the perspectives of religion, society, and rational thinking about suicide in his essay, “The Right to Die”.  The right for patients to end their life when they are suffering unbearably from a terminal illness or have no quality of life, is a controversial topic for many people.  This is true in the case of today’s medical advancements; from advanced medications and invasive surgeries, to maintaining life support in an Intensive Care Unit.  The British Medical Journal released an article reviewing the main points of support for the right to die, that twelve physicians have put forward.  Furthermore, an article in the American Behavioural Scientist, outlined the importance of mental health professionals, and assessment in the decision to grant or deny hastened death requests from terminally ill patients.  This would help eliminate wrongful use of these services.    When it comes to how healthcare providers feel about assisted-dying, an article that mostly focuses on their personal values, workplace policies, and their roles in the physician-assisted dying process was published in the Journal of Social Work in End-of-Life & Palliative Care.  The final issue lies in the fear of death that plagues many palliative care patients.  This is finally addressed in the Journal of Psychopharmacology.  The findings reveal that a single dose of psilocybin can resolve end-of-life anxiety for months; along with other drastic improvements to quality of life.  This analysis focuses on how Norman Cousins uses literary devices to contrast religious belief, social ideology, and rational thought in relation to the topic of suicide in “The Right to Die”.

            Keywords: suicide, palliative care, “right to die”, terminal illness, literary device, rational thought, society, religion, Cousins.

            When a death is unexpected or sudden, due to an accident or acute illness, all efforts should be made to identify any reversible causes; and revive the casualty back into a decent quality of life.  A more complicated situation is when the illness is chronic, or it is known that there will be no return to that state.  At this point, the best possible scenario is prolonged pain and suffering, until cachexia gets the upper hand.  In Norman Cousin’s “The Right to Die”, the author uses allusion, irony, and paradox to explore the various perspectives on allowing someone the right to end the unbearable suffering of terminal illness.  Cousins uses these various literary devices to contrast naïve religious belief, ignorant social ideology, and the reality revealed by rational thinking, in relation to the topic of death with dignity. 

            Religion has been the long-standing obstacle for human beings, when grappling with the true nature of reality.  When human beings are challenged with a perplexing question, it is comforting to place the answers in the hands of the transcendent.  Cousins references the basic religious belief that “suicide symbolizes discontinuity; religion symbolizes continuity, represented at its quintessence by the concept of the immortal soul” (Cousins, 2015, p. 210).  This is an allusion to common religious philosophy; which holds on to the idea that an act of desperation to end one’s suffering, is punishable with an eternity of even worse suffering.  The insidious flaw with this philosophy is that there is no evidence to support enduring the torture of slowly watching one’s dignity, and quality of life slip away.  Several doctors spoke about the Assisted Dying Bill; which is being scrutinized in London, England.   The physicians concluded that:

“The strict eligibility criteria make it clear that the proposed law is intended to help that small group of patients in the last few days or weeks of their life, whose suffering is not adequately alleviated by palliative care and who wish to choose the time and circumstance of a dignified death.  The safeguards in the bill minimise the risk to the patient from coercion by others, and ensure that responsibility for the decision to end their life is taken solely by the patient”. (Dyer, 2013, p. 3279)  

This should resolve any confusion of whether the decision is exactly what the patient desires.  The criteria are specific to cases where unbearable suffering is the only other option for the patient.  Norman Cousins uses allusion to contrast the naivety of religious belief, with the ignorance of social ideology, and the reality of rational thought; on the topic of dying with dignity. 

Although naivety and ignorance are close in comparison, there are some profoundly disturbing differences; such as the fact that ignorance is often willful.  Cultures around the world have adapted social ideologies over thousands of years; which assist the building of a stronger community, to overcome adversity.  Unfortunately, the more deeper-rooted and sacred that these ideologies become, the more likely they are to fall victim to their own hubris.  Cousins points out the irony in how many societies exhibit poor understanding of the pain and suffering that comes with losing all autonomy over your quality of life.  Cousins calls out societies that put harsh rules in place, to deter the patient who is suffering; with hopes that they would be overwhelmed by the “stigma his self-destruction would inflict on loved ones” (Cousins, 2015, p. 211).  The irony lies in the idea that society views prolonging this suffering as humane; although it has been proven to be more embarrassment and torture, than death itself.  Civilians and family members that are normally removed form the horrors of terminal illness, use willful ignorance as a defense mechanism against the realisation that death is a normal part of life.  Norman Cousins uses irony to contrast the ignorance of social ideology, with religious naivety, and rational thought process on the topic of suicide.  This leaves the readers wondering how to avoid allowing their loved ones to suffer due to naïve comfort in the transcendent, or ignorance around the complexities of terminal illness and dignity.

   The key that unlocks the door to understanding reality is rational thought.  Norman Cousin’s reveals a paradox within the way many human beings view life and death; as he reminds the reader that “death is not the greatest loss in life.  The greatest loss is what dies inside us while we live.  The unbearable tragedy is to live without dignity or sensitivity” (Cousins, 2015, p. 211).  When reality holds two possible meanings, rational thought process is the main tool that the human brain has to offer when protecting one’s self against naivety, or ignorance.  Working as a paramedic or a nurse, exposes one to the horrors of nursing homes and Intensive Care Units (ICUs).  The terrified screams of souls trapped in withering vessels, forgotten by loved ones, whose only break from the ammonia-scented ward, is an ambulance ride to an emergency room.  Meanwhile, ICUs are lined with comatose bodies with tubes forced down their throats; waiting for families to make the dignified decision to release them from their biotic prisons.  Having a stable heartbeat does not mean that one will experience a decent quality of life, as it does not consider one’s failure to thrive, or ability to experience happiness with dignified autonomy.  It is most rational and humane to put the decision to end one’s life in the hands of the patient who is suffering unbearably.  Cousins uses paradox to contrast rational thought, with naïve religious beliefs, and ignorant social ideologies, when discussing suicide.

The various literary devices used in “The Right to Die” contrast the naivety of religious belief, the ignorance of social ideology, and the reality revealed by rational thought, in relation to the topic of suicide.  Norman Cousins uses allusion, irony, and paradox to explore the subject of giving human beings the right to die with dignity.  It is both rational, and humane to afford one the option to free themselves from unbearable suffering; when terminal illness is slowly consuming every bit of dignity, autonomy, or joy in one’s life.  Recent evidence in psychedelic-assisted therapy has confirmed that:

“Psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life. At the 6.5-month follow-up, psilocybin was associated with enduring anxiolytic and anti-depressant effects (approximately 60–80% of participants continued with clinically significant reductions in depression or anxiety), sustained benefits in existential distress and quality of life, as well as improved attitudes towards death”. (Ross, Bossis, Guss, Agin-Liebes, Malone, Cohen, . . . Schmidt, 2016) 

This means that patients with terminal illness can come to terms with the reality that they will die from their illness; while allowing them to be comfortable and confident in their ability to end their suffering.  If these psychedelic treatments become legalized in the next five years, it is possible that they may be integrated further within the field of assisted dying.  The other option is that terminally ill patients must suffer through many horrors, like being dragged to tedious appointments, sitting up at night in terror and agony, and losing any independence that they once cherished.  In the most extreme cases of resuscitation, paramedics must snap the ribs with crushing chest compressions, aggressively force airway tubes down into the lungs, and drive multiple needles into vein and bone to administer advanced medications.  This way of dying, is both disturbing and grotesque; in contrast to the calm accepting death that one’s autonomy would bring.  If rational thinking continues to triumph over irrational belief and ideology, the words “time of death” may one day make hearts sing, rather than sink.

References

Cousins, N., (2015). The right to die. In F. Gavin, E. Donville, D. Vavrusa, D. Buchanan.          (Eds.). Effective reading and writing for COMM 170 and beyond (pp.210-211). New York, NY: Pearson Learning Solutions.

Cuddon, J. A., Habib, R., & Birchwood, M. (2013). A dictionary of literary terms and literary theory (5th ed.). Hoboken, N.J: John Wiley & Sons.

Dyer, C. (2013). Twelve senior doctors back physician assisted suicide bill. BMJ : British Medical Journal, 346(4),3279. doi: 10.1136/bmj.f3279

Farberman, R. K. (2002). Terminal illness and hastened death requests. The American Behavioral Scientist, 46(3), 427-433. Retrieved from ProQuest Central database

Norton, E. M., & Miller, P. J. (2012). What their terms of living and dying might be: Hospice social workers discuss Oregon’s Death with Dignity Act. Journal of Social Work in End-of-Life & Palliative Care, 8(3), 249-264. doi:10.1080/15524256.2012.708295 

Ross, S., Bossis, A., Guss, J., Agin-Liebes, G., Malone, T., Cohen, B., . . . Schmidt, B. L. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: A randomized controlled trial. Journal of Psychopharmacology, 30(12), 1165-1180. doi:10.1177/0269881116675512

Published by Jake_flightofthoughts

Flight Of Thoughts was started as a way for me to bring my passion for emergency medicine, addiction & mental health care, and evidence-based research together. My goal is to make training and education available to all who wish to grow in these areas of healthcare, as well as shift paradigms around how our culture navigates healing. I have several years of clinical experience assisting critically ill or injured persons with Basic Life Support, exercising the Primary Care Paramedic scope of practice; under controlled delegation by physician and through the Nova Scotia College Of Paramedics. During that time I developed crisis management skills, assisting those with concurrent disorders and managing life threatening symptoms, while following clinical practice guidelines. I have growing experience with case management, structures relapse prevention, harm reduction, overdose/withdrawal management, and other mental health practices. I have first hand experience with my own struggles which have allowed me to overcome and assist others. My diploma in Addiction and Mental Health Work has allowed me to specialize my expertise. This growing experience has allowed me to form an open-minded and empathetic, trauma-informed approach to caring for patients and clients. I keep up with continuing medical education and constantly seek ways to improve my clinical practice. The Flight Of Thoughts podcast was started as a platform for me to explore these areas of interest, in hopes of igniting passion and open conversation among listeners.

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