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In death we no longer have choice

14 August 2015

THE death of Gill Pharoah, a former palliative-care nurse, at Dignitas last month raises profound issues about human autonomy. Ms Pharoah was a relatively healthy 75-year-old, but she no longer took pleasure in hobbies she had once enjoyed: she was troubled by tinnitus, and did not want to go through the suffering that she had seen in many of the elderly patients she had cared for. Having exercised choice and freedom in her life so far, she believed that she should remain in control of her own death.

Her decision was the outcome of an inescapable logic. If our notions of human dignity are bound up with self-determination, we have the same right to decide, as far as we can, how and when we exit from this world as we have to marry, choose a career, or plan our own finances. Many faithfully religious people secretly or openly agree with this, however much the Churches are inclined to disagree with, for example, the legalising of assisted suicide.

It is certainly true that our current ways of dealing with death do not make enough provision for individuals to think through the end of their lives; nor are medical practitioners trained to enable people to do so. Dr Atul Gawande, in the Reith Lectures he gave last year, argued for greater honesty in end-of-life care. The dying can be helped by working through what they want and expect of their last days. This would not necessarily promote a rise in suicides or assisted deaths. Some have argued that if, as patients experienced greater vulnerability, they were helped to exercise their remaining freedoms well, it might actually reduce such demands.

The current emotive debate about our rights or otherwise at the end of life (which is focused on the Assisted Dying Bill that is being debated again in Parliament next month) does not really address the spiritual issue. Whatever else death is, it is the end of personal choice. "And as it is appointed unto men once to die, but after this the judgement" (Hebrews 9.27).

At death, we no longer judge, we are given over to judgement. In Jungian terms, the ego — that part of us which is expressed in choice and control — must die, to give birth to the self. Traditional religion encourages us to prepare for the death of the ego by practising surrender in this life, in the trust that a greater freedom and a greater selfhood is yet to be given. Whether this can be achieved by the violence of suicide, assisted or not, is the question that we ought to be asking ourselves.

 

The Revd Angela Tilby is Diocesan Canon of Christ Church, Oxford, and Continuing Ministerial Development Adviser for the diocese of Oxford.

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