Death and the loss of meaning
The desire for physician-assisted death should be understood as a cry of despair, a cry that cannot be ignored. To ignore that cry denies the worth and value of the sufferer just as much as causing their death denies that value.
Imagine for a moment that you are walking near the edge of a cliff and you hear a distress cry at the edge. Looking over the edge, you see someone clinging to a ledge, hanging precariously and desperately fearful of plunging to the rocks below. Suppose a friend who is with you offers them a high dose of fast-acting sleeping medicine to help them fall asleep so they no longer experience fear or distress. You might successfully convince both your friend and the person whose life is in danger that it would be unhelpful, unwise, and inappropriate to offer or ingest the sleeping medicine. But the problem remains — how do you actually help them in their moment of peril?
Likewise, even if we have successfully shown that physician-assisted death is an inappropriate and unwise way to respond to suffering, our task is not complete. We have failed to truly care for our patients if we hear their cries of despair, their requests for death, and simply throw our hands up to say, “Sorry, it’s wrong for me to end you, so I can’t help you.” Rather, we must probe the reasons for the request; we must understand the fears and the pain that lead to such a cry. And we must find a way to come to their aid.
It remains to us to offer a better way for our fellow humans who find themselves in the crucible of suffering. In many ways, an effective response to the “Why?” question would render the “Why not?” question moot. If we can show that physician-assisted death is unnecessary in the first place, if we can show how we may bear the unbearable, then we have gone a very long way to resolving the issue. Answers to the “Why not?” question are thus really secondary to finding a deep solution for the “Why?” question.
What, then, is that solution? How do we help others to bear their suffering? Is there an escape from despair?
Get Our Latest News for FREE
Finding a reason to live
Nietzsche, always an incisive observer of the human condition, was quoted to say that “he who has a ‘why’ to live can bear almost any ‘how.’” Lacking the why — the sense of a point to one’s existence and one’s suffering — the how may become unbearable. We humans hunger for meaning; starved of it, we die. Without meaning and purpose, our existence feels futile, absurd, and intolerable. French existentialist playwright and philosopher Albert Camus famously declared, “There is but one truly serious philosophical problem, and that is suicide.” By this he meant that “judging whether life is or is not worth living amounts to answer the fundamental question of philosophy.”
For what reason do we struggle on against the “slings and arrows of outrageous fortune”? Why not simply make a quiet exit? For some reason, we want to live, though we can’t always understand why.
Few have written of the deep human need for meaning and purpose with more penetrating insight than Viktor Frankl. Frankl was a Jewish psychiatrist who endured the horrors of several Nazi concentration camps during World War II. Frankl’s parents, wife, and brother died in the camps at the hands of the Nazis; he alone survived. Frankl wrote movingly of his experiences of the Holocaust in a global bestseller titled Man’s Search for Meaning. In that work, Frankl recounts the power of meaning to endure unthinkable suffering. He came to believe that his survival in the camps and that of his fellow prisoners depended on finding some purpose for their existence, even as their Nazi captors did everything possible to make their lives seem utterly pointless and unendurable. Meaning, he argues, is essential for survival.
Any attempt to restore a man’s inner strength in the camp had first to succeed in showing some future goal. Nietzsche’s words, “He who has a why to live can bear almost any how,” could be the guiding motto for all [mental health] efforts regarding prisoners. Whenever there was an opportunity for it, one had to give them a why — an aim — for their lives, in order to strengthen them to bear the terrible how of their existence. Woe to him who saw no more sense in his life, no aim, no purpose, and therefore no point in carrying on. He was soon lost.
Frankl emphasized the deadly consequences of loss of meaning. “Those who know how close the connection is between the state of mind of a man — his courage and hope, or lack of them — and the state of immunity of his body will understand that the sudden loss of hope and courage can have a deadly effect.” Frankl went on to establish an influential school of psychotherapy that employed the discovery of meaning (he referred to it as logotherapy) as the basis for restoring and maintaining mental health.
Frankl was not alone in his observations. Eminent Canadian psychiatrist and palliative care researcher Harvey Max Chochinov described the central role that meaning and purpose play in upholding a sense of personal dignity for patients with terminal illness. He and his team interviewed over 200 patients at the end of life admitted to palliative care units, inquiring about the factors that affected their sense of personal dignity in the face of their impending death. The patients identified key factors that impaired their sense of dignity, factors such as being treated disrespectfully, feeling burdensome, losing control of life, or feeling a lack of a lasting contribution to the world. Of all the concerns raised, the factor that best predicted loss of dignity was “feeling life no longer has a meaning or purpose.” The authors conclude, “Clearly, engendering a sense of meaning or purpose, as a way of staving off feelings of being a burden and no longer feeling worthy of respect, is a cornerstone of dignity conserving care.”
This research bears out Frankl’s observations of those struggling to live in the face of death. The instinct to live and the desire for life depend on a sense of meaning and purpose.
Originally published at the Worldview Bulletin Newsletter.
Ewan C. Goligher (MD, University of British Columbia; PhD, University of Toronto) is assistant professor of medicine at the University of Toronto and has published over 100 papers and several book chapters. As a physician practicing critical-care medicine, he is regularly involved in helping patients and families navigate difficult decisions about medical care at the end of life.
