Human dignity
Australian, 15 October 1994.

At the close of Kurt Vonnegut’s novel Slaughter-House Five, one of the characters observes that the world’s population will reach 7 billion by 2000. At which, another character remarks: “I suppose they will all want dignity.”

Our planet could feed 7 billion if food supplies were better distributed for use and not profit. But will there ever be enough dignity to go around? And is it possible to create more?

At the moment, the most overfed members of he world’s most avaricious economies are being sold the notion of “dying with dignity”. Before subscribing to that prospect, a reading of How We Die (Chatto & Windus) by the American surgeon Sherwin B. Nuland, is recommended.

Reader resistance to a book which documents the actualities of dying is a sign of how morbid our culture has become. Death is kept for the screen, where corpses are in their millions. Meanwhile, the physical corpse is institutionalized by hospitals, or sanitized by morticians. In 52 years of living, I have seen only two dead human beings – both for but a few second, in their coffins.

How We Die is an antidote to phobias about dying. Everyone who read Nuland tells me how much better they felt afterwards. In part, that renewal comes from the author’s sense of compassion. In addition, he writes lucidly, with narrative skills to shame most novelists.

A no less important attraction of How We Die is the physiological information provided about how the major causes of death proceed through our bodies. None of that knowledge is pretty, and Nuland does nothing to shield us from the horrors. Rather, he dispels fears of the unknown with detail and anecdote of coronary attacks, strokes, HIV-AIDS and road accidents.

Very few of us, Nuland writers, will make dignified exits. Perhaps no more than five per cent will pass away peacefully in our sleep., or drop dead unexpectedly. Most of us will fall apart. Medical certificates specify a cause of death, but that precision is for the statisticians. All lives cease because the supply of oxygen cuts out – a circular definition. Most terminal illnesses involve a multiple failure of organs. Before a brain tumour kills, the kidneys probably will collapse, even if no cancerous cells have reached them. For most of us, any final hours of peace will be the outcome of exhaustion, not a passage through serenity.

In 50 years of medical practice, Nuland has found no easy answer to dealing with death, any more than he has discovered a formula for living decently. The choices before doctors and for patients remain dilemmas: both groups must decide between unappealing alternatives.

Thus, Nuland writes that he has helped patients to die in order to relive their pain. Yet he remains critical of euthanasia, especially on demand. Equally, he is appalled by “medical futility”; by that he means the specialist’s refusal to let bodies stop functioning. He is severe on those who perform major surgery on nonagenarians. We are built to ear out, not as perpetual motion machines.

The dying need hope, but that comfort will be most efficacious when linked to realizable goals, such as hanging on until the arrival of a  loved one. Patients need the trust if they are to remain hope. To promise recovery to the terminally ill is to remove a key prop of their dignity.

On that test, Nuland confesses that he failed his own brother. His collapse towards death became chaotic and demeaning because Nuland had never had the courage to say that the cancer was out of control.

The only way that Nuland knows to bring dignity to one’s dying is to have secured some measure of that quality during one’s life. He does not attempt to diagnose how Vonnegut’s concern is to be met: can there be enough dignity to go around seven billions of us?

Perhaps the human comedy is that there never was enough dignity even for a single person. The mass marketers offer to cover that existential lack through a super-abundance of material goods. Will we have more or less dignity if we live the way the marketers promote?

Consider the prospect for a child dressed in designer clothing and taught that self-esteem grows on a tree of expensive toys. Throughout her teenage years, she will swim in a super-saturated solution of signals to buy. She will imbibe the faith that her worth is visible in her possessions rather than achievements.

In adulthood, while the accumulation of objects if failing to deliver happiness, drug conglomerates will be encouraging doctors to prescribe pills to obliterate the pains of worthlessness. Come the end, grief will be expressed through expensive funerals, even for pets. All these commodities can be multiplied, but will they bring one grain of dignity to life or dying? A marketing imperative which equates human worth with covetousness is the obverse of Nuland’s insight. Indeed, from within that commercial din, the promise of dying with dignity resounds as another entreaty to spend up since you can’t take it with you.

An economic regime which presents morality as a choice between vanity and gluttony need never share Vonnegut’s worry.