PHILOSOPHY - HUMAN DIGNITY
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
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
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
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
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.