The promoters of the Voluntary Assisted Dying Bill (VAD) currently before the NSW Parliament have no idea what they are dealing with. They may feel they are addressing a human rights issue or that they are seeking to ease the terrible pain suffered by the terminally ill. However, they appear to have no awareness that what they are proposing merely further facilitates a very dangerous cultural shift in attitudes towards death that is underway in modern society. While this new view of death might appear superficially to enhance human rights, it has a more sinister potential to expose vulnerable people to exploitation and further reduce human beings to the status of mere components and functions within medico-technological-economic systems that can be administered according to abstract rules and that have no capacity to address the needs of individual human lives, as we will discuss below.
Of course, it may be that the promoters of VAD know exactly what they’re doing and are fully aware of the dehumanising impact their proposals will have. This regrettable explanation seems quite possible given the opportunistic manner in which the VAD Bill has been brought before parliament in the midst of the COVID pandemic. This lamentable act has been highlighted in a full-page advertisement taken out by a large group of health professionals to protest the unseemly haste (Sunday Telegraph, 17/10):
It is extraordinary that Independent MP Alex Greenwich would choose this moment to introduce a Voluntary Assisted Dying Bill into the NSW Parliament. We are especially concerned about the fundamental impact and effects of such a far-reaching, unsafe and unexamined bill [on] an already stretched system … The ambiguities and distress it will add to healthcare systems cannot be underestimated.
The thoughtful and heart-felt statement goes on to highlight the concerns of highly qualified physicians, academics and other health professionals directly involved in the treatment of terminally ill patients, those in palliative and aged care, as well as those folk approaching the last days of their lives and increasingly apprehensive about what awaits them. These professionals describe the anxiety these folk already feel with the Covid threat, and lament the added stress this Bill imposes on all concerned. One, a consultant geriatrician, points out that:
The recent Aged Care Royal Commission showed that older people are a vulnerable group, sounding the alarm on elder abuse, poor care and reliance of ‘quick fixes’.
Many frail elderly will be targeted under the provisions of the VAD Bill and made to feel that they have become a burden and a nuisance to the system, so that “the ‘right’ to die becomes the ‘expectation’ to die.” He concludes: VAD is “the wrong idea at the wrong time.”
However, there is another even more profound issue beyond this grim and immediate danger to the vulnerable. This concerns the cultural shift in attitudes towards death that began in the 20th Century and that now largely shapes the paradigm (i.e., the world-view, or mental framework) within which proposals concerning euthanasia and VAD are formulated, evaluated, judged, legislated, and implemented. Proponents of VAD may think they are acting in good faith, but it seems they are unaware of the unspoken and unconscious cultural factors that now determine how they and modern society conceive of human death.
In fact, the 20th Century saw the emergence in the West of a new paradigm of death that fundamentally revolutionized values relating to mortality and life, displacing traditional principles derived over millennia from religious, philosophical, mythological and traditional sources. This new paradigm has its origins in the unprecedented cultural trauma of the ‘death of a generation’ in the Great War, followed by the horrendous death-toll registered in subsequent wars, civil wars, purges, atrocities, and genocidal acts of later decades. This was accompanied by the subsequent medical revolution in the middle of the century that vastly enhanced public health and made the collective well-being of the citizenry a principle responsibility of the State. Consequently, the paradigm now takes two major institutional forms: the militarization, and the medicalization of death. Both ensure that death is administered on an industrial scale and in accord with institutional and bureaucratic imperatives and values, with ‘administer’ being understood in its twin senses of ‘to manage’ and ‘to dispense’ – the two characteristic orientations towards death in contemporary society.
This cultural shift can be illustrated by considering some of the main iconic images of the 20th Century. Some images strand out, e.g., the blue planet earth seen from the moon, the double-helix of DNA, the Nuremberg rallies under the Swastika, and the mushroom cloud of the atomic bomb. The first two images are iconic in the traditional sense that they serve as windows onto the mystery of life; while it might be said that the latter two images play an anti-iconic role, serving as a window, not onto the mystery of life, but rather onto its negation through the enormous human capacity for hatred, destruction and death.
This anti-iconic realm is represented above all by other terrible images: of thousands of emaciated and naked corpses being bulldozed into open graves at Nazi death camps, and of soldiers mown down by machine guns, entangled in barbed wire, crushed under tanks, and buried in mud amongst the trenches of the Great War. Arguably, it is these images that are the archetypal representations of the 20th Century, not just because they represent the horrors of total war and genocide replicated throughout our era, but because they represent the transformation of death into a large-scale technical and industrial process with human beings coming to figure anonymously as mere resources for warfare, labour, experimentation and even recycling (as was done at Auschwitz, in the case of hair, tallow, tooth fillings and skin, etc.), before being disposed of as refuse – also on an industrial scale.
Sadly, it has been necessary to dwell for a moment on such awful scenes to illustrate not only the extensive processes of dehumanization that have taken place over the past century, but also to emphasize the accompanying demystification, desacralization and banalization of the singular value of human life that now characterise the culture of modern mass society.
This shift has been noted by many commentators in various ways. For example, it was first identified by Sigmund Freud in 1915 as he recoiled in horror at the terrible losses in the trenches. In his study of ‘Our Attitude Towards Death’ he attributes
our present sense of estrangement in this once lovely and congenial world [to] the disturbance that has taken place in the attitude which we have hitherto adopted towards death.” He observed that “the bewilderment and the paralysis of capacity, from which we suffer, are essentially determined … by the circumstances that we are unable to maintain our former attitude towards death, and have not yet found a new one.
The conventional attitudes towards death, which were conceived in terms of the individual, had been swept aside by the total mobilization of the Great War and the ‘massification’ of death:
Death will no longer be denied; we are forced to believe in it. People really die; and no longer one by one, but many, often tens of thousands, in a single day.
Indeed, the catastrophe of the war “strips us of the … accretions of civilization,” and reveals mass death to be an outcome of remorseless dehumanising forces that had broken through the restraining veneer of European civilization. A century later, it is these forces that are being served by the proponents of the VAD Bill in their misbegotten mission to routinize the bureaucratic killing of human beings.
For a time it was the existentialist tradition, with its roots in the work of the Danish theologian Soren Kierkegaard, that opposed this shift and the reduction of the irreducibly particular lives of individual people to the status of mere components or functions within a great, overbearing social collectivity. This resistance first found expression in the early philosophy of Martin Heidegger, who termed this particularity, Dasein. In Being and Time (1927), death is shown to be the primary determinant of Dasein, its presence looming before us all as the ultimate, unavoidable termination of the unique singularity of being human. This situation is, above all, non-relational, i.e., of its very nature, it can only be encountered alone. According to Heidegger, as he contemplated the massification of death unleashed in the War, the great defining characteristic of being human is that human death is pre-eminently a singular event in a life. It is this that a bureaucratised society like ours has great difficulties dealing with.
As Heidegger emphasised, in bringing the life of a person to a close, death both totalizes and individualizes that person, i.e., it determines eternally who that person is. Moreover, Heidegger insists, human beings have an inherent, pre-reflective, pre-philosophical awareness of this situation and this constitutes the Urgrund (i.e., the foundational ontology) of being human. It is this pre-reflective awareness of the bedrock nature of things that prompts the revulsion people spontaneously display at the wanton or gratuitous ‘snuffing out’ of a life, and that no doubt motivates much of the opposition to VAD.
Awareness of these facts about the irreducible nature of the human situation has deep ethical implications, according to Heidegger. Above all, such awareness has the capacity to radically intensify the person’s subjective apprehension of their life, alerting them to the singular value of the time they have on earth, and calling upon them resolutely to live authentically in that time. This conclusion inspired many subsequent existentialists, who explored its demands in innumerable works, e.g., Jean-Paul Sartre in Being and Nothingness (1943) and his many plays; Albert Camus, in all his works, but especially The Outsider (1942) and The Myth of Sisyphus (1942); and John Fowles in The Magus (1965). Ultimately, this existentialist vision of Dasein as ‘being towards death’, with its demand for authenticity, placed what was experienced as an unbearable burden on those who sought to live by it. Consequently, it fell victim to the anti-humanist revolution in thought that set in around 1970 and radically devalued the human subject. This was exemplified by Foucault’s famous declaration in The Order of Things (1966) of ‘the death of man’, and was implemented by structuralism, post-structuralism, and postmodernism, all of which are culturally relativist and have no place for metaphysical mediations or ‘heroic’ notions of Dasein. It is this ideology that shapes Progressivist support for VAD.
Heidegger’s analysis also profoundly influenced his one-time lover, Hannah Arendt, especially in Eichmann in Jerusalem (1963), where she showed how a powerful Nazi bureaucrat could rationalise the extermination of vast numbers of people. They did this by claiming that their allegiance to a ‘higher’ moral imperative, i.e., the legitimacy of laws and orders, overrode any residual concern for humanitarian issues. It is the victory of such abstract, allegedly ‘universal’ principles, and the dismissal of the singular existential dimension of death that produced what Arendt identified as ‘the banality of evil’, exhibited by Adolf Eichmann in his confidence that he was ‘doing the right thing’ in administering the Final Solution.
This attitude proved to be a key defining characteristic of the new paradigm of death, of which the VAD Bill is a primary example. (It is also the underlying rationale behind the repeated refusals of our Chief Health Officers to approve humanitarian requests for exemptions from cross-border restrictions on people seeking medical care or opportunities to visit sick or dying relatives; these CHOs are convinced they are doing the ‘right thing’ and that the universalistic principles that they implement have priority over the particular needs of individuals.)
These foreshadowing insights of Freud and Heidegger were inspired by the trauma of total war, which initiated the paradigm shift in attitudes towards death. Its completion was dependent however upon the mid-century revolution in medical science, which delivered into human hands previously undreamt powers over life and death and forced a fundamental bureaucratic and philosophical reappraisal that verged on the Promethean. As Philippe Ariès observed in 1974 in Western Attitudes Toward Death,
in our day, in approximately a third of a century, we have witnessed a brutal revolution in traditional ideas and feelings [about death] – an absolutely unheard-of phenomenon.
A new discourse appeared, exemplified by various best-sellers and literary prize-winners, including Norman O. Brown’s Life Against Death (1959), Jessica Mitford’s The American Way of Dying (1963), Jacques Choron’s Death and Western Thought (1963), Geoffrey Gorer’s Death, Grief and Mourning (1965), Elizabeth Kubler-Ross’s On Death and Dying (1969), Ernest Becker’s The Denial of Death (1973), and Philippe Ariès, Western Attitudes Toward Death (1974). This was accompanied by the rise of the new field of thanatology, death education and counselling, bioethics, the hospice movement, and growing enthusiasm for VAD and other forms of euthanasia.
In order to grasp the implications of the new paradigm and the VAD Bill that seeks to implement it, it is necessary to grasp the profound ways in which humanity’s religious conceptions had previously shaped the understanding of death throughout history. Prior to the advent of the new paradigm, the world’s religious systems were (and remain) the primary repository of all the symbolic resources and meaning that humanity has been able to construct around the brute fact of death. These invariably locate death in grand schemas and narratives, making death a defining moment of life, or even making life a preparation for death or its transcendence. One’s individual fate acquired a cosmic dimension that far transcended one’s physical passing-away. Although sometimes bleak in their implications, the grandness and richness of such perennial visions highlights the radical departure represented by the core tendencies of the new paradigm and the abrupt rupture with tradition that it involves.
The new paradigm has displaced and marginalised such traditional attitudes towards death, which has been stripped of any metaphysical or spiritual dimensions. We are now integrated into an economic system dominated by the ersatz, hyper-transient, and commodified ‘values’ of consumer culture, and a political system dominated by the imperatives of an increasingly intrusive administrative State upon which we are fervently encouraged to depend. In such a system, it seems ‘life’ and ‘death’ may be purchased and consumed, valued and depreciated, managed and administered in a fashion entirely consistent with any other commercial or bureaucratic transaction, i.e., with ever-increasing superficiality and lack of lasting meaning or significance. In this new regime, whatever broader meaning death possesses will increasingly be associated only with problems arising from technical, economic and utilitarian considerations. And these will be contingent upon the cost-benefit calculations associated with the transition of people from being producers and consumers in the economic system to being cost-centres and burdens within the health system.
And so, here we are in 2021, on the other side of a revolution in our attitudes towards death that set in a century ago. Generally, this has proven to be firmly atheistic and even anti-religious (e.g., ‘Church has no moral authority over assisted dying’, SMH, 16/10), expressing a militantly secular view of death and an annihilationist view of the afterlife. For example, as Peter Singer enthused in his very influential book on Practical Ethics (1993), “when we reject belief in a god we must give up the idea that life on this planet has some preordained meaning. Life as a whole has no meaning.” It seems that Friedrich Nietzsche was only too prescient when he concluded 130 years ago in The Will to Power: “What does nihilism mean? That the highest values devaluate themselves. The aim [of existence] is lacking; ‘Why?’ finds no answer.”
Ominously, as Nietzsche lamented as he looked forward to the history we now inhabit, humanity has never previously lived in full comprehension of this ultimate nullity of the human condition – and it cannot be expected to do so in an unproblematic fashion. Nevertheless, this is what the proponents of VAD are prescribing. It is for such reasons that any further consideration of the VAD Bill should be postponed until the COVID crisis has passed and the Bill can receive the proper consideration it demands.