An octogenarian still-active preacher offers pastoral advice about dying
by John M. Miller
Everyone is going to die. We are all terminal. The older we get, the more we wonder when, and how, and perhaps why. But we know that death is coming.
“Why” is easiest to answer, in a very narrow sense. We shall die because we are mortal, and all mortals die. More specifically, however, we shall die because of cancer, or heart disease, or other diseases or illnesses, or accidents, or from old age, or from “indeterminate causes.”
Dr. Atal Gawande is a Boston surgeon and author. In his outstanding book Being Mortal, he points out in graphic and sometimes disarming detail that modern medical science is able to keep us alive much longer than was the case for previous generations. The problem with that, he says, is that doctors cannot guarantee us meaningful life; they can only guarantee us increased longevity.
In over half a century as an ordained minister, I have observed literally hundreds of elderly parishioners take many months or years to die. Some of them did not object to the length of their death throes, and they clung fiercely to every moment of longevity they were able to wrest from the ever-lingering Grim Reaper. A far greater percentage of these church folks bitterly resented how long their death process stretched out. They wished they would die, but many clearly stated that it took far longer than they wanted or expected.
Dying isn’t what it used to be. Up until the mid-twentieth century, most people died fairly quickly, despite the best efforts of doctors to keep them alive. Now death has been scientifically held in abeyance by an ever more resourceful medical bag of tricks. Often it mercilessly continues mere existence when active life has long since vanished. In terms of dollars spent and increasing human suffering, death has been rendered inhumanely slow and terrible for countless people.
What is being proposed here is primarily intended for octogenarians, nonagenarians, and centenarians with full mental capacity, but also for younger people who know that they shall soon die from inevitably terminal conditions. Choosing to die earlier rather than later is for people in the last stages of life whose minds are still clear.
The concept of the Altruistic Death is not proposed for those suffering from advanced dementia. They are incapable mentally of acting upon it. Nor might it be chosen by “the seriously-ill young,” anyone from childhood through the sixties or seventies who is diagnosed with a potentially life-threatening illness or medical condition. It is a worthy and admirable objective for these people to cling to perhaps an admittedly thin hope of a medical breakthrough which shall cure them, or at least give them several more years of life. Altruistic Death is for older people who know they shall die soon, but they cannot know when.
The Meaning of “Altruism”
Altruism is not a common household word. According to my Webster’s New Collegiate Dictionary, which has not been “new” for over fifty years, altruism means, “unselfish regard for or devotion to the welfare of others.”
There is a Greek word from the Bible which means the same thing as altruism. It is agape. Agape is what Jesus and the apostle Paul were talking about whenever they talked about love. Altruism is not feelings-oriented love; it is action-oriented love. It seeks the best for everyone, regardless of what our feelings may be toward anyone in particular. Altruism is “head” love; it is not “heart” love. It is love that is thought out and then acted upon. It is not based essentially on emotion, but rather on ethics and morality and reason.
The Altruistic Death is a death that individuals choose. It is intended primarily to benefit all of society, and secondly to benefit the family members of those who decide to end their lives before it would happen “naturally.” Those who decide on an altruistic death are voluntarily hastening their deaths in an unselfish regard for and devotion to the welfare of others.
Is a voluntarily chosen altruistic death therefore a suicide? Technically it is. However, the motives behind such a death are quite different from those normally associated with other suicides. Most suicides occur because people mentally and emotionally are uncontrollably distraught. They cannot visualize their lives improving, no matter what they might do to ward off the maelstrom of depression into which they have plunged.
The Altruistic Death is deliberately chosen by those who rationally are certain that their lives cannot go on much longer, nor can they improve. Thus they conclude, altruistically, that the lives of everyone will be enhanced by their deaths, even if some will vehemently object to their deciding actively to die. Many people on moral, religious, or philosophical grounds strongly oppose the mere contemplation of this topic. Much more would they oppose such a decision ever being enacted. Therefore let me try to explain my rationale as a longtime member of the clergy for proposing such an unorthodox idea.
Medical costs include such factors as medical insurance, doctors’ appointments, prescriptions, annual check-ups, hospitalizations, surgeries, and so on. Years ago it was claimed that on average, however much anyone spent on all medical expenses in a lifetime, that amount typically doubled in the last six months or year of life. Now, because medical science keeps us alive even longer, the enormous expenses of the last few years are also extended, making dying far more costly than ever before.
We need to be honest with ourselves as a society. Is it fair to society at large that many billions of dollars are spent every year to keep many very old individuals alive, when the cost of their care might better be directed toward younger people whose lives can be enhanced and extended by the expense of that care? Many elderly people object to what they consider an unacceptably drawn-out process of dying. For others, dementia prevents them from knowing who they are or who anyone else is as they slowly die.
Is it ethically conscionable to spend extravagant amounts of Medicare and other insurance funds to sustain existence for people who are willing and eager to die, particularly when those funds can benefit younger people? They believe that the young have much more reason to continue to live than old people who shall soon die anyway.
Anthropologists say that in some primitive societies, the old would voluntarily go off into the forest or desert or out onto the ice floes to die. It was accepted by the entire society that it was for the good of all when the elderly chose to do that.
Our high cost of living should not be exceeded by an even higher cost of dying. It represents too great an investment in the existence of the old at the expense of those who are younger.
Furthermore, the longer anyone lives, the more likely it is that their process of dying, when it comes, shall be fraught with more orthopedic, neurological, gastroenterological, and other physical or mental problems.
If someone is 84 or 93 or 102, and he or she is mentally clear and without any serious dementia, such people know in their mind and in their inmost being that death cannot be far off. When they suspect that advanced age is starting to erode their mental faculties, they are still capable of choosing an Altruistic Death. If they wait too long, however, they will not be physically or mentally capable of deciding when and how they should die.
Euthanasia is legal in several nations and in several of the states of the United States of America. Where it is legal, however, only a very small percentage of people avail themselves of this recently approved option. Even if it were legal everywhere, it still would be a fairly rare occurrence. That is because there is no ethical or social advocacy for euthanasia.
It is so obvious why that is the case that it does not even need to be stated --- except that it does need to be stated. It is one thing to choose death and quite another to submit to death. In our deepest being, we all know we are going to die. Because our subconscious will to continue living is so powerful, however, few of us can consciously commit ourselves to die, even if it might be motivated by regard for or devotion to the welfare of others.
The Altruistic Death is definitely not for everyone. Statistically, probably not very many would ever choose it. For those who do, however, they have the solace of knowing that it will collectively save tens or hundreds of thousands of dollars per person in unnecessary costs of medical care for people who know they are chronologically consigned to a relatively imminent death anyway.
Altruistic Death is an option only for those who believe that their continued existence does not truly enhance society at large, and in fact may detract from it. They further trust that their likely increased debilitation will cast undue burdens upon family members or friends who may not be in a position readily to accept those burdens.
I know that most spouses or children would insist it is not a burden, and I know that many if not most people in society say that voluntarily giving up one’s life under any circumstances is ethically indefensible. Nonetheless, if an individual chooses to do so on behalf of others, that individual can do it for others, whatever the “others” may think of that decision. It is fundamentally a very personal, irrevocable, enormous, and ethical decision.
A first-century Galilean is quoted as saying, “Greater love (agape) has no one than this, to lay down one’s life for one’s friends.” If in historical fact Jesus actually said that, he surely said those words in the context of what I am calling altruistic love. The very next day he himself agonizingly experienced what he was suggesting. His words have great relevance for this discussion, especially considering who he was and who we can become who try to live by his words.
The Most Humane and Considerate Means to an Altruistic Death
Because most suicides occur when individuals are mentally and psychologically “beside themselves,” they resort to methods which are unintentionally and unnecessarily cruel to their loved ones. Furthermore, these methods may be disastrously unsuccessful, as lethal as they were meant to be, resulting in permanent impairments. Firearms, knives, or anything else used as a weapon for the taking one’s life exact a horrible and unpredictable psychological and spiritual toll on survivors, whether or not the person is successful in what he attempts. Rope is equally damaging to the psyche of family members and friends. To find the body of a loved one whose life ended violently has unpredictably devastating effects for those put into that horrendous situation.
Overdoses of various kinds of medications or poisons are mentally less injurious to those closest to the deceased, but they also may turn out to be unsuccessful. The same is true for almost every other method that might be employed.
Nevertheless, there is one method that is certain to accomplish the intentions of the person who chooses an altruistic death, but it requires huge determination and willpower. It is the uncomplicated decision to avoid all hydration and nutrition until the individual dies.
I have known scores of dying people who ultimately did not or could not drink or eat anything. Some of them were unconscious when the process began; some were totally conscious or semi-conscious. Some refused to eat or drink, while others involuntarily gave up eating or drinking.
In every one of those instances, family members and medical personnel agreed not to insert IVs for hydration or feeding tubes for nutrition. It was concluded by everyone associated with the dying person, and usually also by that person, that the time to die had arrived, and no one would try to intervene to prevent death.
To those who believe that an altruistic death is the means by which we may choose end our lives, this can safely be said: If anyone eats nothing at all, but especially drinks nothing at all, most such people will die within a month or so, if not sooner. The more important of the two abstaining actions is not to drink anything.
In the past couple of years I closely observed two men who chose to die by this method. They both died relatively quickly. The first was gone in slightly less than a month, and the second in eleven days.
Obviously if someone starts this process and then changes his mind, the Dehydration-And-Starvation method will not succeed in accomplishing the individual’s wishes. Therefore there must be an officially signed and notarized document and Do-Not-Resuscitate directive visibly stating the person’s intentions. That implies that no one can stop taking hydration or nutrition entirely by himself. Someone else must be informed of the decision, and must approve it. Further, family members, friends or hospice personnel must check on the individual at least on a daily basis.
This means that the person who opts for altruistic death must notify a few people of his or her decision. Do NOT ask permission, however; inform these carefully selected people of your intentions without soliciting their approval. When you tell them your intentions, be prepared for vehement and potentially vituperative objections. You will want to try to convince them of the validity of your decision, if possible. You must not allow their protests to erode your resolve, which is very difficult to engender in the first place.
It is hard enough for anyone to come to such an enormous decision without allowing others to chip away at such a carefully considered choice. You have been thinking about this for many months or years; they began to think about it only when you told them of your decision.
Furthermore, enlist the support and assistance of a hospice organization. A professional hospice worker will frequently visit you in your home to make sure you are comfortable, and not in pain.
A concern might arise over what might be the cause of death stated on the death certificate. Would it say “Suicide”? No; it would say what was written on the certificates of all those parishioners I knew who could not or did not drink or eat anything before their deaths. The cause of death would be listed as “Failure to Thrive.”
In reality, everyone who dies does so because of a failure to thrive. Nature did not endow us with the ability to thrive forever, and so all of us eventually die.
What Dreams May Come…Must Give Us Pause
Hamlet is considered by many the greatest of Shakespeare’s plays, and the Great Solioquy (“To be, or not to be”) is perhaps the best-known section of that play. Hamlet is contemplating suicide, perhaps by means of a “bare bodkin,” a sharp stiletto.
To die, to sleep,
To sleep, perchance to dream; ay, there’s the rub;
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil,
Must give us pause.
Why on earth would an elderly minister of the Gospel intimate that elderly people might want to contemplate an altruistic death for the benefit of humanity? And why would he be so exasperatingly objective about such a complex ethical issue? Does not religion, all religion, forbid suicide? What would God think of such a hugely unorthodox choice, were anyone to summon up the courage to exercise it?
No one knows beyond doubt that God exists, or that heaven exists. I have always had a lifelong unshakable conviction in the existence of both. I further believe that all of us shall, after death, be with God in heaven, wherever and whatever heaven is. Heaven is probably not a “where,” but it might possibly be a “what,” although on that issue I confess to being agnostic.
I have always been much more theologically devoted to God than to heaven. As for hell, it makes no sense to me at all. Long ago I rejected that insidious, invidious notion. Hell is an invention of super-puritanical people, and of the devil, if there were a devil, which there isn’t.
The traditional view is that God is omniscient. Assuming that is true, He will know whether we decided to end our earthly existence a little early because of our love and concern for all people. Therefore we need not fear He might accuse us of bad motives at the gates of heaven.
Nevertheless, the dramatized Prince of Denmark does give us pause.
Who would fardels bear,
To grunt and swear under a weary life,
But that the dread of something after death,
That undiscover’d country from whose bourn
No traveller returns, puzzles the will
And makes us rather bear those ills we have
Than fly to others that we know not of?
This essay is written with a deliberately “light” touch as opposed to a “heavy” one. Death is a very serious subject, but in the end it is only a subject. It is not The Subject. The altruistric death is very serious, but it is not deadly serious, because death of some sort is inevitable for everyone.
To people with a certain kind of faith, death is not The End. It shall be an end, if not the end, for all of us in an earthly sense, but our individual deaths will not be the termination of the world or the universe. They will instead solely represent our end, potentially, and perhaps actually. As an antidote, John Donne eloquently declared, “Death, thou shalt die.”
On the other hand, if neither God not eternity exist, everyone is forced to agree that we shall all die in any case. And if some of us choose to take our final bow a few weeks, months, or years before “nature” will force us to do it, and we do it for the sake of altruism, we will leave this life for what we believe are ethical, altruistic, loving reasons. We shall not go, as William Cullen Bryant wrote in Thanatopsis, “like a quarry-slave at night/ Scoured to his dungeon.”
Benjamin Franklin declared that nothing in this world is certain except death and taxes. With Donald Trump and the Tax Act of 2018, even taxes may be avoided by millions of Americans. But death? No, we all shall experience death. Every living thing eventually dies. Even inanimate things die. The Appalachians, it is claimed, were once higher than the Himalayas. They are very slowly declining into a long, wide plain, topographical bit by bit by bit.
It is because I am an old minister who has seen so much death up-close-and-personal for over half a century of pastoral ministry that I do perceive individual death as an inevitable necessity for the perpetuation of earthly, social life. Neither God nor nature ever intended anyone to live forever. For the good of all, each must die.
It is understandable but also unnatural for human beings to try to keep living indefinitely. It cannot be done --- by humans, other animals, plants, plains, or mountains. It is immoral to try to keep each of us alive as long as possible to the social detriment of all of us.
Finale
Jeremy Bentham was an eighteenth-century English philosopher. He established a philosophical concept that is called utilitarian hedonism.
It is not what we might salaciously assume it is, given the second word in the concept. Stated in its briefest essence, utilitarian hedonism is the notion that all of us should always strive to bring the greatest good to the greatest possible number of people of which we are capable. Thus utilitarian hedonism is altruism by another name.
Let us now review the primary factors in the Altruistic Death.
- It is obvious that “getting affairs in order” is in order well before such a decision is made. But then, it is wise for older people always to have their affairs in order.
- The altruistic death is a voluntary death with unselfish regard for and devotion to the welfare of others, society as well as family members.
- It is accomplished by resolving to drink and eat nothing until one peacefully expires.
- Those who choose to die for the sake of altruism must inform family members or others of their decision, but without seeking their permission.
- Don’t wait until it is too late. If you choose an altruistic death, be prepared to act on your decision while you are still capable of doing do.
- The altruistic death should be considered mainly by old people who realize their demise is close at hand. The elderly are perhaps more likely to enjoy life in their old age more than younger people enjoy theirs, but they also may be more willing to give up their lives for the welfare of others, because they are increasingly aware of their own ever-diminishing finitude.
If one believes in God, altruistic death is a gift to God, to the entire world, to one’s family, and even to one’s self. By it, in our own small way, we can do our part, while we are still able to do it, to contribute to the future of the human race and to our beleaguered planet.
Even if we do not believe in God, altruistic death is no less altruistic. The human environment cannot indefinitely be sustained when the fastest growing demographic categories in our society are people who are eighty years of age and above.
The hypothesis being proposed here is an enormous one. Anyone who decides to exercise this option must do so only after careful and prolonged thought. When the decision is made, it must be followed with steel-hard resolve.
In that regard, however, altruistic death is like other major choices we make in life, such as whom to marry, whether to have children, and what vocation to follow. Whether we choose to die or merely to submit to death is another of those major life decisions.
According to the Fourth Gospel, a few months before his death, Jesus is quoted as saying, “I lay down my life in order to take it up again. No one takes it from me, but I lay it down of my own accord.” Later, at the Last Supper, the evening before his crucifixion, John quotes Jesus as saying this: “I give you a new commandment, that you love one another. Just as I have loved you, you also should love one another.”
Collectively or individually to contemplate altruistic death is inevitably to engage in a long, strong controversy. Not to do so is to go on as the human race unthinkingly has been doing for the past fifty to seventy-five years. Humanity can no longer afford that costly luxury.
John Miller is the pastor of The Chapel Without Walls on Hilton Head Island, South Carolina. www.chapelwithoutwallshhi.org