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Dying in slow motion
- Waltraud F Coles (28 July 2003)
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Death Fetishism: a 'good death' that threatens the public's health.
- Niyi Awofeso (31 July 2003)
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Waltraud F Coles, I am a patient DH1 1JU Retired
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You asked for patients’ views on dying. Here is mine: I am a 53 year old woman with advanced Secondary Progressive Multiple Sclerosis. Over more than two decades I have experienced steady deterioration and a continuous reduction in my quality of life. I am already severely disabled and have been housebound for many years. Now more and more activities, even ones like short spells of reading or talking to friends, are on many days beginning to be beyond what I still can do. Yet further deterioration to the point of complete helplessness and absolute dependency on carers is certain. I do not want to have to go through the final phase of this illness. However, I am very fortunate to have a husband I love and have been married to for 29 years. He supports and cares for me in a most loving and thoughtful way. We still are profoundly happy in each other’s company and thus I am still glad to be ‘alive’, albeit in a hugely restricted way. I wish to preserve our happiness for as long as possible. So what options do I have? The first one is to simply continue with this ever deteriorating ‘life’. This would mean that after decades of suffering I would have to face the humiliation and distress of many years yet of utter helplessness, appallingly low quality of life and complete loss of dignity. This is, as I see it, simply a dying in slow motion. The second option is to commit suicide. However, despite great efforts I have not been able to get hold of the right kind of drugs that would allow someone with my level of disability to end my life with dignity. I can no longer travel abroad to seek an assisted death in a country with a more humane and rational approach, such as Switzerland. Difficulties with swallowing rule out a sufficiently large overdose of those drugs available to me, and the use of a plastic bag does not exactly fit my idea of a dignified death. Furthermore, as the law stands on assisted suicide, I am now facing the additional dreadful dilemma of timing. Do I end my life whilst I am still physically able to do so unassisted? Doing it at this stage would be too early, since it might deprive both my husband and myself, as well as other relatives I love, of the last precious year or two we still could have together, whilst I still can, just about, tolerate the quality of my life. Or do I wait until I simply can no longer bear what I have to suffer? At that time, with the means available to me, I would no longer be able to commit suicide unaided, thus exposing those who would assist me to the risk of being prosecuted for murder simply because they helped me to end my life according to my wishes. The only other method available to me is to refuse food, in other words starve myself to death. I understand that dying this way will take at least six weeks or so. Thus the second option I have is simply another form of a long drawn out, distressing form of dying. How can someone in my position achieve a good death? What would health professionals advise me to do? What would you do, if you were in my place? Competing interests: None declared |
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Niyi Awofeso, Conjoint appointee, School of Public Health and Community Medicine, UNSW University of New South Wales, Sydney 2052, Australia.
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Sir, In seeking meanings for individuals’ desire for death1, it is necessary to address ultra-religious and ultra-nationalist indoctrinations currently turning militants into suicide bombers, with devastating effects on public health. For instance, Hamas leader Rantisi frames suicide bombers as “self-chosen martyrs”, and suicide bombing as istishhadi - ‘self-chosen martyrdom’. Similarly, Pirabhakaran frames Tamils involved in suicidal terrorism, and militants who commit suicide to evade interrogation, as nationalists.2 Suicidal terrorists’ statements appear to corroborate such characterizations. When, on 04/09/1985, a Palestinian teenager executed a suicide bombing operation that led to her death and those of two Israelis, she left a taped message instructing her mother not to mourn her death, but, “be merry, let your joy explode as if it were my wedding day”. Thus, suicide bombers appear to regard their deaths as “ martyrs’ wedding”; an occasion of joy and celebration.3 However, the strong influence of mass psychology deployed by ideologues like Laden, in turning marginalized youths into death fetishists should not be under-estimated. The issues on which such ideologues capitalize to recruit militants - such as unresolved conflicts and social class polarization (http://www.fas.org/irp/world/para/docs/980223-fatwa.htm), religion and violence4, individuals’ perceptions of burial rituals/afterlife (http://mundanebehavior.org/issues/v4n1/awofeso4-1.htm); and the settings in which militants’ indoctrination occur, such as religious schools5, are important research areas for thanatologists, bio-ethicists, and public health workers. It is not only ‘patients’, defined from a bio-medical perspective, whose views on dying require in-depth study. For health professionals to exclude ‘non-patients’ perspectives on the meaning of death, or for political leaders and human rights activists to deride suicide bombers as “war criminals” without attempting to understanding “why”, is unlikely to reduce the threats death fetishists pose to public health. Recent terrorist events in New York6, Moscow, Riyadh, Israel, and Baghdad attest to the need for further research vis-à-vis addressing suicidal terrorism from health perspectives. REFERENCES 1) Clark J. Patient centred death: we need better, more innovative research on patients’ views on dying. BMJ 2003; 327: 174-5 2) Josh M. On the razor’s edge: the liberation tigers of Tamil Eelam. Studies in Conflict and Terrorism. 1996; 19: 19-42. 3) Kushner H W. Suicide bombers: business as usual. Studies in Conflict and Terrorism. 1996: 329-337. 4) Jurgensmeyer M. Terror in the mind of God: the global rise of religious violence. Berkeley, University of California Press, 2001: 119- 244 5) Awofeso N, Ritchie J, Degeling P. ‘The Almajiri heritage and the threat of non-State terrorism in northern Nigeria – lessons from Central Asia and Pakistan’, Studies in Conflict and Terrorism. 2003; 26: 309-323. 6) Schlenger WE, Caddell JM, Ebert L. et al. Psychological reactions to terrorist attacks: findings from a national study of Americans’ reactions to September 11. J. Am. Med. Assoc. 2002; 288: 581-88. Competing interests: None declared |
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