Surgeons robed for operation

This is the third of a series of three posts on assisted dying. The first discussed the sanctity of life, the second the spookiness of death. This one is about the role of medical technology. As in the other two, I focus on what seems to me to be a blind spot in modern society’s understanding, in the hope that the ethics of assisted dying may be illuminated.

Assessments of modern technology are much debated. For some, it constitutes progress. For others, it enables the powerful to keep ahead of others. (See, for example, Y H Harari, Sapiens: A Brief History of Humankind, London: Harvill Secker, 2014; or John Gray’s arguments against the notion of progress, e.g. in Heresies: Against Progress and Other Illusions.)

What is not disputed is that the emphasis on technology distinguishes modern western society. It has produced a sense of superiority over other societies, a sense which in the past has been used to justify imperialism. Technologies are not just means to ends; they are symbols of our society’s positive self-image.

This changes perceptions. Because we think of new technologies as good things in their own right we do not apply sufficient care to how and when to use them. Too often there is a default assumption that if a technology is available it should be used. If it were not so, we should be debating not ‘assisted dying’ but ‘hindered dying’.

To illustrate the point, let us take a terminally ill man who is in pain and wants to die but the technology is available to postpone death. The relatives could discuss the situation with the doctor. However the wife gets so emotional at the thought of his death that she cannot take part. The daughter has for months been juggling a full-time job with regular visits and is utterly exhausted. The son is hoping to inherit money. A balanced, well-informed discussion of the patient’s best interests is impossible. For everybody involved it is extremely difficult to hold an informed and dispassionate discussion about the implications of the wife’s emotions and the daughter’s stress, especially in their presence. It is far easier to discuss the statistical probability of an operation’s success. As a result the temptation is to jump at the default position: the technology is there, so use it.

This is hardly satisfactory. If nothing else changes except that life-saving technology carries on improving, we shall sentence the dying to longer and longer periods of terminal pain. This suggests that our society lacks two things. One is an open, public discourse realistically assessing the proper limits of new technologies, including medical technologies. The other is a supportive wider community – some equivalent to a small rural village – which knows the family, empathises, and can share the burden of thinking through what to do without being so close to the dying person that emotions dominate.

Technology depends on science, and the cult of technology depends on the cult of ever-increasing knowledge. Until a century ago many physicists believed that one day they would have a complete account of the universe. Now it is clear that the universe is far too complex. There will always be processes we do not understand. The things we do not know will always exceed the things we do know. Our deepest, most significant decisions will always depend on unmeasured assessments of feelings. The cult of technology is reluctant to accept this and often gives undue weight to measurable scientific facts.

By recognising that these facts are only a small part of reality, we can reaffirm that the big decisions of life and death need to be made not just by scientific data, but by love.