OH DEATH, WHERE IS YOUR STING: MEDICAL AID IN DYING AS AN ARS MORIENDI

Long before he is referred to hospice care, Carol Osyter’s father joins the Hemlock Society, a right-to-die advocacy organization that aims to help patients take their life and death into their own hands.[1] Oyster’s father, a “man’s man” who seeks to have control over all aspects of his life, is diagnosed with prostate cancer at sixty eights years old. After having surgery to remove the cancer, he is told he is “cancer free,” a hopeful belief that is painfully dashed just a few years later. To combat the cancer cells, the physicians recommends an orchiectomy, the surgical removal of his testes. Despite the worry and sorrow he must feel, Oyster’s father complies with the physician’s course of treatment. After this surgery, much of who he “is” and how he formerly inhabits the world disappears. The hormone changes caused by the surgeries affect not only his appearance, causing him to grow breasts and have the same hot flashes as menopausal women, but the surgeries also impact his inner world — the choices he makes, his interests, his thoughts. He begins to read romance novels, causing him to fear that his masculinity is slipping away. This time, when his cancer returns, he decides that he will choose what exactly can be taken from him. Rather than accepting hospice care and letting death occur at some point in time within the next six months, he decides it is “his time.” Though his death certificate states that he dies from cancer, Oyster knows that her father commits suicide. Having spent years researching his options for a death with dignity, he chooses to exercise his autonomy and bring his life to an end. For Oyster’s father, this is what it means to die well. In the midst of the tragic, this choice gives him a sense of triumph.

This story begs us to consider what it means to both die and die well. Is death something that happens to us — a tragic, passive experience that overtakes us like a wave crashing upon the shore and engulfing its victim? In the case of Oyster’s father, his cancer is his official cause of death, the perpetual wave crashing upon the shore of his life. Or, on the other hand, is death something we can actively “do” — an event we can execute in accordance with our desires in order to overcome the tragic? In either case, what factors will enable us to die well? Before the rise of the medicalization of death, more often than not, death is thought of as a sort of darkness that claims its victims.[2] Borrowing from Christian theology, death is considered the final curse to be broken. “Oh death, where is your sting?” the Scriptures taunt as they envision the final resurrection and the ushering in of everlasting life. “Oh death, where is your victory?” To die well is to die prepared with this hope. In a paradoxical turn of events, the legalization of “Medical Aid in Dying” gives those who are willfully choosing to die the opportunity to taunt death, shouting, “Where, oh death, is your sting?”[3] This ability to confidently choose a “dignified” death is precisely the aim of organizations such as the Hemlock Society, Final Exit Network, and Death with Dignity.[4] They emphasize the triumph, not the tragedy. And yet, in the midst of the taunt, we cannot ignore the reality that death -- the seemingly ultimate tragedy -- is nevertheless on its way. The wave will crash onto the shore, engulfing the patient in the great beyond. Death still comes, and death still wins. Therefore, we are left asking, why does medical aid in dying give patients a sense of victory in the midst of the loss of their life, this great tragedy?

In this paper I will argue that medical aid in dying acts as a perverse ars moriendi, engendering a false sense of control as it relates to the uncontrollable, i.e. death. First, this paper will describe the history of ars moriendi and its relationship to civic discourse. Second, utilizing the work of Lydia Dugdale and Jeffrey Bishop, in particular, this paper will explore the shift in the dialogue around death, reflecting upon the development of the medicalization of life and death. Third, this paper will conclude by illustrating how key themes in medical aid in dying reflect the medieval practice of the ars moriendi, giving victims of death a sense of triumph in the midst of tragedy.

[1] In deciding how to begin this paper, I chose to utilize a family’s story in order to underscore the “real life” implications of this topic. Oftentimes, the human element is lost in the debate over what types of death are moral. First, engaging in that debate is beyond the scope of this paper. Second, this paper wants to highlight the ways in which this topic influences, informs, and effects real human lives. This story comes from the following book chapter: Carol K. Oyster, “Whose Death is it Anyway?” in Final Acts: Death, Dying, and the Choices We Make, ed. by Nan Baur-Maglin and Donna Perry (New Brunswick: Rutgers University Press, 2010), 93.

[2]  Allen Verhey, The Christian Art of Dying: Learning from Jesus (Grand Rapids: William B. Eerdmans Publishing Co., 2011), 11-14; Fred Craddock, Dale Goldsmith, and Joy V. Goldsmith, Speaking of Dying: Recovering the Church’s Voice in the Face of Death (Grand Rapids: Brazos Press, 2012), 3-4.

[3] In this paper, I am utilizing the term “medical aid in dying” to capture the utilization of a lethal medication with the intent on ending one’s life. I could have used synonymous terms such as physician assisted suicide, death with dignity, voluntary euthanasia, or medically assisted suicide; however, I chose “medical aid in dying” to de-emphasize the role of the physician and focus upon the medicinal aspect of one’s choice to die.

[4] See Deathwithdignity.org.