Born in London and educated at Oxford, Mary Rose Barrington became a lawyer and charity administrator, combining law practice with assisting in the management of a large group of almshouses for the aged. Her principal interests include voluntary euthanasia, animal protection, and psychical research. She is a past chairman of the London-based Voluntary Euthanasia Society (re-named EXIT, The Society for the Right to Die with Dignity, and renamed again Dignity in Dying). She has also been honorary secretary of the Animal Rights Group and is a vice -president of the Society for Psychical Research.
Barrington, an advocate of rational suicide and the notion of “planned death,” argues that humane and advanced societies must embrace this notion—much as traditional pride in extensive procreation has given way to the concept of planned birth—in a world that is increasingly crowded, and increasingly populated by those who are old and no longer have a great desire to live. She argues in detail for the psychological comfort that the notion of planned death would give to the elderly, who might foresee and welcome their own deaths rather than waiting to be “passively suppressed.”
Mary Rose Barrington, “Apologia for Suicide,” from Euthanasia and the Right to Death, ed. A. B. Downing. London: Peter Owen, 1969. Material in introduction and abridgement from M. Pabst Battin and David J. Mayo, Suicide: The Philosophical Issues, New York: St. Martin’s Press, 1980, pp. 90–103.
from APOLOGIA FOR SUICIDE
Of the many disagreeable features inherent in the human condition, none is more unpalatable than mortality. Many people declare that they find the concept of survival and immortal life both inconceivable and preposterous; but they will usually admit to a minimal pang at the thought of being snuffed out in due course and playing no further part in the aeons to come. That aeons have already passed before they were born is a matter that few people take to heart, and they tend on the whole to be rather glad not to have experienced the hardships of life before the era of the Public Health Acts and pain-killing drugs. To cease from being after having once existed seems altogether different and altogether terrible. This is an odd conclusion, bearing in mind that whereas before birth one must be reckoned to have had no effect on the course of events at all, the very act of birth and the shortest of lives may produce incalculable and possibly cataclysmic effects by indirect causation. Viewed in this light we might all be filled with satisfaction to think that our every move will send ripples of effects cascading down time. In fact, speculations of this kind do little if anything to satisfy the immortal longings, and even though being remembered kindly by others is generally felt to be something of a comfort, absolute death remains absolutely appalling. Many people who have no religious convictions save themselves from despair by filing away in their minds some small outside chance that they might, after all, survive, perhaps as some semi-anonymous cog in a universal system; many others resolutely refuse to give any thought to death at all.
If human convictions and behavior were a direct function of logical thinking, one would expect that the more firmly a person believed in the survival of his soul in an existence unhampered by the frequently ailing body, the more ready he would be to leave this world and pass on to the next. Nothing of the sort appears to be the case, at least for those whose religion is based on the Old Testament. Self-preservation is presented in such religions as a duty, though one that is limited by some inconsistent provisos. Thus a person may sacrifice his life to save others in war, or he may die a martyr’s death in a just cause; but if he were to reason that there was not enough food in the family to go round, and therefore killed himself to save the others from starvation (a fate, like many others, considerably worse than death), this would be regarded as the sin, and erstwhile crime, of suicide. Whether performed for his own benefit or to benefit others, the act of suicide would be condemned as equivalent to breaking out from prison before the expiry of the term fixed, a term for which there can be no remission.
The old notions about suicide, with an influence still lingering on, are well summarized by Sir William Blackstone in his famous Commentaries on the Laws of England (1765–9): “The suicide is guilty of a double offence: one spiritual, in invading the prerogative of the Almighty and rushing into his immediate presence uncalled for; the other temporal, against the King, who hath an interest in the preservation of all his subjects.”
Religious opposition to suicide is of decreasing importance as people become ever more detached from dogmas and revelationary teachings about right and wrong. The important matter to be considered is that while the humanist, the agnostic or the adherent of liberal religion seldom condemns suicide as a moral obliquity, he appears on the whole to find it as depressing and horrifying as the religious believer for whom it is sinful. There are many reasons for this, some good, and some regrettable.
Indoctrination against suicide is regrettably to be found at all levels. In itself the tendentious expression “to commit suicide” is calculated to poison the unsuspecting mind with its false semantic overtones, for, apart from the dangerous practice of committing oneself to an opinion most other things committed are, as suicide once was, criminal offenses. People are further influenced by the unhappy shadow cast over the image of suicide by the wide press coverage given to reports of suicide by students who are worried about their examinations, or girls who are upset over a love affair, or middle-aged people living alone in bed-sitting-rooms who kill themselves out of depression―troubles that might all have been surmounted, given time. In pathetic cases such as these, it is not, as it seems to me, the act of suicide that is horrifying, but the extreme unhappiness that must be presumed to have induced it. Death from despair is the thing that ought to make us shudder, but the shudder is often extended to revulsion against the act of suicide that terminates the despair, an act that may be undertaken in very different circumstances.
The root cause of the widespread aversion to suicide is almost certainly death itself rather than dislike of the means by which death is brought about. The leaf turns a mindless face to the sun for one summer before falling for ever into the mud; death, however it comes to pass, rubs our clever faces in the same mud, where we too join the leaves. The inconceivability of this transformation in status is partly shot through with an indirect illumination, due to the death of others. Yet bereavement is not death. Here to mourn, we are still here, and the imagination boggles at the notion that things could ever be otherwise. Not only does the imagination boggle, as to some extent it must, but the mind unfortunately averts. The averted mind acknowledges, in a theoretical way, that death does indeed happen to people here and there and now and then, but to some extent the attitude to death resembles the attitude of the heavy smoker to lung cancer; he reckons that if he is lucky it will not happen to him, at least not yet, and perhaps not ever. This confused sort of faith in the immortality of the body must underlie many a triumphal call from the hospital ward or theatre, that the patient’s life has been saved―and he will therefore die next week instead of this week, and in rather greater discomfort. People who insist that life must always be better than death often sound as if they are choosing eternal life in contrast to eternal death, when the fact is that they have no choice in the matter; it is death now, or death later. Once this fact is fully grasped it is possible for the question to arise as to whether death now would not be preferable.
Opponents of suicide will sometimes throw dust in the eyes of the uncommitted by asking at some point why one should ever choose to go on living if one once questions the value of life; for as we all know, adversity is usually round the corner, if not at our heels. Here, it seems to me, a special case must be made out for people suffering from the sort of adversity with which the proponents of euthanasia are concerned: namely, an apparently irremediable state of physical debility that makes life unbearable to the sufferer. Some adversities come and go; in the words of the Anglo-Saxon poet reviewing all the disasters known to Norse mythology, “That passed away, so may this.” Some things that do not pass away include inoperable cancers in the region of the throat that choke their victims slowly to death. Not only do they not pass away, but like many extremely unpleasant conditions they cannot be alleviated by pain-killing drugs. Pain itself can be controlled, provided the doctor in charge is prepared to put the relief of pain before the prolongation of life; but analgesics will not help a patient to live with total incontinence, reduced to the status of a helpless baby after a life of independent adulthood. And for the person who manages to avoid these grave afflictions there remains the spectre of senile decay, a physical and mental crumbling into a travesty of the normal person. Could anything be more reasonable than for a person faced with these living deaths to weigh up the pros and cons of living out his life until his heart finally fails, and going instead to meet death half-way?
It is true, of course, that, all things beings equal, people do want to go on living. If we are enjoying life, there seems no obvious reason to stop doing so and be mourned by our families and forgotten by our friends. If we are not enjoying it, then it seems a miserable end to die in a trough of depression, and better to wait for things to become more favorable. Most people, moreover, have a moral obligation to continue living, owed to their parents while they are still alive, their children while they are dependent, and their spouses all the time. Trained professional workers may even feel that they have a duty to society to continue giving their services. Whatever the grounds, it is both natural and reasonable that without some special cause nobody ever wants to die yet. But must these truisms be taken to embody the whole truth about the attitude of thinking people to life and death? A psychiatrist has been quoted as saying: “I don’t think you can consider anyone normal who tries to take his own life.” The abnormality of the suicide is taken for granted, and the possibility that he might have been doing something sensible (for him) is not presented to the mind for even momentary consideration. It might as well be argued that no one can be considered normal who does not want to procreate as many children as possible, and this was no doubt urged by the wise men of yesterday; today the tune is very different, and in this essay we are concerned with what they may be singing tomorrow.
There is an obvious connection between attitudes to birth and to death, since both are the fundamentals of life. The experience of this century has shown that what may have appeared to be ineradicably basic instincts can in fact be modified in an advanced society, and modified not merely by external pressures, but by a corresponding feedback movement from within. Primitive people in general take pride in generating large families, apparently feeling in some deep-seated way that motherhood proves the femaleness of the female, and that fatherhood proves the maleness of the male, and that the position in either case is worth proving very amply. This simple pride is not unknown in advanced countries, although public applause for feats of childbearing is at last beginning to freeze on the fingertips, and a faint rumble of social disapproval may be heard by an ear kept close to the ground. The interesting thing is that it is not purely financial considerations that have forced people into limiting their progeny, and least of all is it the public weal; people have actually come to prefer it. Women want to lead lives otherwise than as mothers; men no longer feel themselves obliged to assert their virility by pointing to numerous living tokens around them; and most parents prefer to concentrate attention and affection upon a couple rather than a pack. The modification in this apparently basic drive to large-scale procreation is now embraced not with reluctance, but with enthusiasm. My thesis is that humane and advanced societies are ripe for a similar and in many ways equivalent swing away from the ideal of longevity to the concept of a planned death.
It may be worth pausing here to consider whether the words “natural end,” in the sense usually ascribed to the term, have much bearing on reality. Very little is “natural” about our present-day existence, and least natural of all is the prolonged period of dying that is suffered by so many incurable patients solicitously kept alive to be killed by their disease. The sufferings of animals (other than man) are heart-rending enough, but a dying process spread over weeks, months or years seems to be one form of suffering that animals are normally spared. When severe illness strikes them they tend to stop eating, sleep and die. The whole weight of Western society forces attention on the natural right to live, but throws a blanket of silence over the natural right to die. If I seem to be suggesting that in a civilized society suicide ought to be considered a quite proper way for a well-brought-up person to end his life (unless he has the good luck to die suddenly and without warning), that is indeed the tenor of my argument; if it is received with astonishment and incredulity, the reader is referred to the reception of recommendations made earlier in the century that birth control should be practiced and encouraged. The idea is no more extraordinary, and would be equally calculated to diminish the sum total of suffering among humankind.
This will probably be taken as, or distorted into, a demand for the infliction of the death penalty on retirement. And yet the bell tolls for me no less than for others. Apart from the possibility that he may actually have some sympathy for the aged, no one casting a fearful eye forward into the future is likely to advocate treatment of the old that he would not care to see applied to himself, lest he be hoist with his own petard. It cannot be said too many times that so long as people are blessed with reasonable health, reasonable independence and reasonable enjoyment of life, they have no more reason to contemplate suicide than people who are half their age, and frequently half as sprightly as many in their seventies and eighties today. Attention is here being drawn to people who unfortunately have good reason to question whether or not they want to exercise their right to live; the minor infirmities of age, and relative weakness, and a slight degree of dependence on younger people who regard the giving of a helping hand as a natural part of the life-cycle, do not give rise to any such question. The question arises when life becomes a burden rather than a pleasure.
Many middle-aged people are heard to express the fervent wish that they will not live to be pain-ridden cripples, deaf, dim-sighted or feeble-minded solitaries, such that they may become little else than a burden to themselves and to others. They say they hope they will die before any of these fates descend upon them, but they seldom affirm that they intend to die before that time; and when the time comes, it may barely cross their minds that they could, had they then the determination, take the matter into their own hands. The facile retort will often be that this merely goes to show that people do not really mean what they say and that like all normal, sensible folk, they really want to live on for as long as is physically possible. But this, I would suggest, is a false conclusion. They mean exactly what they say, but the conditions and conditioning of society make it impossible for them to act in accordance with their wishes. To face the dark reality that the future holds nothing further in the way of joy or meaningful experience, and to face the fact without making some desperate and false reservation, to take the ultimate decision and act upon it knowing that it is a gesture that can never be repeated, such clear-sightedness and resolution demand a high degree of moral strength that cannot but be undermined by the knowledge that this final act of self-discipline would be the subject of head-shakings, moralizings and general tut-tutting.
How different it would be if a person could talk over the future with his family, friends and doctors, make arrangements, say farewells, take stock of his life, and know that his decision about when and how to end his life was a matter that could be the subject of constructive and sympathetic conference, and even that he could have his chosen ones around him at the last. As things are at present, he would always be met with well-meant cries of “No, no, you mustn’t talk like that,” and indeed anyone taking a different line might feel willy-nilly that his complicity must appear unnatural and lacking in affection. We feel that we ought to become irrational at the idea that someone we care for is contemplating ending his own life, and only the immediate spectacle of intense suffering can shock us out of a conditioned response to this situation. The melancholy result is that a decision that cries out for moral support has to be taken in cheerless isolation, and if taken at all is usually deferred until the victim is in an advanced state of misery.
But supposing the person contemplating suicide is not in fact undergoing or expecting to undergo severe suffering, but is merely an elderly relation, probably a mother, in fragile health, or partially disabled, and though not acutely ill is in need of constant care and attention. It would be unrealistic to deny the oppressive burden that is very often cast on the shoulders of a young to middle-aged person, probably a daughter, by the existence of an ailing parent, who may take her from her career when she is a young woman in her thirties of forties, and leave her, perhaps a quarter of a century later, an elderly, exhausted woman, demoralized over the years by frequently having had to choke back the wish that her mother would release her by dying. Even in a case such as this, human feeling does demand, I would think, that the younger person must still respond to intimations of suicide with a genuinely felt, “No, no.”
But what of the older person’s own attitude? Here we arrive at the kernel of the violent and almost panic-stricken reaction of many people to the idea of questioning whether it is better, in any given situation, to be or not to be. For if there is no alternative to continued living, then no choice arises, and hence there can be no possibility of an older person, who is a burden to a younger person, feeling a sense of obligation to release the captive attendant from willing or unwilling bondage, no questioning of the inevitability of the older person’s living out her full term. But what if there were a real choice? What if a time came when, no longer able to look after oneself, the decision to live on for the maximum number of years were considered a mark of heedless egoism? What if it were to be thought that dulce et decorum est pro familia mori? This is a possibility that makes many people shrink from the subject, because they find the prospect too frightful to contemplate. Is it (to be charitable) because they always think themselves into the position of the younger person, so that “No, no” rises naturally to their lips, or is it (to be uncharitable) because they cannot imagine themselves making a free sacrifice of this sort?
This very controversial issue is, it may be remarked, outside the scope of voluntary euthanasia, which is concerned exclusively with cases where a patient is a burden to himself, and whether or not he is a burden to others plays no part whatever. The essence of voluntary euthanasia is the co-operation of the doctor in making crucial decisions; the “burden to others,” on the contrary, must make all decisions and take all responsibility himself for any actions he might take. The issue cannot, however, be ignored, because the preoccupation of many opponents of voluntary euthanasia with its supposed implications, suggests that few people have any serious objection to the voluntary termination of a gravely afflicted life. This principal theme is usually brushed aside with surprising haste, and opponents pass swiftly on to the supposed evils that would flow from making twilight existence optional rather than obligatory. It is frequently said that hard-hearted people would be encouraged to make their elderly relatives feel that they had outlived their welcome and ought to remove themselves, even if they happened to be enjoying life. No one can say categorically that nothing of the sort would happen, but the sensibility of even hard-hearted people to the possible consequences of their own unkindness seems just as likely. A relation who had stood down from life in a spirit of magnanimity and family affection would, after an inevitable period of heart-searching and self-recrimination, leave behind a pleasant memory; a victim of callous treatment hanging like an accusing albatross around the neck of the living would suggest another and rather ugly story. Needless to say, whoever was responsible would not in any event be the sort of person to show consideration to an aged person in decline.
Whether or not some undesirable fringe results would stem from a free acceptance of suicide in our society, the problem of three or four contemporaneous generations peopling a world that hitherto has had to support only two or three is with us here and now, and will be neither generated nor exacerbated by a fresh attitude to life and death. The disabled, aged parent, loved or unloved, abnegating or demanding, is placed in one of the tragic dilemmas inherent in human existence, and one that becomes more acute as standards of living rise. One more in the mud-hut is not a problem in the same way as one more in a small, overcrowded urban dwelling; and the British temperament demands a privacy incompatible with the more sociable Mediterranean custom of packing a grandmother and an aunt or two in the attic. Mere existence presents a mild problem; disabled existence presents a chronic problem. The old person may have no talent for being a patient, and the young one may find it intolerable to be a nurse. A physical decline threatens to be accompanied by an inevitable decline in the quality of important human relationships―human relationships, it is worth repeating, not superhuman ones. Given superhuman love, patience, fortitude and all other sweet-natured qualities in a plenitude not normally present in ordinary people, there would be no problem. But the problem is there, and voluntary termination of life offers a possible solution that may be better than none at all. The young have been urged from time immemorial to have valiant hearts, to lay down their lives for their loved ones when their lives have hardly started; it may be that in time to come the disabled aged will be glad to live in a society that approves an honorable death met willingly, perhaps in the company of another “old soldier” of the same generation, and with justifiable pride. Death taken in one’s own time, and with a sense of purpose, may in fact be far more bearable than the process of waiting to be arbitrarily extinguished. A patient near the end of his life who arranged his death so as, for example, to permit an immediate transfer of a vital organ to a younger person, might well feel that he was converting his death into a creative act instead of waiting passively to be suppressed.
A lot of kindly people may feel that this is lacking in respect for the honorable estate of old age; but to insist on the obligation of old people to live through a period of decline and helplessness seems to me to be lacking in a feeling for the demands of human self-respect. They may reply that this shows a false notion of what constitutes self-respect, and that great spiritual qualities may be brought out by dependence and infirmity, and the response to such a state. It is tempting in a world dominated by suffering to find all misery purposeful, and indeed in some situations the “cross-to-bear” and the willing bearer may feel that they are contributing a poignant note to some cosmic symphony that is richer for their patience and self-sacrifice. Since we are talking of options and not of compulsions, people who felt like this would no doubt continue to play their chosen parts; but what a truly ruthless thing to impose those parts on people who feel that they are meaningless and discordant, and better written out.
What should be clear is that with so many men and so many opinions there is no room here for rules of life, or ready-made solutions by formula, least of all by the blanket injunction that, rather than allow any of these questions to be faced, life must be lived out to the bitter end, in sickness and in health, for better of for worse, until death brings release. It is true that the embargo on suicide relieves the ailing dependent of a choice, and some would no doubt be glad of the relief, having no mind for self-sacrifice. But in order to protect the mildly disabled from the burden of choice, the severely sick and suffering patient who urgently wants to die is subjected to the same compulsion to live. The willingness of many people to accept this sheltering of the stronger at the expense of the crying needs of the incomparably weaker may be because the slightly ailing are more visible and therefore make a more immediate claim on sympathy. Everyone knows aged and dependent people who might find themselves morally bound to consider the advisability of continuing to live if an option were truly available; the seriously afflicted lie hidden behind hospital windows, or secluded from sight on the upper floors of private houses. They are threatened not with delicate moral considerations, but with the harder realities of pain, disease and degeneration. Not only are they largely invisible, but their guardians are much given to the issuing of soothing reports about, for example, the hundred thousand or more patients who die of cancer every year, reports in which words like “happiness” and “dignity” are used liberally, and words like “pain” and “humiliation” tactfully suppressed. Let us not be misled by the reassuring face so often assumed by doctors who would have us believe that terminal suffering is just a bad fairy tale put out by alarmist bogey-men. One can only hope that the pathetic human wrecks who lie vomiting and gasping out their lives are as sanguine and cheerful about their lamentable condition as the smiling doctor who on their behalf assures us that no one (including members of the Euthanasia Society) really wants euthanasia. . . .
Here again it must be made clear that what is needed is the fostering of a new attitude to death that should ultimately grow from within, and not be imposed from without upon people psychologically unable to rethink their ingrained views. The suffering and dying patients of today have been brought up to feel that it is natural and inevitable, and even some sort of a duty, to live out their terminal period, and it would do them no service to try to persuade them into adopting an attitude that to most of them would seem oppressive, as aimed against them rather than for their benefit. If people have an ineradicable instinct, or fundamental conviction, that binds them to cling to life when their bodies are anticipating death by falling into a state of irrevocable decay, they clearly must be given treatment and encouragement consistent with their emotional and spiritual needs, and kindness for them will consist of assurances that not only is their suffering a matter of the greatest concern, but that so also is their continued existence. It is future generations, faced perhaps with a lifespan of eighty or ninety years, of which nearly half will have to be dependent on the earning power of the other half, who will have to decide how much of their useful, active life is to be devoted to supporting themselves through a terminal period “sans everything,” prolonged into a dreaded ordeal by ever-increasing medical skill directed to the preservation of life. It may well be that, as in the case of family planning, economic reality will open up a spring, the waters of which will filter down to deeper levels, and that then the new way of death will take root. The opponents of euthanasia conjure up a favorite vision of a nightmare future in which anxious patients will be obsessed with the fear that their relatives and doctors may make surreptitious plans to kill them; the anxiety of the twenty-first century patient may, on the contrary, be that they are neglecting to make such plans . . . focusing attention on practical steps, how is this to be brought about? Should schoolchildren be asked to write essays on “How I Would Feel if I Had to Die at Midnight” or compositions envisaging why and in what circumstances they propose to end their lives? The answer may well be that they should. An annual visit to a geriatric ward might also be in order. The usual argument against facing up to such reality is that life is long and death is short, and that dwelling on an unfortunate aspect is morbid and best shunned. . . . But instant death is granted to few, and the others would be well advised to expect to be an unconscionable time a-dying, and partly a-dying, and be prepared to meet the challenge not only of death, but of the unconscionable time preceding it. I would contend that the true end of education should be to prepare the pupil to learn in the course of life to orientate all knowledge and experience within the framework of a life bounded by decline and death, and to regard a timely and possibly useful death as the summation of the art of living. Pending the comfort of a death-conditioned society, a recommended exercise for the individual who is minded to reconcile himself to dying is a constant making and remaking of wills. An evening spent distributing largesse, followed by the clearing of the desk, the answering of letters and the paying of accounts, has the effect of a direct invitation to the Almighty to take you while you are in the mood to add your final touch to the day’s work.
It is, of course, all too easy to make light of death when it seems far from imminent, and all too easy for someone who has had a satisfying life to say that other people, who may have had very little happiness, must learn to accept that their one and (ostensibly) only life must now cease. It may well turn out that we who insist on the right to come to terms with death before life becomes a burden may, when the time comes, be found to fail in our resolute purpose, and may end our lives by way of punishment in one of the appalling institutions provided by the state for the care of the aged. The failure may be due to physical helplessness coupled with the refusal of others to give the necessary help, or it may be due to a moral failure ascribable to personal weakness and the pressures of society, pressures that sometimes take a form too oblique to be recognized as twisters of the mind. Ending with a further complaint about linguistic misdirection, my final objection to tainted words is that a patient ending his own life, or a doctor assisting him to end it, is said to “take life,” just as a thief “takes” property with the intention of depriving the owner of something he values. Whatever it is that is taken from a dying patient, it is nothing he wants to keep, and the act is one of giving rather than taking. The gift is death, a gift we shall all have to receive in due course, and if we can bring ourselves to choose our time for acceptance, so much the better for us, for our family, for our friends and for society.