Earlier this year we published a paper by Dr Kathryn Mannix, a leading consultant in end-of-life care, which drew attention to the unfamiliarity that many of us have today with what dying is like. Any condition, she wrote, which threatens mortality is met with a rush to hospital and the traditions of supporting a family member during a terminal illness have been lost. "A result of the new patterm of dying is that three generations of Britons have been prevented from observing the onset and progress of dying at first hand". What is unfamiliar can all too easily become terrifying. "Even when death would be welcomed", wrote Dr Mannix, "fear of dying badly may haunt the ill and the aged".
The Guardian has this week published a thoughtful article by another doctor, Seamus O'Mahony. In many ways Dr Mannix and Dr O'Mahony are saying something very similar - that the 'problem' (as it is perceived) with death and dying is a social rather than a medical one. As a society we have lost touch with death in recent decades. "Could the perceived 'problem' with death", asks Dr O'Mahoney, " be partly due to the fact that, after decades of our culture being dominated by individualism and consumerism, our respect for other people has diminished?" He draws attention to "the paradox of rising life expectancy accompanied by a contemporary culture obsessed with youth and beauty, dismissive of the old". This obsession with autonomy and control can be seen in demands for legalisation of assisted suicide, which Dr O'Mahony believes is "a distraction" from the real issue.
He is surely right in his diagnosis. As the science of palliative medicine and end-of-life care has advanced in recent years, it has become possible to remove or alleviate the pain and other distress which dying can bring. Yet paradoxically demands for legalisation of 'assisted dying' have risen almost in parallel with these medical advances. It doesn't make sense. Or does it? Could it be that we have changed too, that we have lost touch with death and dying, that we - or at least the more articulate and empowered among us - have grown accustomed to shaping our lives as we wish and that we have come to think we should have designer deaths?
A good death, writes Dr O'Mahony, is not something for doctors to prescribe. "We have", he writes, "thrust on to doctors and hospitals the messy, intractable and insoluble aspects of life, principally old age and death". There is a perception, he says, "that death is a problem that medicine should somehow sort out, that 'a good death' is something that doctors should be able to prescribe, as we might prescribe a course of antibiotics". "But", he writes, "our needs are spiritual, not medical". That is surely right, taking the word spiritual in its broader sense of what pertains to us as human beings. Until we have a serious debate in our society about dying and until we come to see death and dying in their proper perspectives, it is a dangerous irrelevance to be asking doctors to put us down, whether by handing us lethal drugs to swallow or by injecting them into us - an extension of clinical practice about which which most doctors in this country have serious reservations. As we have said before, we need a debate on dying, not assisted dying.