How to Be Old & Die Well

Assisted dying is about to be legalized in Britain as it already is in Canada

This short introduction to medically assisted dying, a complex and deeply divisive issue, is the first in what I hope will be a series of posts exploring The State of Your Health. I have been searching for a new, integrated direction for my Substack and believe I have found it.

But do not despair: I Intend to make it funny as well as informative. And to give you a taste of what I mean, here is Lewis Carrol on a subject all too often beset by a cranky tone and a long mien: Old Age, a condition that awaits or has already found us all.

Seriously though, Health, how we get it, whose responsibility it is and how we lose it is a powerful theme that is calling me during this time of widespread illness, excess deaths and dwindling faith in the public health system. Health is both a highly personal as well as political and even spiritual matter and how we frame it is of the utmost significance. In addition, rethinking health is going to be on the political agenda in North America for the foreseeable future since Trump has appointed RFK Junior to return the diseased public health system in the US to a semblance of health. Even if you think Trump is crazy, nobody during this aftermath of a mismanaged pandemic can pretend that all is well with public health. So I am going to do my bit to shed some light on why we are so fat, so ill, and so despondent here in North America. (It’s a different situation in Europe). And what we personally can do to change and what the body politic must do to help us stay healthy. The pandemic has done severe damage to the State of Your Health, but perhaps the one good thing outcome is to reveal just how diseased and corrupt the body politic is and how the ill health outcomes in America are not accidental but the result of flawed policies concocted in full view between big government and big, greedy corporations. Yes, Pfizer does come to mind. This is, quite literally, a matter of our life and our death.

I have been studying and also following so called ‘alternative health’ for most of my life so this is not a new interest but rather an attempt to deepen and summarize what I know and also integrate new research as it becomes available. For example, I discovered a fascinating bit of research into Alzheimer's disease and what it might actually be this very morning. According to researchers at the Krembil Brain Institute, part of the University Health Network in Toronto, this dreaded disease may be an auto immune reaction and not strictly speaking a ‘brain disease’. This idea might be a piece of the emerging puzzle that shows a marked increase in Alzheimer’s cases since the Covid-19 vaccinations. I will return to this subject in later posts. But for now, I want to return to the Assisted Dying controversy.

What is the fundamental difference between the young and the old? The young almost never think about death or dying while the old have no choice but to ruminate on how long they have left and if life is even worth living anymore when their bodies malfunction and extreme pain a daily, hourly reality. This is reducing a highly complex issue to its bare bones, I know. And it leads straight to the question of who has the right to decide when it’s time to leave. Just as with abortion, fundamental questions about life and death are about the values a society shares. And the West no longer has that shared ethical foundation. We walked away from the religious world view with the Enlightenment and have found ourselves floundering. There is a general sense that we urgently need to revisit our storehouse of ethics and religious faith because without those guidelines we cannot make ethical decisions. We are sinking into a morass of competing ‘rights’ that cannot be resolved except by appealing to a higher moral or spiritual authority.

Having said that, helping people die when they decide that they’ve had quite enough of pain and suffering has always been one of those deeply divisive issues where there is no right or wrong, even though we reduce it to a legal question because that is how our society works. But it is not a legal issue; it is fundamentally an ethical and spiritual one. A society that cannot agree if we are mere bodies or if we are animated by a soul and whether or not the soul is in fact immortal—such a society is bound to fight over whether or not we ought to have the ability to die when we want, and if the state should be allowed to play a role. It has become a much more visible issue of late because we live longer but are also not living better. The gap between healthy longevity and chronic illness is fast becoming a chasm that even drugs cannot lessen.

Since I live in Canada where the right to die has been legal since 2008 I can report from personal experience. https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html

MAID, the awful misnomer of the Canadian system of assisted dying, has been doing very well, if you want to equate growth with success. Indeed, it’s so successful that the British are now following in our footsteps, though all we hear about is its terrible dangers and sliding down an ever present slippery slope into full-on medical dystopia where doctors routinely and legally kill their patients. This is in stark contrast to how the media framed it before the law was passed.

I remember it well: All we heard then were tragic tales about people who wanted to escape from terminal and painful illness by assisted dying and were prevented from doing that. It was illegal to assist anyone in the process of dying even if they begged for it. The fight for that right was long and bitter. But now that we are getting what we thought we wanted, we seem to be suffering from some kind of buyer’s remorse, the British Parliament notwithstanding. The very high and growing numbers of MAID users is making many people nervous. I believe this is a sign of an overall, severe post-pandemic disillusionment with how our public health systems operate and especially with the bureaucrats in charge. We no longer trust them, full stop. Which leaves the question of how to die in peace and without pain without an answer.

Speaking from personal experience, I have one friend who is signed up though she is not in a terminal state and another close friend, now deceased, who was terminal but never used it. In both cases, they talked about it as a kind of ‘insurance’ against the dreaded prospect of losing control over their situation at the end of their lives. Of being utterly helpless and delivered into the hands of relatives and doctors and the flawed ‘medical system’. Losing control over our bodies and our lives is what we fear and medically assisted dying is supposed to be the remedy. What makes this system frightening is the knowledge that the State cannot be trusted. Given the recent and also historical overreach of public health officials, I think that is a reasonable fear.

Before the law was passed, however, it was an open secret that doctors often administered lethal doses of morphine in spite of it being illegal. I think that the entire controversy might evaporate if we returned the decision and the action to the doctor and simply made it legal for the doctor to do what has been agreed upon with the patient before things got terminal. In other words, take the state bureaucracy out of the death equation and return it to the individual who is ill and the doctor who is treating that person. We’ve had quite enough of massive state bureaucracies interfering in our health and well being. They need to be dismantled because they are not accountable. With AI lurking in the background to turbo charge impersonal health care, they are going to become truly Kafkaesque. On the other hand, AI in the service of individualized health care overseen by a doctor, not a bureaucrat or indentured servant of the State, could open the doors to something new and yes, better able to truly help desperate patients. But we are far from that situation. The medical industrial complex is running the show, not the doctors nor the patients.

I am not immune to the deep rooted aversion we all have to even talk about dying. We are not good at facing that reality in the West. Most of us have never even been in the presence of a dying or dead person. I think it is the British author Diana Athill who, in her memoir, Somewhere Towards the End, when she describes her reaction to her mother’s death, conveys the essence of dying and why it is so confusing to us:

What dies is not a life’s value but the worn-out () container of the self, together with the self’s awareness of itself: away that goes into nothingness, with everyone else’s. That s what is so disconcerting to an onlooker, because unless someone slips aways while unconscious, a person who is just about to die is still fully alive and fully her or himself—I remember thinking as I sat beside my mother ‘but she can’t be dying because she’s still so entirely here’…the difference between being and non being is both so abrupt and so vast that it remains shocking even though it happens to every living thing that is, was, or ever shall be.

Of course Athill, as is evident from this passage, did not believe in a soul or an afterlife for that soul. She was an atheist and would have scoffed at so called Near Death Experiences. That is a subject that has been on the fringes, like UFO’s, for a long time but is suddenly moving into the centre. I hope to explore the implications of this trend next year. As for Athill, she published three highly readable memoirs and died aged 101 in a nursing home, with her mental faculties more or less intact. We should all be so fortunate. I feel like quoting a few more of our novelists and literary giants on this topic, specifically Jonathan Franzen in The Corrections and the perennial favourites, Shakespeare and the Bible. And maybe a few wisecracking humorists. Because as a loosely translated German proverb says, if there are no laughs, nobody will come to the funeral…

My next post will outline how I intend to research and write The State of Your Health. Until then, Be Well.