In October, the Canadian clothing retailer Simons launched a promotional commercial featuring Jennyfer Hatch, a 37-year-old woman who had recently applied, and been approved, for medical assistance in dying (MAID) due to her nonterminal condition of Ehlers-Danlos syndrome. The commercial was upbeat, featuring Jennyfer dancing and laughing with her friends at various scenic locations. In a voice-over, she describes how she imagines her final days: “there is still so much beauty.” The company’s campaign was a clear attempt to center different kinds of lives—including lives that were quickly ending. Yet the public responses were so resoundingly negative that Simons pulled the commercial just days after it had begun to run.
The new year brings changes for Canadian laws affecting MAID policy. Previously, assisted dying was allowed only in cases of terminal illness, but the law was expanded in 2021 to allow applications from nonterminal patients. As a result of tireless advocacy from the activist group Dying with Dignity, MAID will be further expanded in March to allow people to access the services for mental illnesses. While this decision has been highly controversial, especially among policy and medical experts, supporters of MAID expansions argue that there is nothing about suffering due to terminal illness that makes it worse than suffering from nonterminal conditions. Suffering is suffering, and if someone’s suffering is relentless and irremediable, to the point that they no longer desire to go on living, this decision should be theirs and theirs alone.
When the Simons commercial launched, I tweeted the link, along with commentary on how unsettled I was by the ad. Soon after making the tweet, I received a reply from a man who identified as a cancer survivor. Perceiving me to be against physician-assisted death (a presumption not entirely off, but also not entirely correct) he commented, “Why do you want me to feel pain?”
Why do I want him to be in pain? The easy way to respond to this question is, obviously, to deny the assumption. I do not want him, or anyone, to be in pain. I started writing the following reply: “I don’t want you to be in pain, but I also do not want you to be dead.” But I was stopped by my own thoughts: Why? Who is he, to me? He was a stranger on Twitter; I had never met him, nor even, to my knowledge, interacted with him before. I knew nothing about him except that he was suffering, and he (apparently) preferred death to continued life. There was nothing I could say, no prescription I could offer in the face of a suffering stranger.
Sophocles’s Oedipus Rex is one of the most influential works of literature in the Western canon, in large part because it provides a timeless and universal picture of human suffering. In the play, Oedipus, the king of Thebes, hunts furiously for an incestuous murderer hiding in his city’s midst, whose presence brings divinely sanctioned famine and plague. Even an unfamiliar audience will know the ending long before Oedipus can admit it to himself. By the concluding act, the king has lost his wealth and his power. His children are proven to be illegitimate offspring of an incestuous marriage, and his wife/mother has committed suicide out of shame. Oedipus has fallen from the heights of power and happiness to the depths of complete loss and ruination, and exiles himself from the city.
Oedipus’s search for the perpetrator is more than a detective story; the audience observes Oedipus displaying the supremely human trait of being unable to face the suffering he knows is in store for him. Even the chorus of Theban elders, who have been following Oedipus around during his search, struggle to keep watching as the plot begins to unfold. When it becomes undeniable that Oedipus is the only person who could fit the description of the criminal given by the oracle, rather than accept Oedipus’s tragic fate, the chorus begins to doubt the oracle:
Zeus and Apollo know, they know, the great masters
of all the dark and depth of human life.
But whether a mere man can know the truth,
whether a seer can fathom more than I—
there is no test, no certain proof…
The same self-preserving optimism arises in two standard ways of responding to MAID laws: both, in different ways, involved a turning away from the real existence of suffering persons. Those who fight for expansive MAID laws often seem to be seeking a world that lacks all reasons for those who are deeply suffering to continue existing. If someone wants to die, they can die; if they stay alive, they must not have truly wanted to die. A recent defense of Canada’s new laws by Richard Hanania goes even further, arguing that “Suicide is in many cases a noble and heroic act,” preserving the dignity of the sick and incapacitated, and that “it can be a gift to their families” who are doubtless suffering themselves under caretaking responsibilities and medical bills. Here, the desire to die is given a sort of humanistic gloss. In the Simons commercial, Jennyfer Hatch is no longer a woman suffering tremendously from a painful and debilitating connective-tissue disorder—rather, she is a social, effervescent, artistic soul who appears to be utterly at peace. Death is no longer the enemy, a dreaded foe or the tragic end of those who simply cannot bear the agony of living any longer. Instead, one could have “a good death,” a final chapter that could be just as unique and personalized as every other chapter of one’s life. That one has maximal options for when, where and how to die are marketed like a pair of shoes. Even in death, we are more comfortable talking about consumers than sufferers.
In Canada, the number of consumers of death has grown every year MAID has been legal. In 2021, 3.3 percent of deaths in Canada were medically assisted, a huge increase from 2.5 percent in 2020, and 2 percent in 2019. In Quebec alone, 4.7 percent of 2021 deaths were medically assisted. In the Netherlands, the country that previously held the most permissive laws pertaining to MAID, the percentage of medically assisted deaths over the same period was 4.5 percent, with numbers increasing every year. In the U.S. there is a similar trajectory. While physician-assisted death is only legal so far in ten states and Washington, DC, legalization is extremely popular: somewhere between 61 percent and 74 percent of American adults support legalization, depending on how the question is phrased, nearly double the amount of support it enjoyed in 1947. Even as treatment options improve for serious and terminal illnesses, requests to die are increasing year by year. One explanation for this may be reduced stigma: as MAID becomes normalized and socially accepted, those in chronic pain may feel that simply ending their suffering is more of a real option. But another possible explanation—one that seems plausible in light of the continuous exponential increase in applications—is that living with chronic or degenerative conditions is simply becoming less bearable. Regardless of one’s position on MAID laws, the possibility of this second explanation is deeply troubling.
At the same time, those who oppose MAID also often fail to look truly irremediable suffering in the eye. Much anti-MAID argumentation focuses on the ways that such laws may unequally coerce the vulnerable, arguing that those “driven by poverty and a lack of access to adequate health care, housing, and social services, have turned to the country’s euthanasia system.” The worry is that the poor and marginalized may be more willing to accept a quick death rather than burdening their caretakers or suffering an absence of basic needs. Such considerations recently resulted in a pause to the new mental illness amendment to the Canadian MAID law—and for good reason. A law that pressures the needy into ending their own lives rather than demanding their needs be met is not a law fit for implementation. But these discussions avoid rather than address the central question: Why do you want me to be in pain?
It is easy to dispute the ethics of legalizing physician-assisted death when the need could be addressed simply by increasing access to housing or pain medications or other forms of palliative care. It is a far less simple matter when one considers cases that involve a slow but unstoppable descent into deeper and deeper levels of physical and mental anguish, cases where one will surely thrash endlessly in agony, intubated and immobile, often alone, within the sterile confines of a hospital bed. The implication for many who oppose MAID is that a sufficient supply of resources should all but eliminate the public desire for MAID. Yet this position is difficult to hold in the face of data. Of all Canadians who died by MAID last year, over 80 percent of them received government-funded palliative care, and nearly 90 percent of those who did not receive such care had access to it.
We as a culture are excellent at ignoring suffering, in all its forms. We bury the sick and elderly alive behind the walls of nursing homes, in underfunded hospitals and overcrowded shelters. We push the vulnerable out of our line of vision by placing spikes on benches in town, building methadone clinics outside city limits and enacting zoning laws that ensure the suffering of poverty need never be seen by those who have sufficient wealth. There is, perhaps, no more human response to suffering than the urge to turn away from it, no more human response to inevitable disaster than to say, “Surely it can’t be that bad.”
Yet, like Sophocles’s chorus, we too cannot keep our backs turned from tragedy forever. While MAID is debated in the abstract and technical language of parliamentary halls and academic journals, the question echoes insistently from the sidelines and comment sections: Why do they want us to be in pain? Despite the implication of the original comment, I am not convinced this question assumes its own answer. That is, I am not convinced the only way to answer it humanely is to say, “I want you to be pain-free, and if the only way to do that is by ending your life, then you should do so.” Pain is an inextricable feature of a human life—to keep living is to knowingly choose to be anguished at some point. The question asks for a reason, and the listener assumes there is no reason one could give that would not be callous, paternalistic or cruel.
It is no spoiler, I hope, to note that Oedipus Rex ends with the king gouging out his eyes with the dead queen’s jewelry, completing the metaphor of his refusal to look upon the horror he has wrought. He begs to be exiled from the city, away from all humans, so that Thebes may be allowed to prosper once again. But despite the revelation that he himself is the cause of Thebes’s sorrows, the chorus never turns angrily against the king to punish him for their troubles, nor do they continue to deny the reality of his pitiful situation. Rather, they break into their own song of lament:
O child of Laius, would to god
I’d never seen you, never never!
Now I weep like a man who wails the dead
and the dirge comes pouring forth with all my heart!
I tell you the truth, you gave me life
my breath leapt up in you
and now you bring down night upon my eyes.
It is extremely hard to look unflinchingly upon another’s agony. When Oedipus’s true identity—and self-inflicted disfigurement—is brought to light, the chorus, finally forced to face the reality of the situation, shrink back in horror. But their king begs them to return:
it’s all right. Touch the man of grief.
Do. Don’t be afraid. My troubles are mine
and I am the only man alive who can sustain them.
The chorus returns, moved by Oedipus’s cries. And where before they had wailed, “would to god / I’d never seen you, never never,” the play now ends with their instruction to their fellow citizens to
look on Oedipus.
He solved the famous riddle with his brilliance,
he rose to power, a man beyond all power.
Who could behold his greatness without envy?
Now what a black sea of terror has overwhelmed him.
In The Genealogy of Morals, Nietzsche discusses his contention that “pain did not hurt as much” in ancient times as it does in the modern world. After considering less plausible explanations for what might account for a difference in physical sensations, Nietzsche argues that modern conditions make suffering more difficult to bear:
What actually arouses indignation over suffering is not the suffering itself, but the senselessness of suffering: but neither for the Christian, who saw in suffering a whole, hidden machinery of salvation, nor for naïve man in ancient times, who saw all suffering in relation to spectators or to instigators of suffering, was there any such senseless suffering.
But while Nietzsche tries to swiftly debunk such understandings of suffering, we should be skeptical of how quickly he dismisses the value of such “spectators.” In the play, a “messenger” character, used to inform the audience of what is happening to Oedipus offstage, announces the imminent departure of the king from the city:
Now he’ll tear himself from his native earth,
not linger, curse the house with his own curse.
But he needs strength, and a guide to lead him on.
This is sickness more than he can bear.
Oedipus’s suffering, in light of the climactic revelation, is recognized here as being beyond the ability for any one person to bear on his own. The messenger suggests appointing Oedipus a helper to guide him—a companion to bear this new life of miserable estrangement, almost a stand-in for the city, which suffers alongside its disgraced king. Sophocles, using the voice of the messenger, displays an awareness of a feature of suffering that is seldom acknowledged in discussions of MAID: that suffering has a communal quality to it. Why do you want me to be in pain? This question is sensible only when posed by a suffering person to those not suffering the pain themselves. The man who replied to my tweet asked a sensible question: What gave me the right to try to prevent his desired death? I, a stranger, could not experience his pain. Our fates were not bound up with one another’s in any meaningful way; his suffering was his, and his alone. What reason could I cite for opposing any legal means that could bring a peaceful end to his agony?
And of course, there is a dimension of suffering that is inescapably personal. It is hard to watch others suffer in ways we cannot alleviate. But when we shirk this duty by looking away, we abandon the sick and dying to endure waves of senseless pain alone. We deprive our suffering members of spectators who, simply by refusing to look away, carve out for them a place in the city.
It is no coincidence that applications for physician-assisted death around the world continued to rise during the COVID-19 pandemic, a time when social isolation and lack of community reached unprecedented heights. Living now beyond such isolation measures, in the midst of building back our institutions and communities, we have an opportunity to choose to suffer alongside others. Understanding suffering as a communal responsibility requiring a communal response will, in part, involve a redistribution of resources toward those who need them the most. For example proposed laws like the Credit for Caring Act could relieve much financial stress from caregivers and, thereby, from those they are caring for. It will also involve rejecting policies that seek to keep us ignorant of the suffering within our city limits, such as Missouri’s new law that makes sleeping on state-owned land illegal and subject to fining. Fighting policies like these involve resisting the temptation to cover up suffering for the sake of pleasant views and property values. It will likely involve citywide projects (for example, these two in Madison, Wisconsin) to house and care for their vulnerable citizens within neighborhoods, rather than simply driving them to the outskirts. Most crucially, it will involve individuals choosing to resist taking the easy way out of duties of care and recognition. It would be a lie to say that I am optimistic that this will occur on a broad scale. But until we make these changes, however we vote on future MAID laws, we will do so with bloody hands.
When one member of a community suffers, it is only right for others in the community, in whatever ways they can, to lament this suffering along with them in a way that shares in the sorrows. It is fitting to offer com-passion (literally, “to suffer with”). Likewise, when many suffer along with a suffering member of the community (be it a family, a religious organization, a neighborhood, a city, etc.) this lamentation works not to reduce the suffering but to make the experienced suffering more bearable. Viktor Frankl, a psychiatrist known for the creation of what he called “logotherapy,” famously argued, “In some way, suffering ceases to be suffering at the moment it finds a meaning.” This is not a perfect explanation for Oedipus’s situation; his suffering remains suffering, and while there is a definitive cause, it’s not clear the suffering is made meaningful in a telic sense. But there is something close to meaning attained by the suffering person who is given a definitive place in a community of co-sufferers. When one’s existence and experience is affirmed through a chorus’s song and a devoted companion, a seemingly unshareable burden can, in some ways, be shared.