I’m writing this after hearing an apparently innocuous and encouraging snippet of news — that a new lung cancer treatment is capable of giving sufferers a possible “extra 200 days” of life. Another morning, another “battle against cancer” fought, and in this case won — sort of.
Yet I find myself rather in sympathy with the one in five Dutch doctors who, it was reported this week, would consider helping someone die even if they had no physical problems but were “tired of living.” Because these doctors have the maturity to face the fact that life has a natural end.
The wearying truth is there are just so many “battles,” and they appear to be multiplying all the time. A new drug to treat strokes. A promising initiative on Alzheimer’s. We are fed, daily, the hopeful news: fatal disease is slowly on the retreat. But there’s always one more, and sooner or later we all lose.
Which brings me back to the news item on an extra 200 days for lung cancer sufferers. I found myself wondering: what kind of days? Of course, all days may seem worth living when you are faced with your imminent demise. But sometimes the endless quest to extend our days has the smack of futility about it.
For it seems to me that in the constant narratives of “triumphs” over this disease or that illness, we are not engaged so much in a struggle against disease, but death itself. We are only partially rational beings — and at the non-rational level, we believe medicine will save us from our fates.
Of course we all “know” that we are going to die — but that order of knowledge, for most of us, is of the same kind that tells us we are all made of stardust, or that at the core of the atoms in our bodies and brains there is only a void. In other words, our imagination can’t grasp it.
And good job too, you may say. There is an argument that strong denial mechanisms are essential in order to survive our existential plight. The endless fitness regimes, the constant struggle to find out what “superfood” it is this week that will reduce the chance of this or that threat to our health; even the dangerous sports that convince us that we can outmanoeuvre mortality. Maybe the maintenance of such delusions is the secret of a happy life.
Yet for many the thought won’t quite go away. Thus, we are never quite at peace, because we are always working so hard to keep our eyes from staring at the sun. We immerse ourselves in trivial distractions — shopping, loud music, flashing lights. I watch the runners on Hampstead Heath every day puffing and panting — suffering — in order to put off the big event, and while I admire them, I wonder if it isn’t all in vain. As a recent study on cancer at Johns Hopkins University revealed, lifestyle is somewhat overrated as a panacea for extending life. Researchers found that more than two-thirds of cancers are driven by random mistakes in cell division that are completely outside our control. And beyond that, there are genetic predispositions, also outside our control.
“ Instead of trying to outwit mortal disease, we should be learning to face our fate with courage ”
Furthermore, only this month it was discovered that 50 per cent of people will get cancer — as opposed to one in three, the previous estimate. So perhaps, rather than being at constant battle stations, we should get used to the idea, especially as a former editor of the BMJ, Richard Smith, said it was probably the best way to go: “Nature taking its course.”
I was born with cancer, and spent the first three months of my life struggling to survive. Perhaps as a result I have, since I entered adolescence, been acutely aware of my own mortality. Sometimes it is a heavy burden to bear. But at others it can be a liberation, giving me a sense of immediacy and the perception that each moment is precious.
Ernest Becker in his 1973 classic The Denial of Death suggested that the fear of death was the mainspring of more or less all human activity, and that “it is the disguise of panic that makes us live in ugliness.” This idea stretches much further back — to Epicurus, who believed that the root cause of misery was the “omnipresent fear of death.” St Augustine wrote that “it is only in the face of death that man’s self is born.”
But these ideas are unfashionable. Karl Ove Knausgaard in his remarkable memoir A Death in the Family begins with a brilliant cogitation on death — how when someone dies, we cover up the body as quickly as possible. Then it must be consigned, out of sight. He mentions how during disasters, the same bromide is repeated again and again — “it was like a movie.” But it wasn’t like a movie. It was like reality — because it contained death. And this is what we cannot face.
Why does this matter? Why not stick to our denial mechanisms? At one level, because our desperate need to assert our immortality can lead to great violence — as in fundamentalist religion. At a lower level, because it can suck energy out of life, as we work to keep the great gremlin at bay. And at a practical level, because we are increasingly extending life beyond what it should properly constitute.
My father died two years ago, aged 87, and if I have one regret about his death, it’s that he didn’t die a few months sooner. But the clinging on to life, that extra 200 days, meant that eventually he died unable to speak or hear, totally cut off from the world. A lonely hospital death, that had it been faced earlier, could have been altogether more human.
Death is swept under the carpet. But death is part of life — there could be no meaningful life without it. Casting it as unnatural, even evil, is absurd.
Do we not need to remake our relationship with death? To, as the monks once did, keep a skull on our workplace desks? Or public clocks could be decorated with mottos such as Ultima forsan (“perhaps the last” [hour]) or Vulnerant omnes, ultima necat (“they all wound, and the last kills”).
It sounds morbid. But the battle against mortal disease can never be won because it is a battle against the inevitable. To face our fate is to have the courage to live, even if it means dying a little earlier than the experts, and even our families, might — perhaps with more kindness than wisdom — insist. — © Guardian Newspapers Limited, 2015
