IS HUMAN DEATH NATURAL?

By Gabriel Moran

In many ways Sherwin Nuland is at the opposite end of the spectrum from Kubler-Ross, who is often accused of being a nineteenth-century romantic. She seems to suggest that if people have enough time and are helped by a sensitive counselor they will (and should) peacefully accept their dying. What I find surprising and intriguing is that a common theme is found in On Death and Dying and How We Die, namely, that death is "natural." Neither author tries to prove the point; the naturalness is a given.

It should be noted that what seems so obvious now was not the case before the l960s. Physicians were trained to fight against death as an enemy that stalks human beings. Despite always eventually losing, physicians were never to surrender to the enemy. Many physicians today are understandably confused by a quick shift in the public attitude toward death. The new stance is represented in a line that Nuland regularly repeats: "Death is not the enemy, disease is." Were physicians wrong in always refusing to give up the battle with death? I think the answer is yes. But the alternative to fighting death as an external enemy may be more complex than saying "death is natural."

Medical science until very recently was the most dramatic expression of the enlightenment philosophy that pitted "man" against "nature." Death may belong to nature but it is outside "man." The death of the human individual comes from the outside, an invader from the real enemy (nature) that still waits to be conquered. Sigmund Freud was a product of this enlightenment mentality, even if in other ways he was bringing the era to a close. In The Future of an Illusion, Freud writes: "The principal task of civilization, its actual raison d'etre, is to defend us against nature....No one is under the illusion that nature has already been vanquished." Freud was at that moment introducing a "death instinct" into his anthropology, an admission that death is not an external enemy but an inner component of the human being.

In the eighteenth-century language that still bedevils us, "man" was to conquer and dominate nature. Scientific and technological progress was imagined to be the result of this conquest. And indeed until recently there seemed to be much progress; nature was in retreat and "man" saw himself as master of the earth. The dirty little secret behind the victory communiques was that although "man" was succeeding, men and women kept dying every minute of every day. The individual's death, in the middle of man's triumphs, became more galling. The stricken person inevitably felt "how come if man is so powerful, I am so weak?"

The period of western enlightenment viewed itself as a world apart from "primitive" people and their religions. Yet I think there is a remarkable similarity in their outlooks on death. In Primitive Mentality, Levy-Bruhl writes that "uncivilized people do not regard death as natural, but an interference by the magical powers of enemies." Compare that belief with the modern premise expressed by Simone de Beauvoir's A Very Easy Death: "There is no such thing as a natural death: nothing that ever happens to a man is ever natural, since his presence calls the world into question. All men must die: but for every man his death is an accident, and, even if he knows it and consents to it, an unjustifiable violation."

Faced with a death rate that remained 100%, the confident announcements of progress eventually had to sound hollow. C.S. Lewis's Abolition of Man in l948 was one of the first books that sensed the revolution about to occur in the second half of the century. In that book, Lewis writes: "'Man has nature whacked' said someone to a friend of mine not long ago. In their context the words had a certain tragic beauty for the speaker was dying of tuberculosis." Lewis sensed that although this dying person described himself as "one of the casualties of the winning side," a momentous shift was about to redefine what winning and losing means and who is on what side. Of nature, Lewis writes: "All of our supposed victories have turned out to be tactical withdrawals. We thought we were driving her back while she was leading us on. What we thought were hands held high in surrender were arms extended to embrace us forever."

As the alternative to a bitter and unwinnable war against nature, we are now told on all sides that the answer is to follow nature. No line is more common in contemporary advertising than the claim that the product is "all natural." Many environmentalists think that nothing is more obvious than the fact that man must return to nature. Man in his arrogance (often attributed to "Judeo-Christian tradition") has considered himself outside nature; the obvious solution is man inside nature. Everything about man is natural, including his death. In 1976 California passed legislation called "The Natural Death Act."

If death is (or should be) natural then we should accept it, whether it be the painless death that Kubler-Ross holds out hope for or the undignified death that Nuland says is our more likely lot. This attitude of acceptance seems a lot saner than the posturings of a Sartre that "man makes himself" in a place "outside nature, against nature." But the language of man/nature is still floating about in this discussion as the only currency. The complex relations of men, women and nonhuman organisms cannot be explored within the language of man/nature.

The most consistent meaning of nature throughout more than 2500 years has been that which is born, grows, declines, dies. The humans cannot step outside nature, that is, they cannot remove themselves from the cycle of living and dying. Human death is not unnatural; it is not opposed to nature because "man" is not opposed to nature. But to say that human life is natural is not to say enough. Bertolt Brecht's "they die like all the animals" is not in fact true. They die as do all animals but they foresee their deaths in ways that alter not only human life but other life on earth. They ritualize death in puzzling ways so that "the gorilla, the chimpanzee and the orangutan must look upon the human as the weak and infirm animal that stores up its dead" (Ortega y Gasset).

The humans' nature is to transcend nature. Unless they understand and work with the rhythms of nature (both within and outside themselves), they are likely to mess up processes of nature. Humans are in the food chain but their presence radically alters the whole chain. What is not natural about humans is expressed in such terms as history, culture, reason, intelligence, freedom and science. In Edmund Burke's succinct phrase, "man's nature is art." Even if they were to try, humans could not abandon their art, science, politics and religion. Placed in the middle of the world's garden, they are the responsible ones. They are not one species equal to all the others but the species receptive to meaning within nature.

Nuland seems genuinely puzzled that anyone could take issue with the statement that (human) death is natural. He identifies his main opponents as research scientists who are trying to find a way to prevent death. Of course, to reject death as a culminating event in human life would be to go against nature. The inability to accept death becomes the inability to accept life. Much depends, however, on the manner of this acceptance.

All the major religions of the world would object to reducing human death to the natural. Between the primitive notion of death as a punishment for angering the gods and the modern picture of death as external opponent, there arose Jewish, Buddhist, Christian, Muslim and other religions in which dying is more than natural. Even during the last two centuries while "man was conquering nature," individuals found their life's meaning outside the battle, usually in religion. An individual today who does not subscribe to one of these religions is still likely to have a more than natural view of his or her own dying. Writing a book, painting a picture or singing a song can be an attempt to find meaning beyond death. So is caring for the next generation and the generations beyond that.

All of the major religions understood that the human being is natural but not entirely so. The natural drive toward death is paired with the will to live a human life. That life from its inception involves resistance to nature with its accompanying death. Very often these days one hears the statement that "we should not prolong life artificially." But the whole of history is a story of prolonging life artificially, that is, the use of artifice to protect humans against heat, cold, infection, starvation. The person who resists death to the last moment is not necessarily denying that death is natural, that is, a part of life. Nonetheless, humans have some nonnatural control over the manner and timing of their dying.

How humans go to their deaths depends on how they are related to other humans and to the cosmos. Putting people to death painlessly may sometimes be the last, extreme choice. But the research efforts of medical science and the professional attention of health care workers should mainly be directed to the human context of dying. Our marvelous technology has to be put at the service of life inclusive of human death, one that respects the dignity of the person.

Every human being, by reason of its humanity, deserves respect even when the physical conditions of dying are mostly dehumanizing. Nuland's attempt to "demythologize" dying with dignity can unwittingly diminish attention to improving the environment of the dying, leaving the staffs of hospital or nursing to throw up their hands and declare that there is no dignity in dying. The task is always for the living to provide a setting that is as respectful of the dying as is possible under the circumstances. The human being cannot just die a natural death. The context will give it either more than natural meaning, or, in the absence of human care, an unnatural quality. No matter how difficult the circumstances, the community of the living is always called to pay respect to the death of a human being.

 

 

 

 

 

 

 

 

 

 

 

Acceptance of death has to be understood so as to include the attitude expressed in Reynolds Price's extraordinary memoir, A Whole New Life. Price recounts his intense struggle against dying, without for a moment denying that death is part of life. To his fellow sufferers who are diagnosed as having a fatal disease, he offers this advice:

The visible laws of physical nature are willing to last

as long as you can. Down at the core you almost certainly

want to survive. You're of course quite free to balk that

wish by killing yourself and ending your physical will to

endure, but amazingly few people choose death by suicide.

And fewer still consider the strangeness of their endless moaning when death is so easy. To be sure, either God or the laws of nature will eventually force you to fall and die. But that event can tend to itself, with slim help from you. Meanwhile, whether you see yourself as the temporary home of a deathless soul or as the short-term compound of skin and bone called Homo Sapiens, your known orders are simply to Live. Never give death a serious hearing till its ripeness forces your final attention and dignified nod.

Price is aware that these days such an attitude is liable to be misunderstood as a failure to accept death as natural. He therefore further advises:

And keep control of the air around you. Many well meaning mates, lovers and friends will stand by, observing that you're in the throes of blind denial - "Give up, Let go". Get them out of your sight and your hearing with red-hot haste; use whatever force or fury it takes. Then see who you can live with now.

The call for legal and assisted suicide fits within the framework of death as more than natural. Unfortunately, this cause is being pushed without an adequate context. The basic human right is the right to live, not the right to die. When an individual is sick, he or she has the right to be cared for by fellow human beings. Only when this context of care is present and when the individual can decide within this context that dying is appropriate, might it then be moral to hasten death. The United States seems on the verge of a mindless rush to suicide as the answer to a lot of problems. One thing is clear about suicide: it is not natural, a fact that neither condemns nor justifies it. Only the humans can contemplate their own deaths and decide when the time for dying has arrived.

How humans go to their deaths depends on how they are related to other humans and to the cosmos. Putting people to death painlessly may sometimes be the last, extreme choice. But the research efforts of medical science and the professional attention of health care workers should mainly be directed to the human context of dying. Our marvelous technology has to be put at the service of life inclusive of human death, one that respects the dignity of the person.

I think Sherwin Nuland fundamentally misreads the phrase "dying with dignity." Granted it has tended to become a cliche and it may not be able to bear the ethical burden. Nonetheless, the ethical principle from which the phrase gets clipped is that a human being has a right to be treated with dignity, even while dying. Nuland repeatedly attacks the phrase "dying with dignity" as expressive of an unrealistic expectation, as a quality of dying that the individual has been led to expect. But the phrase, at least in its origin, is a demand upon the caring community.

Every human being, by reason of its humanity, deserves respect even when the physical conditions of dying are mostly dehumanizing. Nuland's attempt to "demythologize" dying with dignity can unwittingly diminish attention to improving the environment of dying. The staffs of hospital or nursing home may throw up their hands and declare that there is no dignity in dying. The task is always with the living to provide for the dying a setting that is as respectful of the human being as is possible under the circumstances.

The most positive statement that Nuland allows for dying with dignity is that "the dignity that we seek in dying must be found in the dignity with which we have lived our lives." While I would not wish to argue against living a dignified life, the statement still misplaces the emphasis. Humans do not acquire dignity by how they have lived their lives; they are worthy of dignity by the fact of being human. And even those who - according to fallible human judgments - have not lived good lives (for example, condemned criminals), have a right to be treated with dignity when dying.

The human being cannot just die a natural death. The context will give it either more than natural meaning, or, in the absence of human care, an unnatural quality. No matter how difficult the circumstances, the community of the living is always called to pay respect to the death of a human being.

 

 

 

 

 

 

 

 

 

 

Dec. 28, 1994

 

Dear Editor,

Would you be kind enough to consider the enclosed essay for publication? I think it provides a needed context for some debated issues today. I have enclosed a brief curriculum vitae should you need it.

 

Thanks,

Gabriel Moran

 

 

 

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