070 - On The Will To Live - Moral Letters for Modern Times
Today the sun is shining and everywhere Spring is in evidence. Fragrant blossoms perfume the air and please the eyes with vibrant bursts of color that stand out among rich fields of green. Life returns, refreshed and revitalized after its winter lull and pause! And yet, not every sprig has sprouted. The blueberry bushes my wife and I transplanted have seen their numbers reduced by a fifth, bare stems reminding us that life is also precious and fickle. Was it a nick of the shovel, a few too many rocks blocking the roots, or water that failed to flow when needed? The gardener and farmer take life the least for granted, because they know what conditions it requires to flourish as well as how easily it can slip away.
Much of philosophy, Deuteros, and certainly a great deal of Stoic writing, is concerned with what it means to live a good life. What are the pursuits that give life meaning, and how should we conduct ourselves during our lives? The Stoics believed that a person should become a gardener tending their own well-ordered mind so they could live their lives according to reason. This meant applying reason to every sort of situation, positive or negative, and behaving according to reason rather than the unthinking passions of the moment. Living well thus also meant contemplating the end of life and dying well.
Have you noticed how many topics people today consider inappropriate for polite conversation? Consider: we are all bound for one and the same destination. Though we usually delight in sharing every detail of our planned vacations, this is one pending trip that remains an open secret, known by all but unmentionable. Yes, we’re all traveling there together, but if you mention it, you are as welcome as the dog who drags a dead woodchuck into the living room. Better that you actually raise the dead than raise the specter of thinking of death and let zombies loose on our imaginations.
The Stoics understood that wanting things and fearing things prevents people from living in peace. Because wanting and fearing are conditions of the mind, the thought goes, mastering the mind provides the key to contentment. If fear of death disrupts the good life, then it must be confronted. I fear that in modern society we have completely lost the lessons and the practices of the ancients and have turned things on their heads. We have surrendered fully to the pursuit of more: more things, more life, more experiences. When we know from the evidence daily before our eyes that more is no guarantee of better. We close our minds to things that are unpleasant to think of, as if merely shutting our eyes could make the danger disappear.
“Where does our willful blindness come from? Why have we forgotten that what is limited is precious, and quantity alone is no guarantee of quality?” I put the blame at the feet of two of our oldest professions: first, doctors, about whom more in a moment; and second, those purveyors of hourly pleasure, selling themselves to the highest bidder without regard for the person purchasing their services. I speak of lawyers, about whom also more in a moment, though you may prefer less of them.
Doctors have progressed far beyond the alchemy of their early days. Their collective progress in prolonging life has made some into mad scientists, pushing the boundaries of life extension outward, outward. There is no part of the human body that we will not repair, cut out, or replace, if it means the machine can be kept ticking. No part, that is, except the soul and the mind, which stubbornly resist being duplicated by our best 3-D printers.
“What,” you say, “would you have our medical professionals forget their Hippocratic Oath? They are bound by millennia of ethics to not only ‘do no harm or injustice’ to their patients, but also not to administer poison though asked, or to suggest it be taken.” I say keep reading the Oath, my dear Deuteros, for the following words are misinterpreted by many today:
Into whatsoever houses I enter, I will help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman.
Does it really help the incapacitated or terminally ill to extend by any means their stay on earth for so long as our mad scientists can manage? Can it ever be intentionally wrong to shock a heart back into beating, after the manual massage of cardiopulmonary resuscitation has failed? Is it always a help to keep a body breathing by mechanical ventilator after the will to breathe no longer comes from within? Can it not be abuse to force feed a body by intravenous tube when all desire to eat has fled?
We ourselves might make a different decision were it our own body lying on the table, but the patient who cannot make a decision at all is assumed to always want more: keep the fluids in my body flowing, hook me up to every machine, spare no expense in my maintenance! Though the patient may have been a little lax in their own preventative care, we assume that they mean for others to move mountains to now make up for their neglect.
But how inconsistent we are when it comes to choosing the manner of our deaths! The one who is mute is assumed to ask for every aid. Yet the ones who have their faculties intact and their individual agency at hand put their powers to killing themselves and others with abandon. Consider that most of the deaths in the U.S. today count our own behavior as primary or contributing causes: heart disease, respiratory diseases, stroke, diabetes. It is not blaming the patient to note that a healthy weight and diet, and an active lifestyle, help prevent or mitigate many chronic conditions. Cancer is near the top of death’s choice of weapons, and while it is an indiscriminate killer, some versions are certainly courted by their victims, if not downright invited in to dance.
(And this does not even count the intentional deaths, those actively sought out, of which abortion would be the silver medalist on the podium were we to include it in the statistics for causes of death. We do not count abortion because the unborn do not count. I am not arguing the point about when life beings. I observe merely that murder, suicide, and execution represent but small figures compared to what happens to the unborn, who themselves are least able to express their wishes.)
How and why did this come to pass, Deuteros? Why did we need government accountants to invent the quality-adjusted life year or QALY to tell us that we can determine the economic value of medical interventions by measuring both the quality and the quantity of life lived? That a year lived in perfect health is worth more than one lived in pain and ill-health, and indeed that some health states can be considered “worse than dead”?
Well, let me speculate on a possible reason. If the medical profession has transcended alchemy to arrive at a practice more resembling science, the legal profession has found a way to work true magic: that is, they can speak for the dead. To that short list of things that can be guaranteed in life, death and taxes, we can add a third, lawsuits. No accident, no death, no act, no inaction, no treatment, but that a lawyer will be standing by to take the case.
A tort claim has only a few ingredients: duty, breach, cause, and harm. Doctors more than most professionals owe a duty to their patients. Did we not just recite sections of the Hippocratic Oath, proof of what we intuitively understand? If the patient suffers an adverse outcome in a doctor’s care, a lawyer can easily argue all the other elements of negligence: there must have been some failure (breach), and without it (cause) my client would not have died (harm). Aristotle could have been describing the plight of doctors practicing modern medicine when he said:
There is only one way to avoid criticism: do nothing, say nothing, and be nothing.
This condition leads to predictable outcomes: a strong bias to seek preservation of life at all costs. I may raise the costs of your care exponentially, but that is less expensive to me than getting sued for failing to pursue a possible treatment. So you will be kept alive whether you want it or not. At least in part, it is lawyers speaking for the dead who drive such interventions. But when patients are free to speak for themselves, they are considerably less concerned about extending life in all circumstances. The explosion of living wills and advance directives is proof that laypersons know what professionals do not: we do not want to live forever if it means our quality of life is ignored. Everyone draws the line differently. Ease my pain with palliative care, but do not perform extraordinary measures. Do not resuscitate, intubate, or ventilate.
No matter how much people close their eyes to the consequences of their daily decisions, and conveniently ignore that they will one day have to pay the bill for their lavish expenditures, still I think many instinctively know that their end can be of their choosing. The will to live does not always serve you best by driving you to seek more. You may find that you achieve a better life by virtue of contemplating the end of your life and working backwards from that point to living a meaningful life.