Letting Go: the Good Death and Ethics of Dying Well
Roberto Dell'Oro, Ph.D., Director and Professor, Bioethics Institute Loyola Marymount University
It is not easy to add entirely new perspectives to the vast bioethics literature that has emerged, over the years, on the ethics of dying well. The passing of “aid-in-dying” laws in several states, whether defined by statutes, or as a result of popular referenda, simply stokes a fire that was never really extinguished, only kept alive, under the embers of previously defined conceptual systematizations, by new publicized cases of requests for “assistance” in dying. This is the case because what is at stake in the conversation is the problem of articulating the conditions for a good death – and more specifically, for a good death when faced with the vulnerability of old age, terminal disease, and unbearable suffering.
The debate on the good death – and thus on the normativity of dying – seems paradoxical, in that it unfolds on the premise of a suspension, a bracketing, placed on the anthropological meaning of death. One often speaks of the ethics of dying, of “dying well”, but without always knowing in relation to what. Moral discourse, especially in bioethics, claims to provide normative criteria. It does so, however, on the presupposition of a suspension of any symbolic horizon capable of attributing meaning to death, of saying what death is, what it represents for the person. How could such an approach provide recommendations toward a truly good and dignified death? The existential aspects of death and dying, when considered in their experiential value, that is, as dimensions of our journeying (experior), and, likewise, in their value of trial (peiros), as for example in physical pain or the suffering of loneliness -- all these aspects cannot be left unaddressed. Faced with this existential wager, we must, once again, ask ourselves the question: what is a good death?
One could say that a good death cannot be envisaged other than as the fulfillment of a good life, and this with reference to a life that will inevitably age. Death will be considered good when it succeeds in expressing the meaning of living, understood as living well. That living well can and must end, at times even tragically, and why – these are questions that do not belong to the discipline of ethics per se. Yet ethics cannot even begin to reflect on its proper criteria if not, at least implicitly, beginning with an answer to this question. I believe such question has a metaphysical quality to it: it touches upon the notion of our ultimate attitude to being as such and to the meaning of things. I would like to briefly sketch out two “existential modalities”, one might say, two paradigms, wherein an ethics of aging and death are expounded. Relying upon the work of Leuven philosopher William Desmond, I will call these paradigms the conatus essendi, i.e., the effort to be, and the passio essendi, the suffering of being, respectively, and delineate their ethical implications with respect to the care of the dying.
The debate on the good death – and thus on the normativity of dying – seems paradoxical, in that it unfolds on the premise of a suspension, a bracketing, placed on the anthropological meaning of death. One often speaks of the ethics of dying, of “dying well”, but without always knowing in relation to what. Moral discourse, especially in bioethics, claims to provide normative criteria. It does so, however, on the presupposition of a suspension of any symbolic horizon capable of attributing meaning to death, of saying what death is, what it represents for the person. How could such an approach provide recommendations toward a truly good and dignified death? The existential aspects of death and dying, when considered in their experiential value, that is, as dimensions of our journeying (experior), and, likewise, in their value of trial (peiros), as for example in physical pain or the suffering of loneliness -- all these aspects cannot be left unaddressed. Faced with this existential wager, we must, once again, ask ourselves the question: what is a good death?
One could say that a good death cannot be envisaged other than as the fulfillment of a good life, and this with reference to a life that will inevitably age. Death will be considered good when it succeeds in expressing the meaning of living, understood as living well. That living well can and must end, at times even tragically, and why – these are questions that do not belong to the discipline of ethics per se. Yet ethics cannot even begin to reflect on its proper criteria if not, at least implicitly, beginning with an answer to this question. I believe such question has a metaphysical quality to it: it touches upon the notion of our ultimate attitude to being as such and to the meaning of things. I would like to briefly sketch out two “existential modalities”, one might say, two paradigms, wherein an ethics of aging and death are expounded. Relying upon the work of Leuven philosopher William Desmond, I will call these paradigms the conatus essendi, i.e., the effort to be, and the passio essendi, the suffering of being, respectively, and delineate their ethical implications with respect to the care of the dying.