Misthanasia, the Social Death: A Liberating Way to Understand End of Life in Global Public Health
Alexandre Martins, PhD, Marquette University, Milwaukee, WI
When someone dies prematurely from a preventable disease for which effective treatment also exists, we must ask: Why did this person die? What went wrong? These kinds of deaths occur in contexts lacking appropriate health care, or where healthcare resources are inaccessible to those in need, particularly the poor. Paul Farmer refers to these as “Stupid deaths.” Liberation theologians encourage us to look into the faces and learn the names of those who experience such deaths, as well as those at risk of having the same fate. As Eduardo Galeano suggests, there are no nobodies “worthy of less than the bullet that kills them.” This paper examines the reality where these “stupid deaths” occur from the perspective of those most at risk of being their victims – impoverished and historically marginalized communities. In 1989, Brazilian theologian Márcio Fabri dos Anjos published an essay entitled Euthanasia in Liberating Key, arguing that discussions about euthanasia were narrowly focused on biomedical ethics and the physician-patient relationship. He suggested this focus was insufficient to address end-of-life issues in countries marked by poverty, injustice, and oppression. Dos Anjos noted that “euthanasia” traditionally refers to a “good, happy death” for terminal patients. However, he argued that was also necessary to think about those “bad, unhappy deaths” because of the lack of proper medical assistance and those deaths outside hospital settings. Such deaths make us “to think about slow and quiet deaths created by systems and structures.”[1] Hence, he coined the neologism misthanasia to include these slow, quiet deaths in our discussion on the end-of-life and bioethics.
"Misthanasia makes us to think about those who died by hungry… make us to think about the death of an impoverished person, embittered by the abandonment, because the lack of the most basic resources. It also leads us to see the deaths because of torture by brutal political regimes and became disappeared people."[2]
Following essay, misthanasia became part of the bioethical vocabulary in Brazil, representing deaths because of injustice, oppression, and exclusion from health care.[3] Although this concept remains relatively unknown outside Brazil, we recognize its potential for addressing “stupid deaths” that victimize impoverished and marginalized communities globally. Therefore, we argue that misthanasia underscores that the most pressing end-of-life issues in global public health are not related to individual autonomy to choose or refuse care while dying, but rather the daily risk of illness and death faced by those unable to access proper health care. Misthanasia leads us into the reality of suffering and death among the poor and marginalized, urging us to see their faces, learn their names, and work with them to address these injustices.
[1] Mácio Fabri dos Anjos, “Eutanásia em chave de libertação,” Boletim ICAPS 7/57(1989), 6–7, here 6.
[2] Dos Anjos, “Eutanasia em chave de libertação, 7.
[3] Luiz Antonio Lopes Ricci, A morte social: mistanásia e bioética. São Paulo: Paulus, 2017.
"Misthanasia makes us to think about those who died by hungry… make us to think about the death of an impoverished person, embittered by the abandonment, because the lack of the most basic resources. It also leads us to see the deaths because of torture by brutal political regimes and became disappeared people."[2]
Following essay, misthanasia became part of the bioethical vocabulary in Brazil, representing deaths because of injustice, oppression, and exclusion from health care.[3] Although this concept remains relatively unknown outside Brazil, we recognize its potential for addressing “stupid deaths” that victimize impoverished and marginalized communities globally. Therefore, we argue that misthanasia underscores that the most pressing end-of-life issues in global public health are not related to individual autonomy to choose or refuse care while dying, but rather the daily risk of illness and death faced by those unable to access proper health care. Misthanasia leads us into the reality of suffering and death among the poor and marginalized, urging us to see their faces, learn their names, and work with them to address these injustices.
[1] Mácio Fabri dos Anjos, “Eutanásia em chave de libertação,” Boletim ICAPS 7/57(1989), 6–7, here 6.
[2] Dos Anjos, “Eutanasia em chave de libertação, 7.
[3] Luiz Antonio Lopes Ricci, A morte social: mistanásia e bioética. São Paulo: Paulus, 2017.