Opinion In thinking of the good death, what are the lines we ought to draw?

arranging the time was the closest one could come to “being there”, at least in imagination.

Medical Assistance in Dying, now legal in several countries, is not the same as euthanasia, passive euthanasia, or, even more importantly, suicide. In MAiD the only reason for not wanting to live is the fact that you are close to dying or some possible severe impairment; whereas in suicide, you have reasons independent of the illness to want to die. Or so we console ourselves. There is, arguably, still something important about the near taboo on suicide (having a taboo on it does not mean stigmatising those who attempt it). But what are the conditions under which it really is just a choice between two forms of dying?

In the worldwide movement to liberalise norms on assisted dying, from the Netherlands to Australia, Spain to Britain, this question is answered differently. Passive euthanasia, or the withdrawal of treatment, is already widespread. Our courts also paved the way for it in the Aruna Shanbaug judgment. Many countries permit Medical Assistance in Dying, but under different conditions.

In Britain, the disease must be terminal, with a prognosis of not more than six months. Canada, Switzerland, and the Netherlands have more liberal regimes. In the Netherlands, assisted dying accounts for close to five per cent of all deaths. The right to die with dignity is a growing worldwide movement. Most of Asia, ironically, has the most restrictive legal regimes.

The right to die with dignity was first given the form of a movement in modern India by Minoo Masani. Changes in longevity, new forms of disease and suffering are already making these questions more morally and practically urgent. Masani reminded listeners that ancient philosophies were concerned with dying the good death as much as with the good life. In India at least, the philosophical and literary imagination of choosing death is among the richest — from Ram’s Jal Samadhi to Jain Santhara. We have one of the deepest reservoirs for thinking about the phenomenology of death and the anticipation of dying. Masani’s concern was that we should not shy away from the subject.

We may be in a world where settling on common public meanings of death and dying is nearly impossible. Like so much else, even death has become privatised, a retreat from shared meaning, because it now has too many incommensurable ones. From the point of view of expanding the right to die with dignity, the policy and institutional issues are thorny. How do we ensure that the act of choosing to die is not a reflection of social failure, economic distress, loneliness, or lack of palliative care? In fact, the hospice movement is one of the more unexpected sources of opposition to the right to die.

A philosopher friend of mine used to joke that the subject of death is also where arguments go to die. Masani, and much of the modern movement expanding the right to die, rests on the value of autonomy: It should be an expression of one’s choice. But this is not a straightforward argument. When does valuing autonomy entail permitting the extinguishing of the autonomous agent?

The argument for MAiD and some forms of euthanasia is to avoid a circumstance where a person is no longer able to function as an autonomous agent. David wanted to walk out as an autonomous person. But David’s emails made the neat arguments about autonomy and suffering rest more on fragile foundations. I had written to him two weeks before his departure about his early work on international law. He wrote back, “You cheered my whole day. One thing is not in doubt. My deep love for India in spite of its flaws. Canada seems dull and pedestrian beside it. I miss my Indian friends a lot, you among the most. But I hope we meet in a better universe in the future.” Then there was a PS: “I am sorry this is too short. Lines are becoming an agony for me, as I make splg (spelling) mistakes as I go along.”

The agony was palpable. The passages of lucidity were becoming intermittent. But struggling with spelling? The lucidity of the sentiment? I could not decide where the line lay, where David’s dignity and autonomy would be compromised. I envied David his certainty. But I was also uneasy at how swiftly a private terror can become a public principle. Has Canada gone too far? India not far enough? As more countries move toward assisted dying, autonomy will be invoked to justify choices shaped as much by loneliness, inequity and institutional abandonment as by illness itself. David walked towards a line he could still see. But what lines we ought to draw in thinking of the good death remains an open question.

The writer is contributing editor, The Indian Express