Timing your exit

Charles Cowling


Posted by Charles Cowling


Extracted from an article in yesterday’s New York Times: 

I hope you had the chance to read and reread Dudley Clendinen’s splendid essay, “The Good Short Life”. Clendinen is dying of amyotrophic lateral sclerosis, or A.L.S. If he uses all the available medical technology, it will leave him, in a few years’ time, “a conscious but motionless, mute, withered, incontinent mummy of my former self.” 

Clendinen’s article is worth reading for the way he defines what life is. Life is not just breathing and existing as a self-enclosed skin bag. It’s doing the activities with others you were put on earth to do. 

But it’s also valuable as a backdrop to the current budget mess. This fiscal crisis is about many things, but one of them is our inability to face death — our willingness to spend our nation into bankruptcy to extend life for a few more sickly months. 

Years ago, people hoped that science could delay the onset of morbidity. We would live longer, healthier lives and then die quickly. This is not happening. Most of us will still suffer from chronic diseases for years near the end of life, and then die slowly. 

Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside. We are never coercively going to give up on the old and ailing. But it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing — confront death and their obligations to the living. 

My only point today is that we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon. 

Lessons applicable to the UK, obviously. Read the whole article in the NYT here. If you missed Dudley Cleninden’s piece, read it; it’s brilliant and important. Here


4 thoughts on “Timing your exit

  1. Charles Cowling
    gloria mundi

    Just to add: and reading about inspiring people along.
    Good post, good comments, thanks.

    Charles Cowling
  2. Charles Cowling
    gloria mundi

    Some of Jonathan’s lines here go in The Manual.It is indeed sometimes very difficult to read what’s on the page before reading what’s in our heads, but his sort of writing helps.

    The lack of a certain kind of respect for the inevitability of the Reaper, the idea that there’s an absolute right to survival, the refusal to accept our own mortality – these are surely powerful social ills. In blackest moments, do you not think that only a species perspective will help human civilisation still be here in 150 years? Communal survival.

    We don’t have to put Alzeimer’s patients, or sickly premature babies, out on the frosty hillside, as the Spartans apparently did with their male born (“if he makes it, he’s a Spartan warrior; if he doesn’t, he wasn’t,” sort of thing)

    But we should be more honest about the worth of a week or two of survival, or even a month or two of survival,sustained in a state that could only just be called life, at enormous cost. We find it difficult to be honest about this, because our fear of death makes it difficult to be honest about mortality. As the man said, at the last check, the mortality rate was still 100%. Suck it up, as they say in US media.You’ll enjoy life more if you do.

    And it seems to me changes in funerals and the lead-up to them are, or can be, part of changing people’s attitudes towards our mortality.

    Charles Cowling
  3. Charles Cowling

    Thanks for the book recommendation.

    Yes, you identify the problem: people will think it’s all about money – “You’re getting too expensive; we’re going to do you in.” And that’s not what he’s saying. But what he does say touches on a social responsibility to raise a white flag when it’s clear where we’re headed. A good point. Yes, there needs to be a greater acceptance of the fact that we’re going to die and no one’s going to come running in panting at the last minute with a reprieve.

    Responses to Clendinen’s piece here: http://www.nytimes.com/2011/07/15/opinion/l15als.html?_r=1&emc=tnt&tntemail1=y

    Charles Cowling
  4. Charles Cowling

    David Brooks bravely exposes himself to the obvious criticism that he’s valuing life in dollars. Of course, he’s not saying insufficient budget is sufficient cause to invite patriotic suicide, but people often read what’s in their head before what’s on the page, and I’d expect the usual barrage of uninformed resistance to what he’s not saying. But he has a very relevant point.

    I for one mourn the death of our right to claim the Captain Oates spirit – “I’m going outside, I may be some time.” It’s the same principle: that we live as a tribal community with a common survival interest, except that survival now is not valued most for the fittest but has become an end in itself, falsely valued as an unassailable right for the victims of our terror of mortality.

    Medicine is merely an extremely valuable aid to health and survival, but it has become a shrine on which we worship the impotent god of physical immortality with costly sacrifices of our personal integrity.

    It is not always prolonging life so much as leaning against the door of the waiting chamber where Death must linger. He has the right to our reverent respect, and our cost in withholding it is counted in dollars as well as in grief. And as Brooks points out, ironically it’s counted in our own communal survival.

    I would point the interested reader to John Humphry’s and Dr Sarah Jarvis’ book; ‘The Welcome Visitor’ – the title speaks for itself.

    Charles Cowling

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