Tuesday, June 08, 2021

We’ve been great at extending our lives, but not at ending them.

Steven Pinker does a review of Steven Johnson's recent book "Extra Life - A Short History of Living Longer," whose subject matter overlaps considerably with Chapters 5 ("Life") and 6 ("Health") of Pinker's book "Enlightenment Now" that MindBlog abstracted in a series of posts March 1-12, 2018.
Starting in the second half of the 19th century, the average life span began to climb rapidly, giving humans not just extra life, but an extra life. In rich countries, life expectancy at birth hit 40 by 1880, 50 by 1900, 60 by 1930, 70 by 1960, and 80 by 2010. The rest of the world is catching up. Global life expectancy in 2019 was 72.6 years, higher than that of any country, rich or poor, in 1950...Of the eight innovations that have saved the most lives, as Johnson sees it, six are defenses against infectious disease.
The sin of ingratitude is said to condemn one to the ninth circle of hell, and that’s where we may be headed for our attitudes toward the granters of extra life. In the list of inventions that saved lives by the hundreds of millions, we find antibiotics (squandered to fatten chickens in factory farms), blood transfusions (condemned as sinful by the devout), and chlorination and pasteurization (often mistrusted as unnatural). Among those that saved lives by the billions, we find the lowly toilet and sewer (metaphors for the contemptible), artificial fertilizer (a devil for Whole Foods shoppers) and vaccines (perhaps the greatest invention in history, and the target of head-smackingly stupid resistance).
Johnson shakes us out of our damnable ingratitude and explains features of modernity that are reviled by sectors of the right and left: government regulation, processed food, high-tech farming, big data and bureaucracies like the Food and Drug Administration, the Centers for Disease Control and Prevention and the World Health Organization. He is open about their shortcomings and dangers. But much depends on whether we see them as evils that must be abolished or as lifesavers with flaws that must be mitigated.
A New Yorker essay by Brooke Jarvis also reviews Johnson's book and recaps the story of extending our lives, but moves on to consider another goal that we have been much less clear on - attaining a good death - by reviewing Katie Engelhart’s “The Inevitable: Dispatches on the Right to Die," which describes the right-to-die underground, a world of people who ask why a medical system so good at extending their lives will do little to help them end those lives in a peaceful and painless way. She gives the stories of people who have managed their exit through using the manual "The Peaceful Pill Handbook."
In the United States, physician-assisted suicide is permitted in a slowly growing number of states, but only to ease the deaths of patients who fit a narrow set of legal criteria. Generally, they must have received a terminal diagnosis with a prognosis of six months or less; be physically able to administer the drugs to themselves; have been approved by doctors as mentally competent to make the decision; and have made a formal request more than once, including after a waiting period.
Doctors who specialize in aid in dying often distinguish between “despair suicides,” the most familiar version, and “rational suicides,” those sought by people who have, in theory, weighed a terminal or painful or debilitating diagnosis and made a measured, almost mathematical choice about how best to deal with it. In practice, though, Engelhart finds that it’s hard to isolate pure rationality; many emotional factors always seem to tilt the scales. People worry about their lives having a sense of narrative integrity and completion. They worry about autonomy, and about “dignity” (this is another word that comes up a lot, and when Engelhart digs in she finds that many people define it quite specifically: control over one’s own defecation and mess). They worry about what other people will think of them. They worry about who will take care of them when they can no longer take care of themselves.
Behind every fraught ethical debate about physician-assisted suicide stands this inescapable reality: there are many people for whom the way we do things is not working. The right to die can’t be extricated from a right to care. One of the doctors Engelhart interviews—an oncologist in Belgium, where euthanasia laws are widely supported, and aid in dying is legal even for psychiatric patients who request it and qualify—tells her that America is not ready for such laws. “It’s a developing country,” he says. “You shouldn’t try to implement a law of euthanasia in countries where there is no basic healthcare.”

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