An obiter dictum of history tells us that when an epidemic of the sweating sickness swept through England, King Henry VIII fled London and, panic-stricken, raced from one nobleman’s home to another seeking safety. The panic was justified because the deadly sickness could kill a human within hours of the first symptom appearing.
Life was dangerous then: infections, diseases, famines, epidemics, wars – one never knew where the blow would come from. Even the act of giving birth and being born was dangerous. It is said that more women died in childbirth than men in wars. Infant mortality, too, was huge. The odds were stacked against humans, against their long survival; life was a constant struggle to survive.
The blessing given to the young in India even today is “Aayushman bhava”: live long. Now, we do live long. Nevertheless, the fear of death has not left us. In recent times, the Covid-19 pandemic brought that fear out into the open. We knew then what it was to be helpless, too terrified of an infinitely tiny virus, afraid of dying. The number of euphemisms we have for “death” and “dying” are an indication of our feelings towards the very words.
What then of the actual fact? We come into this world to live; in life we learn about living, not about dying. Living long was, however, a boon granted to few. A lifespan of threescore and 10 years was considered ideal. In actual fact, not many got there. In India, the age of 60 was considered an achievement and celebrated with éclat. In my lifetime I have seen the human life-span steadily climb up. Undoubtedly, there are more 90 year olds on our planet today than the world has ever seen.
Most of this longevity is due to the huge advances made by medical science since the second half of the last century. Miraculous drugs subdued infections, they cured and tamed diseases, cutting edge surgeries came into being and a vast array of investigations as well as replacement therapies emerged. All of these have been life-savers on a very large scale and have contributed to human longevity. Longevity crept so stealthily upon us that we did not notice it until we suddenly found it in our midst.
Even then it took some time to get a glimpse of what it meant. Cities teeming with people should have warned us, but we never imagined that we were galloping at a furious pace towards a catastrophic future. For a world with more of the old than the young is a demographic disaster. And it is not just the fact that there are more old people that is a matter of concern; it is the plight of the old, it is what their lives are like. There is also the problem of a huge gap between the working population and non-working people.
Living is never very easy, except for infants and the very young. For the old, living is much harder. Albert Camus, in his essay The Myth of Sisyphus, compares human life to the plight of Greek mythological figure Sisyphus who had angered the gods and was punished by them. The punishment given to him was to push a large boulder uphill and, on reaching the top, let the boulder roll all the way down, only to push it up again – an endless, futile, repetitive, absolutely purposeless task. As absurd, to use Camus’s own word, as life itself.
The Hindu belief of an unending chain of lives can even seem fearsome. Shankaracharya, in his Bhaja Govindam, speaks of it as “punarapi jananam, punarapi maranam”: once again birth, once again death, then take life in your mother’s womb to live yet again, only to meet death once more. Life after life – for what? How does one go through this? Oh Murari, Shankarachaarya cries out, save me from this endless chain of living and dying. No wonder the enlightened longed for moksha: liberation from these repeated births and deaths.
“Is this the promis’d land?” Kent asks in Shakespeare’s King Lear when Lear enters with Cordelia’s body. The old may ask the same question when they get to the other side of 75. After a lifetime of working hard and raising a family, they look forward to an easier time. Doing what they want to, what they like. Spending more time with family, enjoying the company of grandchildren. Taking it easy. But for how many people does this happen? By the beginning of their 80s, generally a number of people will have lost a spouse, siblings, friends, contemporaries. There are not many left to share memories with.
Loneliness haunts the old; age becomes a burden too heavy to be carried. To which are added fears. Fear of a major illness. Of being bed-ridden and dependent. Of falling and breaking bones. (For the bones of the old are fragile and friable. Nature obviously didn’t intend us to live so long.) Fear of being neglected, of being treated badly. Fear of being alone. Fear of losing control over your own life, of being dominated, exploited. And there’s forgetfulness, which dogs the footsteps of the old. To lose words, faces, names, to struggle to recover them and to fail – this is not a minor failing. It dents your self-confidence, your morale, it hurts your dignity as you grope for the word that’s slipped out of your grasp. Conversation becomes impossible. This, in addition to deafness, almost universal among the old, (again, nature didn’t expect us to live so long) can push an old person into self-imposed isolation. And often there is the problem of money, a fear of money running out as you go on living longer than you expected.
Shakespeare, who was matchless in understanding the human heart and mind, has, in King Lear, depicted Lear’s rapid descent into dementia brilliantly, with all the confusion and contradictions of old age, the wild rambling, occasionally bursting into flashes of lucidity. To his two evil daughters he says:
“I will have such revenges on you both,
That all the world shall – I will do such things, –
What they are, yet I know not: but they shall be
The terrors of the earth.”
“What they are yet I know not/ but they shall be the terrors of the earth”: this is wild exaggeration without substance. Lear’s daughter Cordelia and his faithful followers grieve for the man he was. But that man no longer exists. Age has taken him away. This is always, for family and friends, the most tragic of all possibilities and is the result of living too long. Clearly, old age is not what was envisaged by many of us: a peaceful time of calm and serenity, all the turbulence and storms of life left behind. The old have no control, no choice, except to go on living, however bleak a life it is. If you listen carefully to them you may hear an undercurrent of helplessness. Of frustration. Of questions. How long? How many more years? I am tired, I want to go.
One rarely listens to the old. We are afraid of complaints, of repetitiveness. In fact, people rarely look at the old, either. To look at an old person is to see your own future. Is this what I will look like when I’m old? A frightening thought. One of the problems for the old is that we have embraced the mantra of positivity with such ardor that the old are not even allowed to be old. You are not 75 years old, you are told; you are 75 years young. Age, after all, is only a number. Is it? Is it so impotent, so meaningless? Lear’s words about his own age are a great contrast. “I am a very foolish old man,” he says, “four score and upward. Not an hour more or less.” One wants to applaud this exactitude which is both brave and the truth.
But the point is – if you don’t see the old, if you don’t hear their voices, when there is a reluctance to call the old “old”, how can the problems of the old be recognised, let alone addressed? I remember my mother going to an astrologer friend with her horoscope – this was after she had lived alone for more than 10 years. She showed the astrologer her horoscope, asking hopefully, “When will I die?” And the man gently told her, “We don’t talk of death, we never talk of death.” The taboo on speaking about death is not new. In the Katha Upanishad, a young boy, Nachiketas, gets three boons from Yama, the god of death. As his third boon, he asks Yama for an answer to his question, “A man who is departed, is he or is he not?”
Yama’s reply is that even the gods were doubtful about answering this question. “Ask me whatever you desire,” Yama tells Nachiketas, “health, property, long life and I will give it to you. But ask me not about death.”
No, we don’t talk of death. Why don’t we? Because of our fear of that final end. Because of the unknown that lies beyond it. Today, the same silence surrounds the problem of human longevity. It is baffling that it is still not recognised as a problem.
The problems of the old began when the joint family system ceased to exist. Earlier, the family was a large tree which sheltered people of different generations. For a number of reasons, this changed and the family began shrinking, dwindling to two persons, then finally one. In this system, the old are often left to fend for themselves. Old-age homes and other like institutions have come up, but nothing can take the place of a family.
Eudora Welty, the American writer, speaks of Jane Austen as being born knowing a great deal. To read one of Austen’s letters is to know what exactly Welty meant. This letter to a friend was written after Austen was taken to Winchester for treatment during her final illness. In the letter, Austen writes of her journey with great emotion. Cassandra, her sister and constant companion, was in the carriage with her, she says, and her nephew William and brother Henry riding on either side of the carriage despite a steady rain.
“If I were to live to be an old woman,” she wrote, “I must expect to wish I had died now, blessed in the tenderness of such a family and before I had outlived either them or their affection.”
Yes, Jane Austen knew. She knew that if you lived too long you could outlive the affection even of your family. She knew that relationships in families change. When you are a daughter, you are a loved member of the family, an aunt is loved but distant, whereas a spinster aunt becomes just a duty. And a great aunt? Austen knew that to survive too long is to become an unwanted guest. “Do not outlive your usefulness,” says a character in a novel about the Austens.
Yet, how do you remove yourself from the scene? There is suicide, of course, there has always been suicide. But the desperation of suicide comes only to few. When the moment passes, it recedes. Besides, the will to survive is strong. The survivors of a plane crash in the Andes mountains in 1972, rescued after two-and-a-half months, survived by eating human flesh. The world, when it heard this story, was horrified, but survival made it necessary. Besides, in suicide, there is always the fear – what if I fail? A botched suicide is its own worst punishment.
Some perceptive people are becoming aware of the bleak future awaiting them after the children have left home, leaving old parents on their own. Their solution is to make what is called a living will. In a living will, the testator writes that they should not be given life-saving or life-prolonging treatment, not be admitted in the intensive care unit and so on. Will this work? Doubtful, because both the family and the doctors are afraid. What if the patient dies? What if they are charged with neglect? Besides, whether such a will is as legal as a will that deals with property is a tricky question; right now, it seems to be in the twilight zone.
In any case, this is a small weapon against longevity, which, in the meantime, continues to grow. Birth, infancy, childhood, youth, maturity, old age – this is the pattern of human life. By stretching the period of old age way beyond what it was, by giving old age a larger chunk than the other phases, we will create problems for ourselves.
A solution has been found and legalised in a few, very few countries. Whether or how much it will be accepted is hard to say. This is euthanasia. People are given the right to legally put an end to their lives with medical assistance – also therefore termed medically-assisted death. This has not been much publicised, it seems to be a very hush hush matter. But it came into the news recently when a Dutch couple in their 90s, the man an ex-prime minister, opted for assisted dying in February. They died, one hopes, a painless death. And a dignified one.
A dignified death is what assisted dying promises those who think they have lived enough and want to quit this world. What is noteworthy about this is that it stands firmly on the ground of the desire of the person who is opting for euthanasia. It is legal and one presumes that the procedure laid down has to be strictly followed, with enough safeguards to protect the person opting for death. It is hard to imagine such a measure becoming legal in India when one looks at two cases which came to the courts.
One was that of a nurse who had been raped and throttled during the act. She survived, but the lack of blood to the brain left her a vegetable, unable to do anything, except utter some scarcely-human cries. A journalist went to court pleading for her death. The court refused. Perhaps because the patient could not speak for herself. But it is exactly because a patient is completely helpless, or in great pain that death seems better than life. And now, even as I am writing this, I read of the case of a young man who has been in a “vegetative” state for 11 years. His parents’ plea to let him die was turned down by the Supreme Court. The court was compassionate, but did not think that to stop feeding him was a passive act and therefore the court could not permit death by such means.
In both these cases, a few questions arise. Is it a mistaken compassion that influenced the court’s decision? Does it not matter what kind of life the person is living? In the case of the young man, there is the additional problem of the parents running out of money. Besides, an ad hoc arrangement, which the court suggested, in which a person or an institution takes care of such a patient, is of no use.
There has to be a law so that the solution is a rule, not an exception. We need to go past the idea that life is sacred and that it is wrong to take away someone’s life. What use is it to let a person go on living when it is not a life at all but a travesty of life? Life is not just the heart beating, the lungs breathing. There has to be something more to life. And as for the courts, they can act only if there is a law in place.
But first, we need to talk about the issue. There have been conversations in the country about rape, about abortion, about suicide. Changes have come, both in societal perceptions as well as in some laws on these matters. To reach the goal of euthanasia too we need to talk, not only of hopeless cases like the two that came up before Indian courts, but we need to think and talk about all those who, burdened with a great age, want to give up living. We need to debate whether such a method is right, whether it is compassionate, or whether it is unethical, or immoral. And is it not likely to be misused?
To legalise assisted dying is to walk on a road pitted with potholes, full of questions, doubts, anxieties, fears. If abortion could be condemned, still is condemned, if the unborn foetus was given a right to life beyond the mother’s, there is no doubt that assisted dying will not be easily accepted. The dictionary defines euthanasia as the painless killing of a patient who is suffering a painful illness. Animals are killed rather than allowed to suffer. So why not euthanasia for humans? If we do not even talk about it, it will remain a dark, fearful, to-be-avoided subject.
If euthanasia enters our conversation, the sting will be taken out of the word. It will no longer be a word associated with killing, but one that combines humanity and compassion. It is a corrective measure and will certainly have to be considered at some time, taking into account our ballooning population, and the steadily increasing longevity of humans.
As longevity increases, an increasing number of people will feel the need to put an end to a life which has ceased to have any meaning or purpose. One hears that some states in America are now allowing citizens to opt for euthanasia. Which is, if one looks at it objectively, a sensible measure. The biggest argument for euthanasia is: in this age of the recognition of the importance of human rights, how can an individual be denied the right to take decisions about her/his life?
Euthanasia, as assisted dying sees it, is based purely on the ground of a person’s desire for death. A few days ago, I saw a documentary on old age in which an old woman (she was 103 years old) asked about the quality of her life, said, after a pause, “Pretty useless, I must say”.
That is the truth. A person can desire death because of a very weariness of living. And it is, ultimately, a matter solely between an individual and her/his conscience.
An interesting spin-off from reading and thinking about euthanasia has been a stumbling over serendipitous discoveries, one of which is the great human desire for longevity. Humans have been working on it for centuries, from the alchemists of old to modern day scientists. One hears of a start-up in Silicon Valley which is trying to break the code of aging. The search to prolong human life still goes on. One can understand how much it mattered when life could be brutally cut short. But now? Today? One is puzzled. Why do we need to live more years? What do we plan to do with those extra years? How much is enough? And above all, will greater survival bring humans more happiness?
In our myths we have the story of King Yayati who was enamoured by sensual pleasures. Afraid that age would take away his capacity to enjoy these pleasures, he exchanged his old age for youth with his son Puru. But the pleasures he had desired so much palled, they no longer gave him pleasure. He then gave his son back his youth as well as the throne and took back his old age.
Our experience of life tells us that happiness is momentary and immeasurable. More necessary and more sensible is to find a way to help people who don’t want to live any longer. To whom life has become, for many reasons, a burden. Is it not possible to see assisted dying differently? As a humane and civilised act? So that people who have lived complete lives and can no longer go on living with dignity have the right to choose to die? Let us not ignore the person who says, “I am tired of living. My life has no purpose. I have lived a full life. I have worked, struggled, enjoyed, loved – I have done it all. Now, there is nothing left for me. I am not needed by anyone. I am lonely. I have to end this purposeless meaningless existence.” This person has a right to expect the world to understand her, her desire to end her life.
We have a very long way to go before assisted dying can become part of our conversation, let alone become part of our lives. But attitudes do change. Both suicide and abortion were considered to be sins as well as crimes at one time. with greater knowledge of the human mind, suicide was recognised as a cry for help, a cry which needs to be heard. As for abortion, for centuries, for ages, women lived with the fact of continuing to have children through all their reproductive years. Children died, at times mothers died, but there was no way of preventing conception. Finally, in the last century, the pill came to the help of women. Yet, the life of the foetus is still considered by many as being more important than the life of the mother.
But how can one deny individuals the right to take decisions about their life, their body? The lives of the very old are lives of total dependence on others, even for basic, physical needs; such lives are shorn of all dignity. Surely, a human has as much right to die with dignity as they have to live with dignity. For, death is not always a tragedy; it can be a liberation, a deliverance.
Shashi Deshpande is a writer who lives in Bengaluru. She is a recipient of the Sahitya Akademi Award and the Padma Shri Award.
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