Arcs of life


Death and Life by Gustav Klimt (1915)
IMAGE/Public domain via Arthive

A just society does not kill suffering people, it shares their burden.

Is pain good or bad? The answer seems obvious at first — pain is bad, you idiot, or did you fall asleep in class the day they covered it? The truth, of course, is that there was no such lesson when I went to medical school. There is, as far as I know, no lecture about this at any medical school in the Western world. The extent to which we will go in order to avoid pain shows up in many lectures, but we all simply live with the assumption that pain is bad and thus we ought to avoid it.

The slightly more complicated answer that you can get in medical school (or middle school, for that matter) is that pain has a clear protective biological function, letting us know that we ought to move our hand away from a hot stove or not eat that brightly colored mushroom again. Pain that serves a function: that kind makes some sense, perhaps to let us know there’s a problem inside the body that needs to be fixed, maybe with some kind of medical technology.

Chest pain may indicate that you’re slouching in front of your computer too much, or that you need a stent in your coronary arteries to keep your heart pumping. Joint pain may mean that you need an artificial knee, or that your immune system has, in its overenthusiasm for destroying invaders, targeted your connective tissue instead. Fatigue, which can certainly feel like pain too, may mean that your thyroid hormone levels are low and need topping up or that you are depressed and need … something that insurance can reimburse the medical system for. Whatever the case, modern medicine has many pills, surgeries, and therapies designed to help alleviate pain and suffering.

Another answer to the question of pain that we often learn just before or during middle school is that some pain is necessary in order to grow, like a caterpillar that struggles to emerge from its chrysalis to become a butterfly. This answer, however, is also far short of satisfactory when there is no chrysalis in sight, only the coffin of a classmate or the incomprehensible horrors of the Holocaust.

The ethicist Gerald McKenny has dubbed our quest to relieve suffering “the Baconian project,” after Francis Bacon’s famous idea that the purpose of scientific knowledge ought to be technologies for the relief of human suffering. It seems, again, like an open-and-shut case you shouldn’t need a lecture to understand: Suffering is bad, therefore, if a technological option for putting an end to suffering exists, we ought to use it.

Yet taking this dictum and making it into a law is at the root of many evils. What if the pain can’t be fixed? How does the Baconian project bring us to see the suffering it can’t relieve?

Pain vs. Suffering

Pain and suffering are not synonymous. A toddler who jumps you from behind and chokes you with his meaty little hands as he shouts “Hug attack!” brings a kind of pain overwhelmed by joy, as does pushing your body to run just a little further to cross the finish line. That’s not suffering. On the other hand, many people whose lives have been oriented around avoiding pain will still face many kinds of suffering, some of which can be fixed and some of which can’t. There is a legal remedy for virtually every instance of causing another person pain; there is none for causing many different kinds of suffering.

The most difficult problem facing those of us who live in the world Bacon and his disciples made is that some pain and suffering cannot be avoided in life. Every baby who emerges from the womb cries as he does; if the cold air filling his lungs is not painful per se we must still construe the shock that brings him from one strange world to another as a kind of suffering. Every mother who births a child must suffer pain, even if she has a good epidural. Between birth and death we experience many different pains in our bodies and many different kinds of suffering in our souls, much of which feels pointless. Death itself is usually preceded by significant suffering as our bodies decay, and then, when that is over, the ones who love the deceased suffer in proportion to the joy of the love they felt.

Thus, trying to eliminate pain and suffering altogether is futile, leading some cartoon supervillains and a few philosophers to suggest eliminating or phasing out all who can suffer. I presume that the philosophers who make this proposal, like the transhumanist David Pearce, are flesh and blood like the rest of us and not AI-generated programs. But it is interesting that the cartoon supervillains who want to end human suffering — think of Ultron in the 2015 Avengers movie — tend to be robots who have done the math and found that the world would be better off without humans and their physical and moral flaws. Their mechanistic language of technology pervades medicine and our talk of the human body: Our bodies “break down” or “stop working” like a car, supplements are often called “fuel,” our brains are endlessly and gallingly compared to computers, and (perhaps most ominously) we speak of “reproduction” rather than “procreation.” Our affinity for technological solutions for suffering makes us think more like evil robots than we might like.

Take a step or two back from science fiction plots, and you will see that ending the suffering by eliminating the sufferer is already part of standard medical practice. It goes right along with the fictional narratives where human beings are tinkered with toward some end — smarter, faster, better-looking, or just less prone to suffer. We don’t even have to genetically modify human beings to raise the average (although many people would like to do that, too) when the weakest among us are being snuffed out.

Eliminating Suffering by Killing the Sufferer

The euthanasia regime begins with a pitch to the smartest among us: Wouldn’t you like to go out before the party winds down, before age and decrepitude shatter the autonomy and strength you cherish so deeply? This in itself fetishizes choice and control beyond acceptable limits, but then the next step is such a foregone conclusion it can hardly be called a slippery slope: You’re a burden on the hospital and the people you love. Why not take this injection and save all of us some grief? The Canadian Medical Association Journal published a study in 2017 estimating that millions of dollars could be saved every year through medically assisted dying, underscoring the logic of the system.

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