This past week I heard myself ask anyone who would listen,
“Did you see that episode of The Last of Us on Sunday?”
It was a masterpiece.
If you haven’t seen it, I refuse to share spoilers. So bye, I’ll see you next week after you’ve seen the episode.
For those of you who have seen it, you know why I must discuss it. The story of Bill and Frank in episode 3 of HBO’s The Last of Us may have been one of the most moving fictional depictions of assisted death I have ever seen.
As you know, the show is set in a post-apocalyptic world where a deadly fungus has wiped out much of humanity. Bill is a survivalist whose preparedness paid off and Frank is a survivor who stumbles upon Bill’s idyllic compound. Before Frank promises to leave, they share a moment of intimacy in Bill’s home as they both play two vastly different renditions of the same romantic song. They quickly fall in love, and Frank never leaves.
Over the course of almost two decades, Bill dedicates his life to preserving Frank’s joie de vivre, despite being a curmudgeon. Frank is determined to share that joy with Bill by focusing on painting and renovating nearby dilapidated buildings, which Bill sees as a waste of resources. Despite their differences, they find common ground in small moments of beauty, such as savouring freshly picked strawberries grown from seeds Frank acquired by trading one of Bill's guns.
Even in the apocalypse, they insist on living beyond simply surviving.
Eventually, it is implied that Frank has been suffering with a terminal illness that limits his mobility and ability to paint. One morning, he tells his partner Bill, “Today is my last day.”
It was at this point that my dog Charlie looked up at me with genuine concern as I wept like a baby. It doesn’t take much to move me but this episode was off the charts.
The rest of the episode is a masterclass in story-telling.
Bill asks Frank, his eyes full of tears, “What if we find a doctor? What if someone shows up who can help?”
Frank replies in jest, “Who’s coming, Bill? The door-to-door MRI salesman?”
Frank goes on, “There wasn’t anything to cure this before the world fell apart.”
Since the episode aired less than a week ago, I read many think-pieces discussing the positive response, the beautiful depiction of queer romance, and the sharp rise in popularity of the Linda Ronsadt song. I expected much more commentary about the assisted death theme, yet I didn’t see any at all. Perhaps the media needs more bioethicists. (Perhaps Café Bioethics can fill that gap?)
There have been many incredibly moving fictional narratives that depict assisted death, and most of them depict the theme as an empowering, dignified way to live (and end) a life.
It was actually the 2010 Hindi film entitled “Guzaarish” (translation: “Request”), that further piqued my interest in the field of medical ethics and law when I was 17. Guzaarish tells the story of Ethan Mascarenhas, a radio jockey and former magician who is paralyzed and seeks assisted death. The film explores the right to die with dignity, as Ethan fights to legally end his suffering with the help of his caretaker, Sofia.
Other films I’ve seen and loved include Amour (2012), Me Before You (2016), and Anand (1971). The Black Mirror episode from season 3, San Junipero, is another masterpiece that has stayed with me for a long time. If you’re familiar with these pieces of film and television, you’ll notice the parallel - they all depict a terminally ill and/or paraplegic individual whose condition is not likely to improve. All depict people with sources of suffering that cannot be alleviated significantly and sustainably. All the main characters (except in Amour)1 are depicted as empowered and insistent on exercising their right to bodily autonomy.
So I asked myself after watching Bill and Frank’s story, puffy eyes and runny nose galore, if I loved this episode so much, why is it that my brain continues to stay in a pretzel when it comes to the MAID expansion in Canada? Why was Amir Farsoud’s story so troubling?
I realized there’s some sort of psychological correlation happening here:
The greater the potential to improve a person's source of suffering, the more I am inclined to question the necessity of a MAID request. Conversely, the lower the chance of meaningful improvement, the more I am inclined to consider MAID as a viable option.
Obviously, it is not within my power to determine MAID criteria nor will it ever be, however, perhaps it is possible that this is a contributing factor to the public's view of MAID. And public attitudes impact legislation.
If there is a way for someone’s suffering to be significantly and sustainably improved via access to appropriate and accessible healthcare, mental healthcare, housing, nutrition etc., how can MAID be a reasonable option? Why aren’t we working on fulfilling that potential to improve their source of suffering?
Ah yes, here we are again. The Better World argument. I’m running in circles.
As an excerpt, here is the argument:
The world right now is deficient in some way, which is causing people to choose MAiD who otherwise might not.
We can imagine a better world where, due to some societal improvements, people might not choose MAiD in the same situations.
Therefore, we should ban MAiD in some forms until we reach that better world.
And again I ask:
Why should individuals, who are not eligible for MAID but still request it, be compelled to endure their suffering while we fall short in providing their essential needs?
Frank’s line in The Last of Us can easily be applied to our world:
“Who’s coming? The door-to-door affordable, qualified, and accessible mental health provider?”
This recent piece from The Conversation is much more articulate in sharing the ideas I have described in my newsletters so far. I highly recommend giving it a read and following the hyperlinks for more info on the MAID expansion issue.
Here is an excerpt from the beginning of the article by Professor Andrew Stumpf:
As a philosophy professor and researcher of end-of-life ethics, I ask the students in my ethics class who should be eligible to receive Medical Assistance in Dying (MAID). Should it be open only to people actively dying from a terminal illness? To anyone with any medical condition that causes them unendurable suffering? To anyone who asks for it for any reason, as long as their request is truly voluntary?
Student responses generally align with the original 2016 MAID legislation, which required that the patient’s death be reasonably foreseeable and that they have a grievous and irremediable illness causing enduring and intolerable suffering.
Remember last week how I worried about the conflation between the MAID expansion issue with the MAID 2016 criteria? Many of you noticed the conflation too.
On an even more introspective note than usual, I do worry sometimes about how personal and vulnerable this newsletter can be. However, I think it is important to read thoughts, and not necessarily, conclusions. So I publish what I think is missing from the discourse - honest, vulnerable, personal deliberation. I don’t know the right answer, but there is value in the discussion. There is value in saying, “I don’t know.”
One thing I do know for sure is how grateful I am for your support, patience, and charitable response while I work through these issues in bioethics for myself. Looking back at some of my newsletters from even just two months ago - I can see how the confidence in my writing has grown!
Thank you so much. Hope you have a beautiful, warm weekend. :)
-Nipa
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In Amour, a husband acts as a true substitute decision-maker by insisting on respecting his incapable wife’s wish to never live in a long-term care home.