Why I believe in the concept of a ‘good death’

‘There comes a time, I suggest, at which the end needs to be accepted and embraced – with dignity.’, writes Paul Monk.


Two recent essays and an opinion piece in this newspaper have expressed grave concern about the wave of euthanasia legislation being passed in Australia. The essays were by medical specialists Haydn Walters and Marion Harris and staff writer Jamie Walker. The opinion piece was by Angela Shanahan. As a survivor of a long battle with cancer, I write to take issue with crucial aspects of their arguments.

I am a Fellow of the Rationalist Society of Australia, which supports sound VAD (voluntary assisted dying) legislation. I am also a member of the steering committee for the cancer school for patient education and empowerment at the Peter MacCallum Cancer Centre. On several grounds, therefore, I am implicated in this debate. My cancer was melanoma, so I ­literally have skin in the game.

Walters and Harris argued that “the pro case is a simplistic appeal for autonomy” and, more pointedly, that “suicide has never been an acceptable solution to any problem, even if it is quick, easy and cheaper than care. Such actions impact all of us.”

Walker wrote with evident concern that, with the passage of these laws in state after state, “we as a society are entering uncharted territory”.

Shanahan wrote fiercely that VAD would send doctors into ­hospitals to kill.

The other lines of argument, conversely, are based on special pleading. Opponents of euthanasia – a word based on the Greek for “good death” – insist that legalisation of it will lead down a slippery slope to involuntary ter­mination of afflicted lives or, at the very least, to unnecessary ­suicides. All the above writers line up on this position.

But such an argument implies that the voluntary nature of euthanasia isn’t the problem. What is feared is involuntary termination or poor judgment on the part of stranded or afflicted people. If so, then it is precisely autonomy that needs to be accentuated. Opponents of euthanasia can’t have it both ways. What is it to be, insistence on autonomy or denial of it?

If, as Jamie Walker put it, we are “entering uncharted territory”, we’d best get busy charting it. There are now many case studies overseas and a rich literature on the subject. The territory is by no means as uncharted as Walker appears to believe. But there is every reason to explore it further and to deepen our collective understanding of what is at stake.

A splendid recent exploration of the matter is Katie Engelhart’s The Inevitable: Dispatches on the Right to Die (Atlantic Books, London, 2021). It is impossible to read her reflections without coming to appreciate both sides of the debate and the irreducible dilemmas and complexities entailed in euthanasia. Her case studies are poignant and often excruciating, but she hasn’t written a polemic, whether for or against euthanasia. She charts the territory.

It is equally clear that the Walters/Harris line of defence is problematic. Rather than asserting that we are not entitled to autonomy in end-of-life choices, they would have done better to argue that we need to educate for and facilitate authentic autonomy in such matters. Quite plainly, that is what opinion polls show a majority of people want, which is why state after state has come around to passing legislation permitting euthanasia under closely defined conditions.

The word euthanasia has been disowned by some, in favour of “voluntary assisted dying” (VAD) or “dying with dignity”. Opponents such as Walters and Harris prefer the expression “physician-assisted suicide/euthanasia”, or PAS/E. There’s a history to this. But, perhaps because of my classical education, I don’t have a problem with the term euthanasia. It seems to me entirely appropriate that we should desire and seek a “good death”, rather than a lingering, incapacitated, painful one. There comes a time when saying “Enough, no more!” is both dignified and appropriate.

The question that ought to exercise us, I submit, is not whether this is desirable, but how to facilitate it, while minimising abuses or ill-considered decisions.

Over the course of more than a decade grappling with recurrent and then metastatic melanoma, I was often given to pondering this subject and it was clear to me that I would want the option of calling it quits under certain circumstances and that, importantly, this seemed a natural right. Walters and Harris assert that suicide is never an appropriate solution. Really? They must know, given their fields of expertise, that cells die based on a programmed process called apoptosis – they reach their use-by date and give up the ghost.

Cancer cells are those that refuse, as it were, to accept the rules of the game. We need to naturalise dying as human apoptosis, instead of prolonging physical life under any and all circumstances by any means possible.

One of my favourite case studies in suicide, as distinct from VAD or PAS/E, is the great Carthaginian general Hannibal, in 182 BCE. He was then the age I am now. He had devoted his life to war with the rising power of Rome. Defeated, he sought other allies, other means, but these, too, had been thwarted and the Romans were coming for him.

Hannibal could have awaited them and suffered capture, humiliation and execution, or he could have tried fleeing and hiding. He had had enough, however. In dignity and pride, he swallowed poison and died. He didn’t require legislated permission or a doctor’s authorisation.

There have been other cases in history. ­Socrates took his hemlock. Was that inappropriate? There comes a time, I suggest, at which the end needs to be accepted and embraced – with dignity.

Why should a lucid and dignified option not be available to us, when we have concluded that “the Romans are coming”, at last, for us? The question, surely, is not whether it should be, but how to make possible authentic autonomy in the face of end-of-life ­dilemmas. If our new legislation seems inadequate for one reason or another, let it be amended. But let’s frame our approach around apoptosis and autonomy, not fear and patient disempowerment.

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