{Book} THE MAINTENANCE OF LIFE

Preventing Social Death through Euthanasia Talk and End-of-Life Care – Lessons from the Netherlands

This book helped to clarify for me what it is that I most dread about the end of my own life – the possibility of “social death” in which the body continues to exist while everything that made me who I was, and which I counted precious, has been lost . This destruction of an individual’s spirit and essence, in effect a living death, is graphically illustrated by the experience of the author when she met an elderly Dutch man, who – pointing to his dying, bedridden wife, said “That’s not my wife” and then: “My wife; she’s here” – indicating the framed photograph of her which he held in his hand.

This clear and beautifully written book is the result of a 3 year study by Frances Norwood, an American anthropologist, who moved to The Netherlands and learned the Dutch language in order to undertake it. A key theme of her book is that the Dutch laws on euthanasia enable people to talk about the possibility of ending their lives legally, even though most of them will never actually ask for assistance to do so. The fact that this “euthanasia talk” happens – with doctors, family and friends – has a palliative effect, she believes, and this in itself helps to affirm social bonds, and prevent or allay social death.

She speaks of the inherent drive we have to maintain social identity and relationships, and yet the protracted, slow process of decline that many of us will experience is an ongoing series of social losses as well as bodily ones. This is what particularly resonated with me. I myself dread the long period of going downhill; my arthritis hurting more and more, being able to do less and less, being tired most of the time, no energy, no drive, not wanting to read or write, eat a meal, see my family or friends, or gossip with my neighbours, having no role, unable to contribute in any way. Dying is a messy business; I dread becoming incontinent, being unable to get to the lavatory without help, needing someone to wipe my bottom. I dread pain, delirium, breathlessness, constipation, nausea; all the horrid things that happen at the end of life.

I dread losing control of my life and of my body.

Before the time comes that life is a pain and not a pleasure, a burden not a joy, I would like to be able to say: “Dr dear, come on Tuesday with your little bag, give me an injection so that I can go to sleep and not wake up”.

Frances Norwood has made a powerful contribution to helping us understand what happens in the kind of dying process that many of us will experience nowadays. She highlights the great benefit to individuals and their social network of living within a legal framework that allows, not only the practice of euthanasia (which most studies focus upon), but freedom to talk about it.

For me, this is another strong argument for a change of the law in this country. Imagine having the right to choose to die physically before social losses have turned into social death – or at least to more closely coincide the timing of the two. The fact that people in the Netherlands can and do frequently take part in “euthanasia talk” with their doctors and families, the fact that they can legally choose the path they want to take is – to me, something to be envied and fought for.

A review by : Nan Maitland

http://euthanewsia.posterous.com/book-review-the-maintenance-of-life-reviewed