Session Four: Speech/Finding the Language

Shai Lavi, Ph.D. Candidate
Jurisprudence and Social Policy, Boalt Hall School of Law, UC Berkeley

I got interested in death and dying after I heard from a friend about Dr. Kervorkian. Because I study law and sociology of law, I became interested in the phenomenon of a person walking around basically killing his patients. I thought this was quite extraordinary. And I thought that this whole idea of physician-assisted suicide and the management of dying can't be that contemporary; it can't be that it just started ten or twenty years ago. So I'm trying to trace back the idea where this notion of euthanasia came from, this wish to control the time of dying, of death, and the manner of death and dying. And, of course, I found that it's an ancient idea, but it has a modern history that begins sometime around 1870. There was a notion of the "art of dying" even before euthanasia, but I see the two as related: the old tradition of the art of dying, controlling the manner in which one dies, and the more contemporary notion of euthanasia, controlling the moment of one's death.

What I want to try to bring out from the discussion that we've been having these past two days are some thoughts about time and technology, both of which came up quite often. And they both occur in the photograph that Jim Goldberg offered to us, the image of the watch telling the time of death. The photograph captures both the need to have a perception of when death happens, the time of death, and also the technologies that are involved in configuring time.

I think one thing that was raised is this idea that death is universal, that it transcends, in a way, cultural differences. We all die; it's a brutal fact of human existence. But precisely because it is universal, it's also culturally determined: different societies, different cultures have different rituals, different understandings of what death is, and what after-life is. Then, similarly, death varies in space, and it also varies in time. There's a question of the history or the historicity of death and our understanding of death.

One of the questions that came out of the first panel and to which we return again and again, is what is the precise way in which Americans today, or in the twentieth century, deal and have dealt with death? Are we a death-denying society? Are we obsessed with death? Are these exclusive ways of understanding and dealing with death? And I think that rather than asking whether we are this or that, I think another way of putting the question is to ask in what way these terms help us understand different phenomena concerning dying and how they work together.

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There is another aspect of the temporality--not historicity but temporality--of death and dying that I mentioned above as the need to determine with accuracy the time of death. How do we define dying? How do we understand what dying is? We define dying most commonly in terms of time, the last six months left for a person to live. And what does that notion of time do to dying? What is the difference between the existential feeling of dying and the temporality related to it? And how do suffering and pain affect our understanding of time? Time is not only a linear and quantifiable measure, but also something that becomes part of the process of dying.

I've spoken of the medical understanding of time, as well as the human existential experience of time, but also, I think there is a plurality of time that's important. I think that if we look at the different institutions in which people die, we will see a different logic to the way the time works in each. Time in the hospital for the dying patient is different from time in the Hospice. If you have more time to live you're out of the Hospice; if you have less, you're in. What about nursing homes? Or, what does it mean to die at home?

I think it was Dr. Schneiderman who talked about the dangers, or perhaps even the hubris inherent in the attempt to prolong life--even to insist on prolonging life--beyond what seems to be reasonable, beyond what some would call the point where this is still a self. I was wondering whether it is no less hubristic to decide that death has arrived, that, despite the fact that there are some brain signals, some sign of life, to make the decision that this life has come to an end. So I think rather than being faced with the possibility between choosing between technological life or natural death, that we no longer have that option to go back to a natural death, to think, "Okay, we should stop the machines and allow nature to take its course." Every decision we make is, in a way, a decision whether to go with the technology or not. Even when we say that we don't want to prolong life, that we want palliative care, the latter is also a technology of dying. I'm thinking of the morphine drip and the new art of dying, producing a "natural death," so to speak, by general sedation, and so on.

Finally, there is the issue of emotion and technology. Dr Tripathy talked about the dangers of certainty when the medical profession, even unwittingly, produces notions presented regarding its power to cure or heal or relieve pain. There is also hope, which is no less dangerous, I think, than certainty. It produces the hope that even if there is only a 20% chance, there is at least that 20%. What does this do to the process of dying? There may then be rage when technology fails: the cold rage of the physicians, the heated outrage of the patients, the family. What is the role of technology in that rage?

In summary, our discussions seemed to bring out, then, the schizophrenic condition of a technological age where death has become medicalized, but there remains also the human face of death and dying. We say on the one hand that we want to use technology, but we also still want to enjoy, to recognize the human face, the Buberian "thou" in the dying patient. I think that it is important to see how this schizophrenic condition works, how we live in a split world, in which the human condition co-exists with the technological condition.

I want to end my remarks by saying a few words about another attribute of these two fascinating days of conversation. We usually think of emotions as opposed to a rational discourse of these matters. I was fascinated with the way that emotions and personal experiences played out together in the past two days of discussion. When the subject is death and dying, this seems to be a necessity.

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