The confusion we suffer over the question of mortality

Relatives of the COVID-19 patient perform the last rites of the victim, outside the electric crematorium
Relatives of the COVID-19 patient perform the last rites of the victim, outside the electric crematorium

Summary

An obsession with saving lives has created a culture of delaying death just because science lets us

India has no objections to your death, as long as it is unexpected. You are allowed to fall off trains, be buried in the debris of a building that is designed to fall, be bitten by rabid stray dogs, be burnt in an overcrowded illegal factory in the heart of the national capital. But India does not want you to die of covid. This is in line with a sentiment of Indian lifeā€”if you are dying, the country will not let you die. We will create hospital beds at great cost, organize pipes to shove down your throat, and procure oxygen tanks from petrochemical factories. We will even mass-produce vaccines at low cost in record time, or at least say we will do so.

A part of this, the part about not letting the dying die, is a universal human condition. We are obsessed with saving lives. Especially the lives of the very old. And what we mean when we say ā€˜saving livesā€™ is not really saving lives, but prolonging a life until the inevitability of impending death. That all people wish to live another day is the only confident assumption most people make about others, as though there was a giant survey commissioned by a respectable research agency with the question, ā€˜Do you really want to live?ā€™

It does appear that people do want to live. For instance, many do wear a mask these days; at times, they lift it gingerly, tuck in a samosa, or take a deep thoughtful drag of a cigarette, and then pull the mask down again.

Our pandemic has demonstrated that even if people do everything they can do to die, like attending weddings and festivals after a whole life of having lovingly nurtured diabetes, society has no doubt they wish to live. But there is something more significant that the pandemic has reminded us of. The optics of delaying death are the same as saving lives. The young and the old, the healthy and the unhealthy, the lovers of life and the suicidal, all endure the same process of medical care.

In reality, saving lives and delaying death are different things. Saving lives, say when a disease sweeps across the world, is the primary moral obligation of medicine. Delaying the inevitable among the affluent old in expensive private wards is how the industry makes money. Our medical response to illness has saved many lives, but it has also created a culture of delaying death even if the life that is prolonged is worse than death.

Science has helped us become the first generation of humans that simply does not let go of life. This has less to do with any special love of life, or perhaps even of the dying, than our common fear of death.

In most people, being comatose is the biggest fear. They would likely have conveyed to the spouse these famous dark words: ā€œIf I am ever a vegetable, pull the plug." Yet they do not have the heart to pull the plug on their own parents. The size of the hospital bill, which reflects how long and how intensely a personā€™s death has been delayed, has become a sign of love in peopleā€™s conscience and for public display. As a result, people today are doomed to be flogged to their very limits by the very people they love.

In a 2010 essay published in The New Yorker magazine, Atul Gawande, a surgeon and author of Being Mortal, wrote, ā€œFor all but our most recent history, dying was typically a brief processā€¦These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition."

All my life, I have tried to find out how the elderly feel about the realization that they have just about another five or ten years to live. They are not fooled by optimism, I learnt, but they love to live, even if it is with their sight dimming, hearing fading, mind wavering and legs collapsing. A time comes when the predominant sign of life in a person is a tremendous pain in parts of the body that they never knew existed, and such a life would be unbearable without modern pain-killers. Yet they extract enough from life to wish to continue. So when the final days come, their children will extend a confused rationale and keep them strapped in a bed as a living corpse.

It is usually never the old but the young who keep talking about dying. We are, after all, a species that distinguishes itself from other animals in possessing the merciful ability to kill ourselves and be liberated from boredom, or gloom, which are usually the same thing. But even those who contemplate doing it keep themselves alive, and they do so in ways that are metaphorically similar to how the world keeps the terminally ill going on life support.

Even terrorists in a suicide squad get punished through life. About 12 years ago, after a Pakistani suicide attacker survived his attack, India undertook a long process to sentence himā€”to death. The countryā€™s then home minister P. Chidambaram said it was ā€œa message to Pakistan", and the message was that if you are a suicide attacker, we will put you to death. India considers living so precious that it was the most valuable thing it could take even from a person who had resolved to die.

There are many things that are natural to human beings that are unnatural in the wider animal world. One that we rarely talk about is the way we delay death. Our attempt begins at birth. A high proportion of people are not innately strong enough to have survived life without vaccinations and medicines. For long, we have been a species that has stopped rewarding the fittest with the exclusive rights to procreation.

Today, a majority of adults are unhealthy. But they will live longā€”if not vertically, then at least horizontally.

Manu Joseph is a journalist, and a novelist, most recently of ā€˜Miss Laila, Armed And Dangerousā€™

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