Science & technology | The right to die

What is unbearable?

Some data about an emotional issue

“A FATE worse than death” is a journalistic cliché, used this week alone to describe a visit to the dentist (in a British newspaper) and the plot arc of a character in J.K. Rowling’s new “Harry Potter” play (in an American magazine). But for the terminally ill, such fates do exist: death really can seem preferable to a lifetime of pain and suffering. A growing movement, including this newspaper, thus seeks to legalise—with stringent safeguards—doctor-assisted suicide around the world.

Yet doctors are taught to keep patients alive regardless of the circumstances, says Emily Rubin of the University of Pennsylvania. A paper by her and her colleagues, just published in JAMA Internal Medicine, attempts to give statistical rigour to scientific hunches about end-of-life care. Over an eight-month period, beginning in July 2015, her team surveyed 180 patients who had been admitted to a hospital in Philadelphia suffering from serious illnesses, including lung and heart disease. All participants were over 60, and were asked by medical staff to hypothesise whether they would prefer to die than be in progressively worse vegetative states.

As the chart shows, half or more said that they would consider being incontinent, being unable to get out of bed or relying on a breathing machine to stay alive as fates worse than death. Being so debilitated that they were reliant on food delivered via a tube, were constantly confused or required round-the-clock care were judged similarly by a third or more of respondents.

Although it draws on a small sample, Dr Rubin’s study adds data to the discussion. Too much of the debate around the “right to die” focuses on individual opinion, often that of campaigners (on both sides) who are in rude health imagining how they would feel were they faced with severe illness. And when the views of those who are actually afflicted by ill-health are considered, the cases cited are often the hard ones that proverbially make bad law. Asking people approaching, or threatened with death, how they feel about it, and the moment at which they would like it to come, is a welcome development. Both sides of the doctor-assisted-dying debate should pay attention to it.

This article appeared in the Science & technology section of the print edition under the headline "What is unbearable?"

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