An Unbearable Task

January-February 2010 To the Editor: My awareness of the barriers in our current system and my support for the emergence of palliative and hospice care move me to respond to John Hardwig’s essay, “Going to Meet Death: The Art of Dying in the Early Part of the Twenty-First Century” (JulyAug 2009). Hardwig seeks to counsel those who, in light of medical technology, are forced to grapple with a death that comes “too late.” This counsel is laden with one distinctly modern assumption surrounding autonomy— that we determine life’s meaning, and thus, its length—and one unfortunate conclusion for those “blessed” with this freedom—that we now must bear the burdens in a loveless and graceless world. Seeking to liberate his readers for autonomous action, Hardwig ironically destroys the reason for seeking autonomy and enslaves his readers in a hopeless mire of guilt at the end of their lives. In this, he does a disservice to the palliative care movement. The stark individualism that decides for itself the meaning of life (and the time of its expiration) leads Hardwig to a justification of suicide, not in the face of unbearable pain and suffering, but in the proud self-determination of our own musings. Although Hardwig wants to limit this argument to those at the end of their lives, he provides no reason throughout his article why it should be so limited, provided we find ourselves in a “long stretch of perfectly lucid and pain-free though meaningless and purposeless days.” In his fight for free choice and action, he provides an argument that, quite literally, collapses upon itself. Dostoevsky’s Kirillov puts it this way in his book The Devils: “Man’s been unhappy and impoverished up to now because he’s been afraid to express the essence of his self-will; . . . For three years I’ve been seeking the attribute of my own divinity and now I’ve found it: the attribute of my own divinity is— Self-Will! That’s all I can do to demonstrate in the highest degree my independence and my terrifying new freedom. For it is very terrifying. I shall kill myself to show my independence and my terrifying new freedom.” Life is a gift, so my autonomy is not fully actualized until I can take my own life. Hardwig’s own defense of suicide ends with the same conclusion, albeit presented in a more placid and—perhaps for that reason—crueler form. He further asserts that if we can “make peace” with our decision, surely it is a right one: “In any case, if one can truly make one’s peace with it, suicide can clearly give one a