The issue of legalised assisted dying to the forefront of our consciousness.

But before we talk about dying with dignity, we must talk about death.

Why do we age? The answer to this question lies in the genes. Even if we have the right genes, they cannot help us to live forever. Cells are damaged all the time; sometimes they began to replicate uncontrollably and become cancerous. This damage is accumulated over time, leading to the breakdown of healthy functions of the body, which ultimately results in death.

Brain death is arguably the most accurate biological and philosophical representation of death. Heart failure, in itself does not constitute death. Pumping of blood is important, but it only supports the functions of the brain. Brain death means the cerebral cortex is destroyed forever. This largest part of the brain controls everything that makes us human: sensory analysis, spatial location, language, memory, attention, emotion, motivation, thought and consciousness.

Is death instantaneous? No, we take from a few seconds to a few minutes to go through the dying process. “The last breath is taken, death takes hold and life is over,” writes English biologist Thomas Kirkwood, in Time of Our Lives: The Science of Human Aging. “At this moment, most of the body’s cells are still active. Unaware of what has happened they just carry on … In a short while, starved of oxygen, the cells will die.”

In the fourth century BC, Epicurus said that death is the primary cause of anxiety among human beings. He argued that death involves neither pain nor pleasure. The only thing that we should fear is pain. Therefore, we should not fear death. Shelly Kagan, a professor of philosophy at Yale University and author of Death, echoes Epicurus when she says fear is one of the most common reactions to death. “Indeed, ‘fear’ may be too weak a term: terror is more like it,” she adds. It’s reasonable to be afraid of the process of dying, but most people are terrified of death itself.

It’s evolution that inculcates our desire to live. It’s also evolution that cruelly takes this desire away from some of us, for it has failed to equip us with a mechanism to cope with excruciating and continuous pain. When this pain becomes unbearable, it’s understandable to me at least, that desire to end life overtakes millions of years of genetic programming designed to perpetuate life.

My belief system, which has been shaped by science and philosophy and not by any religion, can easily embrace the idea of dying with dignity. But it fails to reconcile with the idea of a person placing a limit on their life.

Ezekiel J. Emanuel, an American oncologist and bioethicist, says that 75 years is all he wants to live: “By the time I reach 75, I will have lived a complete life … I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make.” He makes his compelling argument that society and families will be better if nature takes its course swiftly and promptly in an article in the October 2014 issue of the prestigious The Atlantic magazine.

We are now living longer but not necessarily healthier as the ageing cells put breaks on our mental and physical abilities. In spite of all the medical advances, there is also no getting away from the pain that Epicurus advises us to fear and not death.

Emanuel says that he won’t be actively ending his life when he turns 75, but won’t try to prolong it, either. He plans to stop getting any regular preventive tests, screenings and interventions: “Today, when the doctor recommends a test or treatment, especially one that will extend our lives … The momentum of medicine and family means we will almost invariably get it.”

The ethical questions we face are not only about dying with dignity when pain becomes unbearable but also about prolonging life beyond a certain age.

“I’m pretty much anti-death,” says Hal Incandenza, the protagonist of David Foster Wallace’s novel Infinite Jest. “God looks likely all account pro-death. I’m not seeing how we can get together on this issue, he and I.” Like Hal, most of us don’t know how we can get together with God or our conscience on the issue of death.

© Surendra Verma 2016

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