In Defense of Natural Death

by Sylvia Engdahl

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In recent years a good deal has been written about the suffering caused by excessive medical treatment of the dying. There is an increasing number of fine books and articles on this subject, including some by doctors who point out that such treatment frequently amounts to torture. (See my page Today Most People's Death Is Painfully Prolonged for a list of them.) More and more publicity is being given to the necessity of preparing advance directives specifying what treatment an individual wants, or does not want, when near death. Although in some cases physicians take the lead in providing futile and cruel technological interventions, too often it is patients' families who demand them, being unwilling to have it thought that they have not done everything possible to keep their loved one alive at any cost.

Yet despite all this attention to needlessly-prolonged dying, rarely if ever is the root of the problem acknowledged: the refusal of our society to admit that death is no less a natural phenomenon than life, and that to deny this is to reject the very essence of biological existence. The unrealistic view of death prevalent in our culture has widespread effects, which are increasing as medical technology advances and go far beyond the matter of how to treat people who have already reached the end of their lives. A more fundamental issue concerns those merely approaching the end: is the delaying of death by technological means always beneficial?

Society generally says yes. This assumption is a holdover from the centuries when there were no cures for most illnesses and the majority of people died before age 70, many in childhood or youth. Living as long as possible was the aim--and of course it was, and still is, desirable to use all possible means of preventing premature death. Thus death itself was seen as an enemy, and the military terminology surrounding it such as "fighting" an illness and "combating" disease became firmly established. The question of how to define "premature" did not arise.

Aging bodies are maintained by one medical intervention after another, usually at the cost of lowering quality of life.

But today, that question has become a crucial one, although it is seldom asked. On the few occasions when it is considered, there are indignant protests against "ageism" and alleged discrimination against the elderly. Yet everyone must die eventually, and despite the prevailing view of the body as a collection of parts, there is such a thing as death from old age. Perhaps in the future the maximum human lifespan can be extended; for now, however, there are limits to how long even a healthy person will survive. And most of the very old are not healthy. On the contrary, their aging bodies are maintained by one medical intervention after another, usually at the cost of lowering quality of life. That one should endure whatever discomfort is necessary to gain a few more years, or even months, of living is taken for granted. The acceptance of it is considered not merely admirable, but virtuous, as if there were some moral obligation to stay alive in defiance of the inevitable outcome.

To me at the age of 85, this does not make sense. Bodies wear out and at some time, usually in a person's 80s, this normal process results in failures of internal functioning. Personally, I believe that treatment aimed at prolonging life is unwise after this point. There is no real gain from such treatment when it is likely to mean suffering through a succession of serious illnesses rather than a single final one. Furthermore, at least until a cure for dementia is found, the prevention of natural death in old age simply increases the odds of becoming mentally incapacitated. It is not as if postponement could "save lives." Death is not optional. We are all going to die, if not from the first life-threatening illness to develop in extreme old age, then from another; and to put it off is of questionable benefit when quality of life can only decline.

Moreover, many medical procedures--and even some drugs--carry a risk of cognitive impairment over and above the danger of dementia that increases with age. This concern is usually dismissed on the theory that keeping bodies alive is more important than preserving minds. I want no such treatments, since to me the preservation of my mind is of the highest priority and my worst nightmare is of suffering mental decline due to some form of medical intervention. The danger of its natural occurrence is bad enough without adding to it.

Much is now said by economists about the "epidemic" of dementia that has developed with the advent of lengthened lives, which is expected to lead in the next few decades to an unmanageable need for long-term care. There is no solution to this problem in sight. But the worst aspect of it is not the economic impact but the devastating effect on individuals who, having lived fully and achieved much in the past, lose even the memories of everything that has mattered to them. This fate (which eventually befalls an estimated 50% of people over 85) should not be so common, and it would not be, if custom did not demand curative treatment of all preceding illnesses an octogenarian experiences. Dementia sometimes strikes prematurely, but more often it is the result of bodies being kept alive by technology beyond the point where they have become too worn out to maintain normal functioning. Alzheimer's disease is now the 6th-leading cause of death in the U.S. and its rank is rising as the rate of death from heart disease falls. Given a conscious choice, who would not prefer to die naturally of heart disease?

Too often, dementia is the result of bodies being kept alive by technology beyond the point where they have become too worn out to maintain normal functioning.

Rarely is the choice conscious, however, for most people do not think ahead. To be sure, the fear of death is instinctive; if it were not, few of the young would choose to live through the periods of pain and despair that come to nearly everyone. Yet with age, that fear generally declines. Very old people are often tired and feel ready to go. Even before that point, they accept aggressive medical intervention not because they are afraid they will die without it, but because in our culture it is viewed as the proper course at all stages of life. Just saying no to treatment is not a socially-approved option--it is viewed as "giving up," as if life were some sort of game or contest. Limiting health care to the relief of suffering is considered only after the failure of drastic attempts to cure.

Should people nearing the end of their lives seek to die, then? Of course not. Natural death comes when the body--or in my opinion, the subconscious mind--"knows" that it is time to stop resisting the failure of internal functions. Current pronouncements to the contrary, this does not constitute disease; it is normal. Either prolonging the process or hastening it is a violation of one's deepest impulses, a denial of one's inner knowledge. "Let nature take its course" is a maxim that should be interpreted literally. This does not mean rejecting all medical care. Ongoing palliative care (comfort care) is essential except in the rare instances when death is sudden. For the "oldest old" that, not curative care, should be the norm.

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Incredibly, some speculators now doubt the inevitability of death. Many, including a number of scientists, claim that someday people may become physically immortal, a game changer that certainly would transform our outlook on the future of humankind. In my opinion this unrealistic aim is mere wishful thinking on the part of people who are afraid of dying and yet, paradoxically, believe themselves to be no more than biological machines--though the scientists who endorse the idea may be motivated more by an urge to vindicate the materialistic basis of their assumptions than by personal fear.

What, I wonder, do these people think makes them care about living forever? Machines lack the ability to care. The desire for immortality is an ancient theme of mythology, and the very fact that it exists shows that humans are more than mere machines subject to redesign as if they were soulless robots. Even if bodies or brains could be made invulnerable via technological enhancement, the mind would die, for subconsciously it senses when a person has gotten all he or she can out of life. This is true whether or not there is any form of afterlife. We don't know the meaning of life and death, but it is the most fundamental fact of existence and no amount of intelligence or technical skill is going to alter it.

Some people are now paying large sums to have their bodies or brains frozen and preserved indefinitely after they die

There are people now who are paying large sums to have their bodies or brains frozen and preserved indefinitely after they die in the hope that they can someday be revived and given an endless--or at least extended--lifespan. Such an illusion is on a par with the maintenance of dead bodies in stasis in my science fiction novel Stewards of the Flame, which was intended to be seen as a reductio ad absurdum. It is indeed absurd. Whether it will ever become possible to freeze people, either for future cure of illness or for interstellar travel, I don't know; but if it does, they will have to be frozen while alive. Unlike a machine, a body cannot be "restarted" after it ceases to function. Fortunately in the eyes of most of us, it can't be turned into a zombie--although folklore about zombies lacking volition and memory reflect an intuitive sense of what will happen if it is ever tried.

On the other hand, it may well be possible for normal lifespan to be lengthened. While statistical life expectancy has been steadily increasing, that is a misleading fact because it has been due not to lengthening the lives of the elderly but to decreasing the number of deaths among infants, children and young or middle-aged adults. The life expectancy of a person who reached age 80 was the nearly same hundreds of years ago as it is today. Advances in medical science may add to it, although at age 86, I can attest that this won't be desirable until the disabilities of old age are eliminated, a goal that should be given priority.

I doubt that maximum lifespan will be extended much past 100 through improved health alone, though there are rare cases of people living to 115 or more (and characters in my Flame novels live into their 120s or even to 130). It may become possible to increase it further by means of technology, possibly genetic engineering--but I suspect that there is a point past which this would result in insanity, since the brain's capacity for storing and retrieving memories is not infinite. Personally I believe lifespan will be limited by the length of time the unconscious mind chooses to remain tied to a body. We have no idea how long that is likely to be for the average person, but underlying will to live has always been recognized as a factor in survival.

I think that length of life is overrated as a factor in human happiness. In the past the odds of dying prematurely were large, and of course people wanted to live as long as possible, which they envisioned as somewhere over 80. Probably most octogenarians who are healthy want to live into their 90s, maybe to 100. But how often do we hear of someone over 100 who longs for more time? Aged people frequently feel that they've had full lives and that there is nothing left worth doing. Some view death as rest, while others envision it as moving on; but rarely do they approach it fearfully. It is the younger people who want life extension, and there's no knowing how they would react if they got it. I suspect they would simply die when subconsciously ready to die, and researchers would wonder why the modifications to aging bodies kept failing.

As I've said in my essay "The Roots of Disbelief in Human Mind Powers" (In my book The Future of Bring Human and Other Essays), we are more than our physical substance. To some people this fact implies that we survive beyond the death of the body, but whether we do or not, the non-physical essence of us can't be accessed, let alone eternally preserved, by technology. We cannot know how or why it comes into existence. All we can be sure of is that life and death are inextricable aspects of being human.