How will we come to understand life—and death—in the future? (given that in the future we will likely be able to keep people alive almost indefinitely).

The future will require a new, more mature relationship with death, and through this ultimately with life.  Dramatic changes lie ahead in how we relate to death, changes that will present both fascinating new possibilities and wrenching new moral quandaries.

Philosophers through time have identified death as life’s greatest teacher, and rightfully.  Nothing so directly challenges an individual to ask the important questions than confronting his or her mortality.   At a cultural level, addressing death more maturely should be no less profound—and no less unsettling.

Many of the most important challenges to our thinking about life and death lie well in our future, barely grasped consequences of the  manipulation of the genome.   But many confront us right now.  For example, how we relate to death lies at the heart of the modern health care debate.  Health care costs are spiraling uncontrollably.  Unless we are willing to spend an ever-expanding percentage of human resources on medical care, we have no choice but to somehow limit its availability.  We already in effect limit care—we make it extremely difficult for people who can’t afford care to get it.  But consciously choosing to do so is something totally different.

Medicine has always required life and death decisions.  But limiting care demands, in effect, the conscious choosing of death—at the least, in the sense of withholding care that might delay death’s arrival.  Limiting care requires a level of responsibility in our relationship with death not before necessary or, I would argue, within our human capacity to handle.

Plenty of situations existed in time’s past where we “chose” death.  But always before this was for people we considered fundamentally different from ourselves—enemies, criminals.  Imbedded in our cultural mores has been the assumption—I think  accurate—that anything else risked starting down a slippery slope that we likely could not manage.  Nazi death-camp atrocities performed in the name of medical advancement powerfully illustrate this slippery slope.

Today we have no other option.  The health care delivery debate is mute unless we are willing to confront the face of death more directly.  Without this, none of the delivery approaches we debate today will work.  Each leaves us in the same impossible tangle.

Health care delivery is but one of a provocative list of quandaries that we can address only with a new maturity in our relationship to death.  Some of the issues are decidedly familiar—abortion, assisted suicide, capital punishment.  Others, such as the moral entanglements that will inevitably accompany efforts at artificial life, we can only guess at.

Each will require both a new responsibility in our relationship with death and a new sophistication in how we think about death if we are to go forward.  For example, without these things the abortion debate will remain eternally unresolvable.  At present, neither side is any closer to maturely addressing death.  The pro-choice side denies that abortion is about death—that it is at least a kind of killing.  The pro-life side keeps well at arms length the unsettling truth that sometimes death can be the best way to support life.  As long as the face of death is not more consciously confronted—from both sides—the two extremes of the abortion debate will sit forever at opposite ends of an unbridgeable divide.

It is unlikely that death in the future will be any less an unsettling specter.  Or any less a mystery—indeed, most likely death’s mysterious nature will only become more obvious.  But more directly confronting death will free us to make choices that before were beyond us—at least to make wisely.  In the end, doing so will help us not just better understand death, but to more deeply appreciate, and better support, the wonders of life.



Fill out the form below to receive monthly articles and updates from Charles Johnston, M.D.