Altruistic Suicide

Catholic Medical Quarterly, 27/4 May 1976, pp. 197-201

On the morning of the 17th March 1912, at 79° 50' S, a young map crawled out of a tent into a blizzard, and was not seen again. He was Captain Lawrence Grace Oates of the Inniskilling Dragoons. He and his party, led by Captain Scott, were on their way back from the South Pole. Oates suffered much from frost‑bitten feet, but he marched on as long as he was able. At length he could go no farther and asked to be left behind. This request was of course ‑ of course?‑ refused.

'He slept through the night', wrote Scott, 'hoping not to wake; but he woke in the morning. It was blowing a blizzard. He said, "I am just going outside and may be some time." ' His self‑sacrifice enabled the survivors to push on, but unfortunately not fast enough nor far enough to reach their depot of food and fuel, though safety was only eleven miles away.

Everything hung on the time limitation. Oates was not the first man to die on the way back from the Pole. Petty Officer Edgar Evans was the first to break down; and marching had been very slow for several days before his death on the 17th February. It was the time lost then which was the critical factor in depriv­ing his comrades of their chance of reaching base.

It is not for us to criticise Evans, nor perhaps to think of him as being less heroic than Oates. Perhaps only out of obedience to his leader, or for other reasons that then seemed good and sufficient, or perhans because he did not become fully aware that he was ultimately himself responsible for action or inaction; but whatever the cause it remains true that the failure of one member of the party to sacrifice himself when a voluntary sacrifice was in order, did more harm to the prosoects of his comrades than could later be made good by the self‑sacrifice of another.

I am sure that an audience as quickwitted as mine tonight has taken my point before it has been made. I shall not be talking about the right to die, but about the duty to die. The act of Oates was the very type of altruistic suicide; and altruistic suicide is not now something appropriate only to the very rarest con­tingencies. No, it is something that should be carefully weighed and considered as an immediate and realistic recourse by thous­ands of people every clay of the week. The doctors have ex­plained to us that they cannot and will not be our executioners. Captain Oates's request to he left behind was refused. He had to act for himself. We, too, may have to act for ourselves, and act in defiance of constituted authority, because such an act is demanded of us by any adequate ethical standard, by our humanity and by our self‑respect.

Our position in the world today is much like that of Scott's party, but on a global scale. Humanity faces a world‑wide enviropmental crisis, no less threatening because we have brought it on ourselves. One part of the picture is that millions are dying of starvation, or malnutrition, or the diseases consenuent on malnutrition, while we live in fatness. It is also .a part of the picture that there are very very few of us who make a contribu­tion to the world's physical or mental resources that is equal to the resources we consume. In those terms, then, whatever our value to our near and dear ones, our value to the world as a whole is a minus quantity. By an infinitesimal degree. the total pressure on world resources is actually relieved when the hand of death rubs us out.

This estimate of the value of the individual human life might be criticised by some as too narrowly economic, or as too much seen in an ecological context. The Chief Rabbi, Dr. Immanuel Jokobovits, in an article in The Times of the 27th January 1975, made a larger‑in fact an infinitely large‑claim for the value of human life. He wrote:

"Unless religious teachings help to restore the infinite regard for the sanctity of life, we will face catastrophe; as our cities turn into jungles, and terrorist gangsters. holding up to ransom governments, citizens and even children, will rule the world in an orgy of human self‑destruction.  I stress religious teachings, for only religion postulates that no life is expendable, that life being infinite in value, is indivisible, making one human being worth as much as a million others and conferring on each equally infinite value."

I cannot share this view, which seems to me to be valid only in an exclusively theological context. For me, the value of a human life lies in how it is lived, whether in fostering love or hate, in the search for truth r the spreading of lies, in considera­tion for others or in greedy self‑seeking. Unlike Dr. Jakohovits's theological world where all values are infinite and the laws of arithmetic cannot be applied, in the world of here and now the suffering of a million human beings is a million times worse than the suffering of one.

On one point at least Dr. Jakobovits's statement, even in its purely religious aspect, is certainly over‑simplified and incomplete. Whatever the value of individual human lives in God's eyes, they cannot, they must not be all of infinite value in our own. While it is permissible, though I think unrealistic, for me to regard every other life than my own as having infinite value, it is not open to me so to regard my life. My life is not worth as much as a million others. Nor is it for me to claim that my life is not expendable. It is expendable; it is expendable by me. If and when the time comes, as it came for Captain Oates, it must be expended. This may be, as I see it, my supreme duty; and if it is, then it becomes the duty of others not, unless for good cause shown, to impede or restrain me from carrying it out.

Of all aspects of the environmental crisis in which we find ourselves, the health crisis is the most immediate. The burden on our hospitals, our doctors and nurses grows day by day, grinding the health services into increasing inefficiency under the overload. Many thousands of suffering people come to the tail-ends of long queues and must wait months for relief, even if their condition is quickly and easily curable, and even if delay turns a curable condition into an incurable one. When we are ill and go into a hospital we are stepping in ahead of other sufferers and making them wait that much longer. Whatever the balance between what we give and what we take when we are well, when we are ill large new entries are made on the debit side and the account shifts far over into the red. When we are ill we multiply our demands on the services of others tenfold or a hundredfold. An ethical problem arises. We cannot be justified in pre-empting these precious and insufficient resources quite without limit, without hope of recovery, without hope of ever doing anything to redress the balance. Each of us has, must have, his own personal scale of values by which he lives. In this we must give up the insane delusion that our own petty life is of infinite value and worth a million others. Those others - and they are millions, for half a million people die in these islands every year-those others too have their just claims.

When we come to die it is as a rule after weeks and months of illness. A terminal illness places a particular strain on the caring services. This varies with the cost in treasure and man-hours which are taken from others and given to the dying man.  It is enormous in the extravagant organization of an intensive care unit. It is less but still very great if, among the favoured few, we can spend our last weeks or months surrounded by the loving care of one of the Hospices, and in our own selfish persons be sustained by all that is meant by a nurse-patient ratio of approximately one to one. It is less again, but still very costly in psychological terms if we spend our last illness in our own homes. We must remember that our miseries are sent us not for our own personal enjoyment alone. They have to be borne by others too. So when the man with an incurable malignant growth decides that he will slog it out to the bitter end, he is making a decision for others as well as himself. His wife, too, will have to live through those weeks and months, in agonising anxiety and love and suffering. He will have condemned her as well as himself to an ordeal he thinks he can bear, forgetting that perhaps she can't. The strain of caring for a terminal illness in the home is a bearable one if it is a matter of days or a few weeks. But as it continues it wreaks an ever more destructive effect. Loving and united families can be wrecked by the strains of long-term care, indeed the more loving and united they are, the more utterly can they be overwhelmed.

We cannot evade the predicament. The responsibility is ours; action or inaction are equally a matter of personal decision. We cannot leave it in God's hands, because the advances of medicine have taken these decisions out of God's hands and put them in our own. There they lie. Too many other people are involved for us to leave the problem unfdced, the decision undecided.

You may think, perhaps rightly, that to die of senile dementia in a psychogeriatric ward is a nice cosy way to die, and an eventuality we should accept with resignation. After all, the patient himself knows nothing of the fact that he is constantly in need of care, that he has no sooner been washed and put into clean linen than he has fouled himself again; or that the fondly who visits him meet only the blank unfocused shifting gaze of non‑recognition. His mind has retreated into an ever deepening sleep, though sometimes a sleep that is broken by nightmares. As Dr. Cicely Saunders has explained: [1] "Many disorientated and even demented people do not seem to he unhappy or dis­tressed, and some are certainly quite the reverse. Insight into the change that is taking place is often lost at an early stage… Even incontinence, the greatest dread of many, need be no more offensive nor humiliating at the end of life than it is at the beginning.” She is right in this, that the real obscenity is not the poor worn‑out piece of mechanism, the mindless thing living like a parasite on the energies it sucks from healthy and vigorous young nurses in back‑breaking toil. The real obscenity is the fact that this was once a man who had the power to choose, and did nothing.

    Well, how is it to be? We can all see the day cooling, our own personal day that is. If we are rational beings, if we are able for some small measure of contingency planning, if we are willing to put our fears second and our love and respect for others first, we can plan to do our own particular job of dying with decision and courage and kindness. Captain Oates saw his death near and he went out to meet it. He was determined not to burden his fellow beings to the point where he endangered their lives. We can do the same. I can see no excuse for evading the duty of suicide, if the alternative is months of dependence without hope of recovery. But the dung is a hard one. In accepting it we should he able to count on the understanding, the respect and sympathy of others. We should not have to face the hostility of society or fear the officious intervention of rescue teams.


[1] On Dying Well: An Anglican Contribution to the Debate of Euthanasia, 1975, London, Church Information Office, p. 41.