Why Is There a Duality Between Suffering and Hastening Death?

Several years of studying cancer biology in the lab did not make me ignore the suffering and pain of cancer patients in hospitals. My father loved life and hoped to live longer. He died from esophageal cancer. The doctors were disappointed with his outcome and recommended that he go home without telling him that he had deadly cancer. A couple of weeks before his death, he lost the ability to move, eat, and drink. He fell into a coma-like state a few days before passing away. However, when I said to him several minutes before his death, "If you hear me, push my hand," he weakly squeezed my hand. He appeared to remain aware of me until the end and faced his inevitable fate.

A philosophical question: Why must we endure the suffering caused by diseases or death without selecting them?

Almost all living beings have an instinctual intention to survive and a fear of death. In this regard, existential fear of death in humans is associated with an individual's awareness of their own mortality; however, not all human beings experience this awareness in the same way, nor do all anxieties regarding death necessarily stem from consciousness. The fear of death should not be reduced to the fear of pain or the process of death. Humans may feel anxious because they fear nonexistence, separation from loved ones, and the loss of their life goals. Clinical evidence revealed that fear of death is not just a philosophical issue. It has been shown that death anxiety is a basic fear underlying various mental health conditions, such as hypochondriasis (excessive worries about illnesses), panic disorder, and anxiety and depressive disorders.[1]

Existential death anxiety has raised questions among scholars throughout history: Do we have the right to bring children into this world without their consent, knowing that they will inevitably face death? Regardless of entering into discussions about these philosophical issues, it is clear that humans have always been concerned with death and their responsibility for the deaths of their loved descendants. The book Better Never to Have Been: The Harm of Coming Into Existence by David Benatar is one of the best-known contemporary works on antinatalism (the belief that having children is unjustifiable).[3]

To avoid philosophical debates about the meaning of life and falling into nihilism, this perspective focuses on the rights of patients with serious and painful diseases. Although everyone faces inevitable death sooner or later, these patients have a unique situation: They may be aware that death is near, while healthy people can more easily keep thoughts of their own mortality at a distance.

The duality of continuing life with suffering and intentional ending of a person's life

In patients with life-threatening illnesses, anxiety becomes more complex as it mixes with pain, suffering, loss of independence, and concerns about the meaning of life, leading to the need for psychological interventions. Various studies have proposed that psychological methods—for instance, methods based on terror management theory (TMT)—can help patients understand how to confront death and make end-of-life decisions.[2] According to TMT, the awareness of the inevitability of death can create anxiety that humans manage by relying on cultural beliefs, religious beliefs, a sense of personal worth, and meaningful relationships.

With the legalization of euthanasia in France, ethical and sociological debates surrounding the issue have been reignited. Euthanasia and physician-assisted suicide are practices that raise questions about the rights of people experiencing severe suffering due to serious or incurable illness. Now, few countries accept this right legally, including the Netherlands, Belgium, Switzerland, Canada, and, recently, France. The word "euthanasia" comes from the Greek roots "eu," meaning good, and "thanatos," meaning death. Commonly, euthanasia is a physician-assisted active procedure, and doctors administer medications that provide an easy death. However, there is a type of euthanasia in which someone may refuse treatment and choose death passively.

In some cultures, particularly in religious societies, euthanasia is forbidden. In most religions, human life is considered sacred. Therefore, challenges around the right to end suffering from disease continue to persist. Some believe that acceptance of euthanasia may open the way for the legalization of suicide because the logic behind it is the same.

However, is there another ethical way to rescue patients from pain without helping to kill them? One might envision a third scenario: a profound alteration of subjective experience in which the individual remains alive, yet their relationship to pain, fear, personal identity, and even their sense of "self" is transformed.

Modern medicine can help terminally ill patients to die peacefully

Modern medicine offers options to reduce suffering at the end of life without necessarily ending a patient's life.

A new systematic review examined psychedelic-assisted psychotherapy, including psilocybin and LSD, for anxiety, depression, and existential distress in people with life-threatening diseases.[4] However, further research is needed to clarify the efficacy, safety, and appropriate use of classical psychedelics in these patients, as they may also cause anxiety, psychological agitation, and increases in blood pressure and heart rate.[5]

But approved medical options already exist. Palliative sedation is used in clinical practice for patients with advanced disease whose symptoms cannot be relieved by other means. Sedatives such as midazolam and lorazepam reduce the patient’s level of consciousness, and guidelines recommend their use only as a proportionate, carefully monitored response to refractory suffering.[6]

The question arises: Why—perhaps due to economic reasons or a lack of cost-benefit analysis—do governments and healthcare systems leave patients and their anxious loved ones to face death alone? Perhaps the right to a peaceful death, free from terror, is a more ethical issue than the broader debate surrounding the right to end one's life.

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