Hello! My submission for the creative writing contest! But first, a note! I recently a course about the economic impacts of climate change, and one notion discussed therein was the possibility of Green Dying. Dying comes with large carbon and monetary costs in the Global North, and therefore, making prducent decisions about advance directives and what sorts of care you want to pursue at the end of your life can save a lot of money and emissions, at little cost to you! This is a super sensitive and personal topic and while I try to treat it with a light hand, I recommend you don't read this submission if you're somebody who has recently gone through the grieving process or are terminally physically or mentally ill yourself. In any case, my piece is an attempt to start a conversation about the difficult topic of dying well in the 21st century, and also address what Dying might mean to an effective altruist. It isn't something I've seen discussed too often, and when it has been discussed it has not been seriously considered. I hope this piece can be the beginning of a conversation!
DYING GOOD WHEN DYING'S BAD
You spend most of your life thinking: I can’t imagine how a dying person feels. At your grandfather’s death-bedside, mystery dulls the pain sympathy brings. Maybe it was painless. Maybe he was fine. Maybe they are fine, the emaciated bodies that show up occasionally on your television, advertising for this hospital, that charity—for only dollar a day you could save a life, all that. They have to make things seem worse than they are, don’t they? That’s the only way they get people to donate. You spend most of your life treating the dying as if they were already on the other side of life’s only remaining unpenetrated frontier. You’re not selfish. You care about others’ suffering—you’ve comforted friends through divorces and firings, the loss of loved ones. But the suffering of the dying seems remote to you, artistic, mystical. You could never understand how they feel. You spent most of your life thinking, and now you’re dying yourself. And you still feel like you’re the same person. You still feel unworthy to speculate on the experience of dying, but now people are looking at you like you’re behind a pane of glass.
You have some easy decisions ahead. You’ve always loved Science, and now you’re giving your body to her. Maybe a pathologist will find something odd in among your intestines and then they’ll see: you did have a discovery inside you. Maybe your articulated skeleton will grin at generations of incoming med students, and you can add to your utility balance sheet hundreds of instances of “demonstrated location of clavicle: +1 util”. Your family will donate funeral costs to charity, as you have directed them. But you have one more direction to give, while you’re still lucid. You have some hard decisions ahead.
You know no-one will judge you, not where you’re going, for choosing to hang on. Your family might love you for it. You know that the utilitarian philosopher you admire most finally compromised his philosophy when it came to keeping his own mom alive. But you also know that depending your decision, more money will be sunk into your intractable case than will be spent on most people’s health over their whole lives. Life support doesn’t always support life.
This is a hard decision, but for you it’s easy compared to the decision most people have to make in your place. You’re a linguistic artefact in a parable about effective altruism, dying from an ambiguous disease with an invented prognosis and with no sisters, daughters, brothers, cousins, nieces, nephews, sons to mourn you. Or friends. You have it easy. Pull the plug on me, you’ll say—don’t make me last for longer than a full sitting. But those in slow decline from nonfictional maladies face a more devilish version of your predicament, and maybe, if you can answer your question well, you can help them in their hour of need.
It’s dangerous to suggest your life isn’t worth the lives you could save by losing it. Once, in darker adolescent years, you did doubt that the money you spent and the fuel you burned wouldn’t be better spent and better burnt by the many people in the Global South whose collective lifetime earnings and lifetime emissions your single lifetime’s would equal. But your privilege meant you had value to add, and over your life you gave more than you took. Knowing that is enough for you to die happy. You did it. You ran the race. You started giving because it was modish, but you kept on doing it, even when it stopped being fun, even when your communities fractured, even when it was banal or boring or out-of-trend. You had seen it through. You improved the world.
It’s dangerous to suggest your life isn’t worth the lives you could save by losing it. The cognitive traps that people can fall into thinking about that question make it almost impossible to evaluate correctly, and too many people are tempted to weigh too little their potential contributions and weight their burden too much. It’s dangerous, and for most people, it’s better to believe you can and will make good on your promise to do good than to speculate about what you should do if you don’t. It’s dangerous, but what does danger matter to you now? What are your potential contributions, now?
You were a logical person and you’re aware you probably as a result undervalue ritual. Funerals clearly mean something to some people and while the part of your corpse’s trajectory you’re really excited about is when people start doing experiments on it, you figure if your loved ones want to make you up nice and put you in a box and say nice things about you, you’re not in a position to object. The funeral industry’s exploitative pricing gives you some pause, but this hospital is in a valley, and you’ve picked another hill to die on.
That hill is this: it doesn’t make sense for you to pursue aggressive treatment at this point. Even if there is a small chance you revive, if you are close to your life’s full term, aggressive treatment will mean pouring a lot of money into ever decreasing gains. End of life care is tremendously expensive. “Nobody should have the power over life and death”, you’ve heard heroes yell at villains in countless movies over your long life. Well, look at you now. Doctors and hospital administrators have to make grim utilitarian calls all the time, when apportioning scarce resources to respond to overwhelming medical demand. But by giving your family directions for your care once you continue to decline, you will save your doctors one of these tough decisions.
There is no such thing as noble suffering, you have always believed. Pain is not good, and the existence of death is the ultimate ill. You have fought it your whole life. There are in modern life so few moments of glory and of valor and for someone like you—who has dedicated their life to doing good well—there are even fewer. Well, here, at the end, bed-confined and exhausted, maybe there’s one. It’s never noble to die, but once the life you can save can no longer be yours, it may once again be someone else’s. Now you understand how to feel.