The urgent question posed by the pitiful news photographs of Natasha and Courtney Smith, the latest conjoined twins, is: are we in the affluent, scientifically advanced West morally obliged at the start of the 21st century to maintain all life at all costs, whenever we can? The approved answer, even in an increasingly irreligious society, seems to be yes. This may reflect the terror of death rather than the perpetual sanctity of life, but now that most people doubt the existence of a life hereafter, perpetual death holds more terrors.
Even if we concede that the answer is yes, we don't do all we can to preserve life. We inflict death deliberately and daily, and which particular slaughter you object to will depend on whether you are a pacifist, a vegetarian or a Jain. But in the medical field the current belief, judging by public opinion and the decisions of the law courts, would also seem to be that life should be preserved at almost any cost.
Whether it is that of a tragically malformed infant (and judging by their photograph, little Natasha and Courtney are not malformed, just conjoined) or a very old person most of whose faculties are no longer working, the spark of life must be kept glowing.
My own moral stand is frankly inconsistent. I believe the life of the very young deserves more nurture and cherishing – yes, and more medical support – than that of the old. First, because the parents of new-born babies often have the most miraculous capacity to love their damaged infant; they will dedicate themselves to its care and suffer terribly if their child dies. Those who are just starting life demand special protection; and who knows what discoveries may come along to improve their condition?
If we are able to separate conjoined twins, by all means let us do so; and if that means the inevitable death of one – looking at the Smith sisters, who can say they were ever really two? Until three or four decades ago, babies who would never be able to lead an ordinary human life – "not viable", as the jargon had it – were quietly snuffed out. The doctor might tell the parents their baby was born dead; or explain why the decision seemed inevitable.
Once, when I was a television reporter, I was expressing big-mouthed disapproval of this practice. The hospital consultant I had come to interview went to a filing cabinet, pulled open a drawer and spread a handful of transparencies across the table. "Look at those," he said, "and tell me if you think those lives should have been preserved?" Such were the monstrosities displayed, I could not argue that they should. They weren't then, and I suspect they would not be now. There are horrors on whom no doctor could be so cruel as to inflict life.
The "thin end of the wedge" argument is valid here. Amen, the new film by Costas-Gavros, includes a vivid scene showing a coachload of handicapped people, many smiling confidently, being driven off to die in an early, experimental gas-chamber. Pleasant, ordinary passers-by stand and watch, grinning, grimacing or turning away from their helpless, hideous simplicity. Once the nutters and the wonks are done away with who is next? Gypsies, homosexuals, drug addicts, alcoholics? Me? You?
Now I contradict myself. I don't believe the same absolute protection should be extended to the very old. A few decades ago, the family doctor, relatives and even vicar often colluded in the humane decision that a long, well-lived life should not be prolonged far beyond its natural span to the final comatose breath. Frail, ill old people with no hope of an independent or contented, let alone pain-free, future were allowed to slip away without aggressive medical intervention. Not any more.
I believe this change started in the United States. It was fostered by the medical profession's dread of being sued for millions if a "loved one" – the ghastly euphemism for a geriatric relative – were not kept alive with every tool that medical technology offered. There was another unspoken, deeper and perhaps more powerful reason: the fear of death.
Americans worship youth and beauty. The opposite of youth is old age and the extremity of old age is death. Hence cryogenics; hence cosmetic surgery and its many offshoots; hence medical intrusion until the last possible moment. Nowadays, if you are an American millionaire, with luck and attentive doctors you may survive for 30 years beyond your Biblical three-score and 10. In Britain, too, as in any secular society, timor mortis conturbat me – "the fear of death surrounds us".
I have been in hospital during the small hours, when death most often happens, and seen very old ladies dragged back from the very edge of their own peaceful dying with emergency measures and swift injections. Usually they died a few days later in a deep, stertorous coma, rather than calmly, with dignity.
Very old people – by which I mean, I suppose, those over 80 – have their hips done, their hearts done, are pumped with antibiotics to prevent them being carried off by pneumonia ("the old man's friend", it used to be called). For many it's worthwhile; reinvigorated, they enjoy a new lease of life. But others – long past the time when they can walk, let alone run; talk, let alone laugh; see, let alone appreciate; or recognise, let alone converse – are threaded with tubes and filled with pills so that their pathetic travesty of life may be prolonged for years. I know; I watched it happen to my mother, who died two weeks ago at the age of 90. I have made a "living will" and implored my own children not to let me degenerate into a spoon-fed, tube-fed, geriatric foetus. My mother, had she known, would have hated it too.
For a few days after she had died, I read the obituary columns more attentively than usual. I noticed how many of those listed were over 85; at least a dozen every day were over 90. Some 90-year olds remain in full possession of their faculties. One friend of mine lived in her own house, gardened, read, wrote letters and even had people to stay until a few months before her death, aged 90. Another friend of 95, when I rang to ask when I could visit her, said, "I'll have to look in my diary: I'm frightfully busy at the moment. There's this Russian pianist – tremendously talented chap – coming from Moscow to see me..." It is possible to be engaged with life until almost the very last minute; but few are so lucky.
I see friends of my own generation looking after aged parents – not usually under their own roof, but even in residential care an old person needs to be visited, entertained, shopped for, telephoned, cheered up, perhaps several times a week. This is fine for those who had a loving and harmonious relationship with their parents: but what of those who didn't? They can find themselves enslaved by the querulous demands of an increasingly angry, bitter or frightened person. Two or three decades may be spent ministering to someone who was, perhaps, a destructive and unloving parent when it was their turn to do the caring. But try telling the visiting doctor that you don't want mummy or daddy kept alive and would rather he didn't prescribe antibiotics or perform another hip operation, let alone the latest miracle, life-prolonging treatment.
By all means do whatever is possible to prolong the lives of babies born with a condition that can be improved and maybe, in the long term, cured.
But please, can't we let the very old die in peace?Reuse content