Is a Dying Person's Pain 'Repulsive?'
Dismantling Bad Arguments in the Medical Aid in Dying Debate
In 2015 I experienced a near-death episode after a 25lb, 40x30x11cm tumour perforated my bowels. Racing against the onset of sepsis, Dr. Husien performed a 6 hour emergency surgery, successfully removing the tumour, taking with it significant parts of my digestive system. My three weeks in the ICU was marked by more pain than is even describable, more pain than I would wish on anyone. I was given every possible painkiller they could, combined with all the anti-anxiety/panic meds that I could handle. At one point, they had to put me under in order to take out a port in my neck, as my panicked pain was causing blood to spurt out of my neck, which only reinforced my panicked pain with thoughts of bleeding out in front of my wife. The nightmares I experienced still haunt me.
I spent three more weeks on the ward before going home.
Eight years later, I remain in near-constant abdominal pain and unable to work.
This experience colours the following remarks.
Let’s look at this tweet from Anti-MAID activist Amanda Achtman (who also writes on Substack at
) critically, shall we? I have three specific objections, one with the question supposedly asked by Achtman, and two of the answer supposedly given by the palliative care doctor.
Objection One
Achtman claims that there exist people such that they "think some deaths are so agonizing and repulsive as to justify euthanasia [sic]." The word 'repulsive,' - which means ‘arousing intense distaste or disgust’ - is doing most of the intellectual work here.
By pairing the word 'agonizing,' which I read as referring to a subjective feeling experienced by a patient at the end of their life, with the word 'repulsive,' which I read as referring to a subjective feeling experienced by an observer who is not the patient themselves, Achtman subtly moves the goalposts.
Instead of thinking about how a patient may be experiencing their final moments, we're now focused on the visceral emotional responses of some supposed on-looker, statistically likely to be a family member or physician.
That is, Achtman has shifted moral agency from the patient's own experience of their condition as 'agonizing,' to the on-looker's disgust at the natural process of death, represented by the word ‘repulsive.’
Objections Two and Three
The shift in moral agency is reflected in the answer given by the palliative care doctor, assuming this interaction actually happened. I’ll get to that in a second. But first, is what the doctor said in response even true?
The claim that “no one needs to suffer in agonizing pain at the end of their life” is demonstrably false, something a palliative care doctor should know. Insofar as my own experience counts for anything, I can personally attest to the limits of modern health care when it comes to pain management and intensive care in situations that can lead to death.
Using the throwaway word ‘Plus,’ to indicate the apparent triviality of the next comment, it’s also simply not true that the experience of extreme pain is “often a matter of sheer projection of our own suffering onto the dying person.”
Notwithstanding the obvious falsehoods in the two claims supposedly made by the physician, the problem of shifting moral agency remains. The effect of the doctor’s response is two fold
It overvalues the successes of the modern medical system, placing the onus of pain management entirely on the system, ignoring the individual realities that make each patient’s life different (See my experience above).
It devalues the experiences of the patient while privileging the experiences of an outside observer, which in this case seems assumed to be a loved one. The effect of the claim is that a patient’s report about their own condition couldn’t possibly be true, but that the observer’s being convinced that it is true is, itself, a matter of the observer’s own inner emotional pain when faced with the reality of the death of a loved one. This is a profoundly selfish and misguided idea, one that does a massive disservice to the realities that accompany the end of life.
What frustrates me most about the usual claims that Achtman makes - this isn’t the first time she’s made some obviously false claims - is that she seems unwilling to grapple with the reality that many people want to have a say in the time and place of their own deaths, borne out in the scads of MAID provisions that come and go without any public outcry. The data [.pdf] shows that the majority of these folks are cancer patients, in tremendous amounts of pain, that know that they have no prospect of remission, and want to pass on peacefully in the presence of their loved ones.
I know that Amanda Achtman claims to be standing up on behalf of Canadians targeted by the supposedly eugenicist Medical Aid in Dying program. But, as we’ve seen, the very claims that she makes are dependent on preconceived - and demonstrably false - notions about the abilities of the medical system to alleviate pain. Additionally, her thinly disguised paternalism makes itself known in the way that she privileges the feelings and thoughts of uncomfortable on-lookers ‘repulsed’ by pain over the desires and needs of the patient in front of her. If there is anything that stands in the way of Achtman’s advocacy is is her incredulity in the face of patient reports about their own end-of-life decisions.
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