Don't Disparage Death: a Call to Curb our Transthusiasm

The Last Sleep of Arthur in Avalon, Sir Edward Coley Burne-Jones, 1833 – 1898

As a transhumanist I am full of hope that one day the knowledge of certain death will no longer be the prime mover of the human heart. Whether by digital or biotechnological means (or both) I believe it is possible that within my lifetime I may witness breakthroughs in science that could extend the life of bodies and brains, and the existence of individual minds well beyond one century. I hope, but humbly so, recognizing that for now and the foreseeable future--what lies beyond the singularity is not foreseeable--we die.

Death and Medicine

As part of my residency training, I spent the month of December in the hospital caring for some very sick patients, some of whom medicine could not help. I became a doctor because I believe in the healing power of compassionate medical science and want to extend its reach, but more often than I anticipated I have been humbled by the limits of what I can do for those who are dying. During this month of "wards" I had the responsibility of calling and leading four family meetings to discuss the diagnosis and prognosis of  a terminal illness in their loved one, the futility of current medical treatments aimed at cure, and what is for now the best alternative we have: palliation and hospice.

After these emotional and difficult conversations, my patients and their families came to accept the reality and imminence of their mortality and resolved to come closer together, to turn away from false hope, to face death with courage and dignity and to stop the madness of bed alarms, monitor beeps, IV replacements, early morning vital sign checks, blood draws, side effects, scans and the other thousand unnatural shocks the inpatient flesh is heir to. Despite my efforts, and those of many other doctors, there was one patient I could not spare from these tortures: a 70 year old Eastern European immigrant with glioblastoma multiforme--the boogie man of all brain cancers.

His wife of 40 years, and self-published herbalist, remained in complete denial of his diagnosis/prognosis after multiple neurosurgeons had evaluated his scans and determined his tumor inoperable. His deficits included complete aphasia (inability to speak), almost complete paralysis and only minimal responsiveness. He had developed several very serious infections during the previous few months with drug-resistant organisms requiring the strongest antibiotics modern medicine has to offer, which only provided him marginal improvement.

Despite all of this evidence that he will soon die, no matter what we do, his wife remained adamant that his condition is only temporary and that he can be completely cured and return to his prior state of health. She insisted that everything possible be done for him. I have learned and accepted that sometimes no amount of objective evidence can displace a firmly held, but false belief. I wanted so desperately to direct this woman's strong hope toward something achievable, such as a dignified and pain-free death for her husband, but at the end of the day she was his next of kin and it was my duty to respect her wishes. I am a supporter of the hospice philosophy in such cases, which cares for the dying and those seeking refuge, restoring dignity and fulfillment in the midst of irresistible suffering.

Within this past few months my mother and grandfather were both hospitalized with serious illnesses. As the medical person in my family it fell to me to interpret what the doctors were saying for the rest of my family, and often the impossible task of predicting what lay in store for them. It is humbling to see the health of those I love in decline and know there is little I can do to stop it. Medicine is a form of humanism in that we accept the animal body, warts and all, and seek to facilitate its healing compassionately. Enhancement, while very important to transhumanism, is still far from the minds of most physicians as the primary objective of medicine is to remove the barriers to health and relieve the many sources of physical suffering, and for now our hands are already full with these!

I believe my unique past experiences with the infirm, the dying and the dead have given me perspective and a vocabulary to discuss these issues with compassion and clarity.

My Early Experiences with Death

During her nursing career my mother worked in hospice, and frequently brought me along on her home visits when I was young. At first I was afraid of her patients, older people who were missing teeth, spoke loudly, smelled bad, and were often grumpy. But sometimes they were delighted to see me, asked my name, and told me their stories. One of my friends, a woman named Martha, had large, expressive, frightened eyes. She lived in a floral print recliner with her cat. She always admitted that I helped her feel better, and sometimes her eyes would even smile. When my mom told me she was gone, I imagined her gaping recliner, filled only by her lonely, pining cat. I missed her, but was comforted that I had known her and been her friend.

Shortly after returning from my LDS mission in Brazil, I was engaged in a conversation in the halls of church between blocks about looking for work when a brother I had not formally met who had overheard stopped in his tracks and offered me a job. I accepted, then asked what sort of business he had--"A funeral home," I was told. "Oh!" was all I could think to say. Having already accepted, I began the internal rationalization that follows all hasty decisions, and quickly concluded it might be educational. Thankfully, it was!

I was able to help transfer the bodies of the deceased with care and respect from their home beds, living room floor, the hospital, the road, and transport them to the funeral home where we washed them, embalmed them, dressed them and prepared them to be viewed one last time by those who loved them. I attended their memorial services in many different faith traditions, and was present for both the digging and the filling of their graves. I tried to be present for their families' grief, and when appropriate to share in that grief. As you may imagine, it was a difficult duty, but very rewarding. This experience pushed me to leave the familiarity of my family and my small town to begin my higher education with the goal of becoming a doctor.

My next experience with work for the dead was with those who were still living but on borrowed time: I became a nurse's assistant, and following after my mother I found work in hospice. After relocating to the Phoenix area to attend Arizona State University, I was hired by Hospice of the Valley as a CNA where I had the privilege of training in the facility where (unknown to me at the time, since I never met her) my Jewish grandmother had passed away only a few months before.

I served the dying across the socioeconomic spectrum. I began working the night shift on weekends in a small inpatient unit on the campus of the Maricopa County Hospital. While there, I cared for people from various backgrounds (e.g. former school teachers, the homeless, and developmentally disabled) and ethnicities (e.g. African-American, Central and South American), and learned to respect and care for them equally. I remained at that position for 9 months, and was then transferred to work as on the campus of the Mayo Clinic in Scottsdale,where my patients were mostly well-to-do, upper middle class white people. By experiencing such contrasting environments of healthcare, I began to understand some of the strengths and weaknesses of our system, and developed a commitment to improve access to high quality care for all people as a future physician.

How Death Can Heal

In the summer of 2010 I was reunited with my Jewish family, thanks to my father's wife, whose last wish while dying of ALS was to see me reunited with their family. In our second meeting, after the emotional reunion around Father's Day, they asked me to explain the hospice philosophy and what they could expect if they decided against going back to the hospital for aggressive care the next time she deteriorated. It wasn't long after that she did pass away, peacefully in her home surrounded by her loved ones. It was at her funeral that I first recited the Mourner's Kaddish, the prayer uttered by so many Jews through time at the death of a family member or friend: a prayer that praises God and renews hope for the coming of His kingdom. This hope can be glimpsed in the Zionist hymn Hatikva, now the national anthem of Israel.

The Kaddish is associated with the Holocaust for many non-Jews, whose only exposure is reading Elie Weisel's Night. It is a quintessentially Jewish thing to express praise and lamentation, worship and worry, hope and heartache together--Job-like-- in the same breath. Many survivor's stories (Viktor Frankl, Primo Levi, etc.) stress the strong desire to live and find meaning--something to live for--as the only thing that got them through. Those who lost this fire, who had accepted the God-role of the guards whose will it was that they should die, were referred to as "Muselmanner" by other prisoners, and they did indeed die more quickly. I believe this deep desire to live, to survive, to hope in the face of imminent death is why Judaism has avoided extinction in the face of its very obvious out-competition by its spiritual children, Christianity and Islam.

I believe this same strenuousness drives the desire for eternal life among religious transhumanists; however, our hope in post-humanity should be balanced with our humility prehumously. After all, our immortality may not come in the way we envision or hope for it. I doubt the victims of the holocaust envisioned their legacy as black and white photos of piled, naked, emaciated bodies, but we have not forgotten them. In their mortem they are immortal, in their dying they are born to eternal life.

As a humanist, I do not feel that my individuality warrants immortality, or that I myself am of much value in the universe, but that humanity as a whole does and is. I would rather see all people live happy, healthy lives for 100 years and preserve the cycle of life, growth, reproduction, flourishing, ageing and death than to interrupt that cycle so that a few can live 1000 years. It may be a value-based position, but I very much doubt that, pragmatically, we can have it both ways.

In demonizing death we deprive ourselves and devalue an experience that has driven our species since its dawn. The first millenarian may be born, but it's probably not you or I. Should this lead us to lose faith? Should we gather our loved ones--Goebbels-style--and go quietly into the night?  Such an absurdism deserves its own reduction. Existentialism was born in the dying breath, the aleph, of those who taught us there is more to life than joy: that suffering, too, is worth living for.