a new definition of death

What Is So Bad About Dying?

Spiegel: Dr. de Ridder, as an emergency physician, you fight to save lives every day. Which makes it interesting that you, all people, are now calling for a new definition of death in an era of high-tech medicine. Isn’t that a contradiction?

De Ridder: In my field in particular, I see how the limits of life are constantly expanding, without regard for the well-being or will of the patient. In some emergency rooms, half of all admissions now come from nursing homes. If someone who is chronically ill has a heart attack or gets pneumonia there, the most sensible thing to do is to make sure that they don’t suffer, and to refrain from doing anything else. But this is all too rare. Instead, old people, who are dying, are torn out of their familiar surroundings, rushed off to hospital in an ambulance, resuscitated and given artificial respiration. If they’re unlucky, they die in the elevator. These are horrible, undignified situations.

Spiegel: Why does it happen like this?

De Ridder: Dying a simple death is no longer an option in our society, even in places where one might expect to. Hardly anyone dies without an infusion or artificial feeding. For a long time, dying has not been natural.

SPIEGEL: What do you consider “natural death”?

De Ridder: I’m reminded of a woman in her late 80s who was still very vigorous. Her daughter brought her to our emergency room with massive intestinal bleeding. A colonoscopy showed that it was caused by a tumor. The bleeding could only have been stopped with an operation. She didn’t want it. She said that she had lived a full life and now preferred to die rather than embark on an indefinite path of suffering. The daughter agreed, and the woman died that same day. It was a totally plausible decision that no one could object to, particularly as bleeding to death is a gentle way of dying. But the doctors felt snubbed. There were bitter discussions over whether this should even have been allowed to happen.

Spiegel: But don’t doctors see themselves as guardians of human life?

De Ridder: The mandate to heal is primary, of course. But the mandate to allow someone to die well is equally important in terms of ethics. In reality, however, the chain of resuscitation and treatment often takes on a life of its own. The person who is supposed to benefit from it, with his or her individual ideas about living and dying, is no longer relevant.