m. scott peck's "The Road Less Traveled" has been on and off the New York Times bestseller list since approximately the Precambrian Era, which of course means I came to his new book prepared to dismiss it as fluffy self-help. And I disagreed with him about the issue at hand, euthanasia, which was a second strike against him, since we read mostly to confirm our own wisdom.
All of which is to say what a bracing shock it was to actually plow through "Denial of the Soul" and discover not only that it was stern and serious stuff, but that Peck had managed to change my mind about the subject of dying.
It's not a question I'd given endless thought, but like most people I know I pretty much assumed that Dr. Jack Kevorkian was, well, right. That is, though Doctor K seems like a certifiable loon, it seemed logical to me that people nearing the end of their lives should be able to choose to kill themselves. More, it seemed logical that they should. Now I'm not so sure.
One of the first stories in Peck's book concerns a young Air Force sergeant with a brain tumor whom Peck treated 30 years ago in his early days as a military doctor. Tony slipped into a coma, breathing through a respirator. He was kept "alive" only by massive doses of adrenaline, but he was clearly dying: "What disturbed me more than anything was the copious amount of frothy light brown liquid that had begun to ooze out along the edges of his tracheotomy. It seemed to me that Tony's body had clearly begun to rot."
So, disobeying a direct order from the Army doctor above him, Peck clamped the IV tube supplying Tony's body with drugs, and 10 minutes later Tony was dead. Peck defends such decisions squarely; he is no advocate of "heroic measures," and in the past few decades most other doctors have joined him -- pulling the plug is no longer unusual practice in most cases. Peck and his wife have living wills asking that medical technology not be used to prolong his life "at the expense of our humanity by maintaining us as 'vegetables.'"
So he is not in any way an absolutist, nor is he a sadist -- the next chapter of his book is devoted to physical pain, and it reads like a script and a screed. The script is for morphine, Demerol, codeine. The screed is against the many doctors and hospitals that dole them out in stingy, inadequate doses and on inflexible timetables that leave patients shivering in fear. Everyone should read this section, whatever their interest in questions like euthanasia; it is a valuable user's guide to the hospital and its pharmacy.
Left to their own devices, with a handy pump that allows them to deliver their own dose of morphine, Peck says patients often use less of the drugs than a doctor would supply; even if they use more, the fear of addiction is insufficient cause to deny them relief from pain. In fact, he writes, it is "torture," "malpractice" and "a crime." "If I ever encountered a patient suffering serious chronic pain for which there was no hope of relief, I would consider euthanasia -- physician-assisted suicide -- a valid option," says Peck. But that justification is "purely theoretical for me" since "I've never actually encountered such a patient."
So far, so good -- all right-minded people can agree. But why does Peck go on to say that sometimes he hopes for a lingering death? His answer lies in the realms of theology and psychology, and in some sense it is aimed at those Americans who feel they have souls -- something inside them connected to a larger reality. Which, as he points out, is the vast majority of this professed religious society -- even a great number of those who would never go to a church buy books about caring for their souls. But as he also points out, we simultaneously live in an essentially secular society, where even most of those who identify themselves as religious are in fact good materialists. Peck thinks euthanasia may be the best issue to shake that secularism a bit -- to make the culture think seriously about something beyond convenience and comfort.
To take seriously the notion that we are creations of God, he points out, imposes certain limits on us. "This is not solely my life to do with as I see fit. To kill myself is to deny God, to deny Her timing and right to my life," he writes. Peck argues not that we can't kill ourselves -- free will gives us every opportunity to do so -- but that we shouldn't.
But why on earth not? Is there any really convincing reason, one that might infect even a non-religious person with doubt? Peck doesn't take the intuitive (and hideous) Protestant position that dying is one more trial that God throws at you and you should show your toughness by dealing with it bravely. No, his argument is considerably weirder. For Peck, dying is, well, educational. In fact, it's "the opportunity of a lifetime for learning and soul development."
This is not glib happytalk. All Peck's books are pretty fierce, especially for therapeutic bestsellers. They are about relinquishing one's illusions, about "doing the work of depression." They are about giving up parts of ourselves: arrogance, unrealistic fantasies, a habit of sarcasm. This one in particular is about defeating the very ego that most of his psychological colleagues stoke and soothe. It's about killing off parts of yourself before you die.
Peck says that the stages of dying that Elisabeth Kubler-Ross identified in her book "On Death and Dying" (denial, anger, bargaining, depression, acceptance) are the schema for any of these kinds of ego-death -- in individuals, in marriages, even in national traumas like Vietnam. (Of Vietnam, he writes, "Only recently, 25 years after the fact, does it look as if we have done some portion of the work of that depression by learning to relinquish a shred of our arrogant desire to control the world and come to some modicum of humility in our international relations.")
Of all the opportunities for denying the ego, for reaching the religious understanding that "ego is its own worst enemy," none is so powerful as one's death. Kenosis, which Peck describes as "the process of the self emptying itself of self," is the exact opposite of a consumer understanding of the world, and so in this culture it is hard for most of us to engage in it short of extremity. But at its end is a kind of acceptance that he claims is beautiful to watch -- and that many of us have had the privilege to see in those deaths we call "good."
Why not simply plan your death so as to cut off the last few weeks of unpleasantness, by orchestrating your demise so as to make it neat? Because in two or three or four weeks at the end of your life, with your physical pain controlled by morphine, hopefully in your own home or a hospice, you might learn about "how to negotiate a middle path between control and total passivity, about how to welcome the responsible care of strangers, about how to be dependent once again ... about how to trust and maybe even, out of existential suffering, at least a little bit about how to pray or talk with God."
To me, that is a powerful idea -- it is not even necessary to share Peck's belief in some form of afterlife to feel its power. It accords with all that I intuit about the world: most crucially, that our survival as a species and our happiness as individuals demands that we mature beyond the mindless consumerism that we currently identify as "human nature." A culture that begins to understand death in new ways would almost certainly begin to understand life in new ways, too.
Peck has not solved every issue about euthanasia. In fact, he's not convinced me that it shouldn't be a choice for those who don't care about any of the questions he discusses. And there are cases (ironically, many of those addressed by Kevorkian) that do not fit his model: people who may linger helplessly but consciously on the edge of death for years or decades, which seems rather a long semester to learn these lessons. There are difficult economic questions, too, in a society that feels it can't afford to provide decent basic health care for Americans with many potentially happy years ahead.
But I've never read anything that made me think more seriously about my own death and what it might involve, and for that I am very grateful. Death -- God willing a long ways away -- scares me a tiny bit less than it did before I picked up this book.