[Book Review] Choosing Death... Sin or Dignity?

Anita Hannig's "The Day I Die"
The Core of Assisted Dying Is the Right to Self-Determination
Choosing Whether to Continue Life on One's Own
Religious Groups Define It as Clear "Murder"
Most Applicants for Assisted Dying Are White People Over 65
Few People of Color Choose Assisted Dying Due to Cultural and Religious Factors
Confusion Between "Suicidal Impulses" and Depression
When Patients Fall into a Coma After Attempted Assisted Dying
Raises Profound Questions About Whether to Continue Treatment

The word "euthanasia" originates from the Greek words "eu" (good) and "thanatos" (death). From the late Middle Ages through the Enlightenment, the concept of a "good death" did not simply mean a painless death, but rather a death blessed by divine grace. The popular guide to death at the time, "Ars Moriendi," taught readers how to act at the moment of death to achieve salvation. Priests, summoned to the bedsides of the dying, would use this book to help believers prepare for death.

However, in the 19th century, the role of the priest at the deathbed was gradually replaced by doctors, and around this time, the meaning of euthanasia began to shift toward "a painless death." By the late 19th century, the concept had come to mean, as it does today, a quick and peaceful death facilitated by a doctor and lethal medication. This book delves deeply into the current state and limitations of euthanasia?in other words, "assisted dying."

Assisted dying remains a hotly debated issue even in the United States. While it is legally permitted in some states, the conditions are strict. The individual must be an adult over the age of 18, have a terminal diagnosis of six months or less confirmed by at least two doctors, clearly express their wish for assisted death, and be able to take the medication themselves. The core of assisted dying is the right to self-determination?the right to decide whether to continue living, and specifically, the right to choose death when there is no hope for life and suffering is severe. However, there are sharp disagreements about what constitutes "hope" and "suffering."

The book presents a balanced overview of the history of assisted dying and the arguments on both sides. Proponents argue simply: "My life is my own, and I have the right to decide when it ends." They believe that if illness has drastically reduced the quality of life and there is no possibility of recovery, choosing death may be the better option not only for themselves but also for their families.

Some also argue that assisted dying is necessary because it can be carried out safely within the boundaries of the law. Assisted dying is performed by ingesting medication, causing no physical harm, but those who cannot make this legal choice often attempt to end their lives themselves, sometimes suffering severe physical injury. Such cases can leave deep trauma not only for the individual but also for their family members.

On the other hand, religious groups strongly oppose assisted dying, defining it as clear "murder." They argue that it infringes on God's authority as the sovereign over life and death, violates the sanctity of life, and represents an abandonment of the struggle that is life itself. From the Christian perspective, which views suffering as a path to salvation, the hardships experienced at the end of life are seen as important opportunities for spiritual growth. They say, "Rather than seeking an easy escape, enduring suffering until the very end is a virtue."

In reality, such religious perspectives and cultural backgrounds create clear differences in attitudes toward assisted dying. Anita Hannig, the cultural anthropologist who authored the book, observed the practice of assisted dying in medical settings for five years and discovered several commonalities. One of these is that the vast majority of applicants for assisted dying are "elderly white Westerners." In Oregon in 2020, 81% of those who applied for assisted dying were over the age of 65, and 97% of those who actually underwent assisted dying were white. In California, although white people make up only 37% of the population, 87% of assisted dying cases in 2019 involved white individuals.

Why, then, is the proportion of people of color choosing assisted dying so low? The author points to relatively lower income levels and differences in access to healthcare as major reasons. Because of their experiences with inadequate medical services, people in these groups are more likely to choose aggressive life-sustaining treatment when given the opportunity. Culture and faith also have a significant impact. Black and Latino communities in the United States are generally considered to be highly religious, and many see assisted dying as contrary to their beliefs. In cultures that prioritize the family over the individual, it is also common for family opposition to override the wishes of those who desire assisted dying.

The author emphasizes that assisted dying should not be confused with "suicidal impulses." In many cases, people feel depressed and think about suicide not because of pain caused by illness, but because of pessimism about their current situation and despair about the future. Linda Ganzini, a psychiatrist in Oregon, pointed out, "If they had received treatment for depression, they might have made a different choice. However, such cases are extremely rare among patients seeking assisted dying."

Assisted dying remains at the center of controversy. While it is positively regarded as a well-prepared and peaceful death, there are uncertainties and concerns in practice. In some cases, it has taken up to four days for death to occur after taking the medication, and there have even been instances where individuals regained consciousness. From 1997 to 2020, eight such cases were reported in Oregon alone. There are still no clear legal guidelines on whether to provide active treatment if a patient falls into a coma after attempting assisted dying.

The author uses numerous real-life cases to illustrate the complex reality of assisted dying. While the overall tone of the book leans slightly in favor of assisted dying, it does not limit the reader's thinking. On the contrary, it offers a variety of cases and perspectives to encourage deep reflection on this contentious topic.

The Day I Die | Written by Anita Hannig | Translated by Shin Sohee | Suoseojae | 248 pages | 20,000 KRW