More than half a lifetime ago, before she was a renowned bioethicist—in fact before she had ever heard of the word “bioethicist”—Peggy Battin wrote a short story about a husband and wife who make a pact to end their own lives, together, when they get old.
It’s a beautiful, chilling story, and the questions it raises go far beyond what we are now only marginally willing to discuss in America. This isn’t about a physician writing a lethal prescription for a terminally ill patient. This is about what bioethicists call “preemptive suicide.” If you want a close-up look at the kind of unflinching ethical questions Margaret Pabst Battin thinks we should ponder, her story “Robeck” is not a bad place to start.
Battin is Distinguished Professor of philosophy and adjunct professor of internal medicine in the Division of Medical Ethics and Humanities at the University of Utah. It was only after she moved to Utah in 1975 that she began to steer her career toward issues of death and dying, but in the short stories she wrote while still in graduate school, she had already begun to grapple with end-of-life issues, spurred in part by a question her own mother asked in the last, debilitating stages of cancer: “Why should it be so hard to die?”
In “Robeck,” the elderly wife—faced with the prospect of an even older age filled with “despair, decay, continuing loneliness”—still wants to follow through with the suicide pact she and her husband had made when they were younger. The husband—faced with the realization that dying as an abstract concept is not the same as actually dying—changes his mind.
“Robeck,” written in the 1970s, wasn’t published until 2005, when it appeared among the philosophical essays in Battin’s book Ending Life: Ethics and the Way We Die. On a November afternoon three years later, Battin’s husband, University of Utah English professor Brooke Hopkins, was riding his bike down City Creek Canyon and collided on a blind curve with another biker heading uphill.
Suddenly, like the characters in her short story, Battin came face to face with how complicated living and dying can be, much more complicated than even a philosopher can imagine.
Here’s how she once opened a talk to a group called Compassion & Choices, which focuses on planning for end-oflife: by drawing a line that went straight across a chalkboard for a few inches then sloped relentlessly downward, dragging on and on until it thinly petered out. This, she told the group, is our typical life trajectory. In the modern world— with its ventilators and pacemakers, feeding tubes and chemotherapies—our deaths are often a slow decline, full of protracted suffering.
After Battin’s talk, a woman with ovarian cancer spoke up. She explained that she had done a dress rehearsal of her future death, using a method she had found on the Internet: Placing a turkey baster bag over her head. The practice run was awful, she said, so instead she had bought a gun.
The trajectory and the turkey baster bag: this, in some form or other, is the backdrop for current battles over physician-assisted suicide and other “right to die” legislation as we try to sort out our 21st-century deaths. It’s an issue that has become more pressing as technology has become even more advanced and the percentage of elderly people and health care costs rise.
Battin has long been a proponent of “death with dignity” laws that give people some degree of autonomy in how and when they die. That’s what made her husband’s accident, as she says, “so overwhelmingly ironic”—because the accident left Hopkins paralyzed from the neck down, and the bioethicist who had championed the right to die had to let the husband she deeply loved make up his own mind about whether he wanted to go on living.
“I don’t think anybody said this to my face,” Battin says of people on the other side of the right-to-die issue, “but I’m sure they thought it: she deserves this, this will teach her.”
But Battin has not changed her view that people should have a choice in the manner and time of their own death. Instead, she says, what Hopkins’s ordeal taught her was that the choices are “much more complicated than I thought.”
During the nearly five years that Hopkins lived following his accident, Battin witnessed a series of vacillating emotions and experiences: his gratitude at being alive, his pleas to let his life be over, courses in great literature that he continued to teach from their home, moments of excruciating pain, moments of transcendence, and eventually his final decision that he couldn’t go on any longer. She realized firsthand that a severely restricted life can also have many moments of joy, and that a loving wife might in subtle ways encourage her husband to keep on living when he might want to die.
When, on the last day of July 2013, Hopkins finally asked his doctors to turn off the five technologies that were keeping him alive, Battin lay next to him as the ventilator was dialed down and his breathing eventually stopped.
“As hard as it was for me to have him make this choice to die, you have to respect it,” Battin says in her soft, measured voice. “That’s what it is to love somebody, to try to see it through their eyes.”
How many philosophers does it take to change a light bulb? It depends on how you define “change.”
Philosophers are notoriously parsers of language and logic, and this intellectual rigor is what first drew Battin to the discipline, from the very first class she took as an undergraduate at Bryn Mawr College in 1959.
The first day of class, the professor walked in, sat on the edge of his desk, and said “You know, I look around at the world and I think, ‘all is water.’ ” He went on at great length and was very persuasive that water is the material substrate of everything, Battin remembers. At the next class, he walked in, sat on the desk, and said “You know, I think I was wrong. I think it’s air.” On the third day it was fire.
“What he produced,” Battin says, “was a skeptic. It was one of the best and most engaging intellectual lessons you could possibly have.”
After college, she worked, married, had a first child, and moved to California. Two weeks after the birth of their second child, in 1969, she entered the University of California, Irvine, to get her doctorate in philosophy—and, simultaneously, an MFA in creative writing.
She explains the dual degrees this way: “I liked the intellectual rigor of philosophy, but you can’t read Spinoza all day long. I liked the inventiveness of fiction, but you have to make it meaning-rich and rigorous; you can’t just feed on someone else’s struggles with their inner confusions.”
She sent her fiction to literary magazines and got lots of rejection letters. So, with typical moxie, she flew to New York and began the rounds of publishers and agents in person. At first she still had no luck. Then she called The New American Review (publisher of literary giants like Gabriel García Márquez and Sylvia Plath) and asked to speak to the editor.
“After a few minutes of silence, the voice on the other end of the phone said ‘Mr. Solotaroff will be happy to see you. He has four minutes,’ ” Battin recalls. Luckily, she was calling from the phone booth in the lobby. Later that year, M. Pabst Battin’s “Terminal Procedure” was published in The New American Review. And the next year it was published in Best American Short Stories 1976.
By then, Battin was divorced and living in Salt Lake City, hired by the University of Utah’s philosophy department for a one-year appointment. She had written her doctoral dissertation on Plato’s theory of art, and she thought she was headed toward a career focused on the ancient philosophers and aesthetics. But as a new, temporary hire, she was assigned to teach Intellectual Traditions of the West (ITW). One of the other new hires for ITW was Brooke Hopkins, who had joined the U after five years of teaching at Harvard.
And then, three things happened: she fell in love; she gradually began merging her prior literary interest in issues of death and dying with her academic pursuits; and she won a National Endowment for the Humanities Fellowship for Independent Study and Research, one of just six in the country, for work on the ethics of suicide. Within a week of the award, her temporary job became tenure track. She would eventually win the U’s most prestigious award, the Rosenblatt Prize.
“You know, people have been dying for a long time,” Battin deadpans. “And such a large percentage of them, too. So I’m not the first person who ever thought about death and dying.” But she was among the first, and the most prolific, thinkers in the emerging field of bioethics—a mash-up of theoretical ethics with the practicalities of day-to-day medicine and science.
Battin’s personality dovetailed with this practical approach. “She’s by no means an ideologue or inflexible,” says Arthur Caplan, founding director of the Division of Medical Ethics at New York University. “She’s always been a person who’s been tuned in to the specifics of a case.”
At the New York-based Hastings Center, which is often credited with starting the field of bioethics and where Battin is a Fellow, president Mildred Solomon describes her this way: “She has comprehensive talents you rarely see all in one mind.” Philosophers are well known for being analytical, Solomon says, and Battin is “deeply analytical.” But she is also able to see how logical arguments “play out in messy and emotionally rich human contexts. That’s very unusual.”
If you could look inside Peggy Battin’s brain, perhaps it would look something like the inside of her house.
There are stacks of paper on each of her six desks (seven desks if you count the dining room table). On the stacks there are sticky notes, and there are sticky notes around every inch of the doorframe in the kitchen and inside each kitchen cabinet. Upstairs there are stacks of paper leading from one bedroom to another, a trail of research and pondering.
She keeps paper copies of every draft of everything she is writing or has written. In a stack on the windowsill is the 16th draft of a chapter she began in 1995; eventually it will be a book about the ethics of reproduction, tentatively titled Sex & Consequences.
“Sometimes I joke that what I really need is to move into an old motel,” she says, “so I could have a different room for each project.”
The topics she has published about include: death and dying, age-rationing of medical care, ethical issues in organized religion, the ethics of religious refusal of medical treatment, drugs and justice, disability, aesthetics, and ethical issues about infectious diseases. That’s a total of 20 books authored, edited, or co-edited.
Battin’s latest book is The Ethics of Suicide: Historical Sources, published in the fall of 2015. It’s 720 pages in teeny type—but even that wasn’t enough to handle all the research amassed by Battin, her 46 consulting editors, and 27 research assistants. So she proposed a partnership between the book’s publisher, Oxford University Press, and the University of Utah’s Marriott Library in what became a first-of-its-kind publishing venture. While many books have associated digital archives, this is the first time QR codes have been embedded in each entry in the print edition, linking directly to expanded primary sources and interactive features online.
Battin didn’t set out to write such an exhaustive investigation of suicide. When she started the project four decades ago, she was simply filing away photocopies of interesting historical references. “You can’t just throw them away— they’re too interesting and too hard to get ahold of (this was, of course, pre-Internet)—so you put them in a file drawer,” and eventually the file drawer goes from ancient Egypt to the present. “And then you say, well, what about Hinduism, Buddhism, Jainism, Confucianism, Islam? So now there are more file drawers. And then you say, what about these oral cultures that didn’t have written records, the Maya, the Aztec, the Inca?”
The book, notes Battin, “takes no sides” in these historical debates about suicide, instead presenting primary sources that give a variety of pros, cons, and neutral discussion on topics that include suicide as sin, suicide as heroic choice, physician aid in dying, Buddhist monks who immolate themselves to protest a war, and jihadists seeking martyrdom. The book, she argues, “challenges monolithic thinking about suicide.”
Battin has spent 39 years, off and on, working on this book, and even longer immersed in thoughts about death and dying. She has never been suicidal herself, she says, which makes it possible to devote so much time to thinking about what others might consider morbid topics.
She is, she says, an optimistic person. More than four decades after writing “Robeck”—which has now been turned into a play by Salt Lake City playwright Julie Jensen and will be produced by the Salt Lake Acting Company in the fall of 2016—she can imagine an America in which everyone “has a full range of choice about how they’d like their own deaths to go.”
Or, at least, “that such an outcome would in principle be possible.”
—Elaine Jarvik is a Salt Lake City-based journalist and playwright and a frequent contributor to Continuum.
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