I put two books on the counter: The Future of Dying by Marli Huijer and The palliative society by Byung-Chul Han. “Are they presents?” asks the saleswoman. I want to answer, but can’t get past: “Hahahahaha.” Then she also has to laugh softly: “Hahahahaha.” Laughter rolls between us like the surf of the sea.
If it were up to philosopher Marli Huijer, it would not be a laughable idea to give someone books about death as a gift. That’s exactly what her book is about: that death should be a more normal, less terrifying part of life. She herself, should she become terminally ill, “rather die in a few months than prolong it.” Huijer refers to the German-Korean philosopher Byung-Chul Han, who contemptuously observes that people no longer care about the good life goes, but about comfortably survive† (All important words Han has italicized in his booklet.)
Better to live well than as long as possible: this is also the message of the campaign ‘#dezorgvanmorgen’, which was started last month by the Zorginstituut, the organization that determines which care is insured. The institute notes that too much is treated unnecessarily. Not illness but health should be central, and not care but ‘quality of life’. “Only care that is actually of value will be on the ‘appropriate care menu’ in the future,” according to the Zorginstituut and the Dutch Healthcare Authority in the advisory report. Working together on appropriate care (2020).
Both Huijer and the Zorginstituut want to bring about a change in mentality: we must look decay and mortality in the face, instead of running from it. This looks like a realistic and therefore also human message. Those who disagree with it deny the reality: that life is not infinite, nor is it always comfortable.
Yet something is wrong. The change in mentality is presented as a development with only winners: patients have a more pleasant end of life, relatives have a healthier grieving process, and society is cheaper. The latter seems like a nice by-catch, but in reality it is a pure necessity: because of the aging population, if we do nothing, one in three people will have to work in care in 40 years’ time, according to the Zorginstituut. Impossible and unaffordable.
This means that treatments will not only be refused in evidently pointless cases, but also when it is less clear what is ‘of value’ and what is ‘unnecessary care’. Those are not objective terms. I imagine the following conversation between a doctor and a patient:
Doctor: “You won’t be cured anymore. We can extend your life with a heavy and nasty chemotherapy, or you can spend the time that you have left with nice things with friends and family!”
Patient: “I want chemotherapy.”
Doctor: “Um… that wasn’t the right answer!”
The difficult thing about texts like those by Marli Huijer is that they ignore the fact that since time immemorial there has been such a thing as fear of death and, in connection with this, the urge to live – even if that life has lost its quality. I remember a column in which Renate Rubinstein, who suffered from MS, was surprised to find that during her decline she continued to cling to life much more strongly than expected.
That’s not how Huijer thinks about it. There is something cool about her almost light-hearted talk about death: she stands on the high diving board without bending knees. She even wonders why we actually celebrate our birthday every year, and not our death anniversary. Well – maybe because it’s not a nice prospect to say goodbye to everything we are attached to, in fact, to everything we know, to disappear into the unknown nothing?
Of course, there needs to be a conversation about what we are willing to do for a longer life, as individuals and as a society. But it must be an honest conversation, in which everything is on the table. So also that some people want to live at any price (“surviving the naked”, as Han and Huijer call it), that that is understandable and not strange, and that there is not always money for it.
Floor Rusman ([email protected]) is editor of NRC
A version of this article also appeared in the newspaper of June 18, 2022