The dying decision: choice, coercion and community

A Japanese drama about medical assistance in dying, Plan 75, reveals a lot about our relationlessness.

Sian Brookes

Sian Brookes is studying for a Doctorate at Aberdeen University. Her research focuses on developing a theological understanding of old age. She studied English and Theology at Cambridge University.

In a retirement home, a older person sings karaoke while the person behind waves a hand.

Chieko Baishô plays Michi.

Happinet.

“Being able to choose when my life will end provided me with peace of mind. With no feelings of doubt. She led a good life on her terms, people will say”.

In Chie Hayakawa’s 2023 dystopian drama Plan 75, these are the words of a silver-haired, wrinkled woman in a promotional video for the eponymous plan – a government scheme which offers all over 75-year-olds the option of a pain-free death at the time of their choosing.

And yet for Michi, an older lady toying with the decisions around Plan 75 it doesn’t really feel like it is her choice which matters at all. Whether it is the $1,000 grant offered as an incentive to die, the luxury amenities on offer at the Plan 75 facility promoted in leaflets and magazines, or the young person employed to gently guide the candidates towards their death (but whose real job it is to make sure they follow through with it), this is a world which has a clear agenda – to rid society of older people. Indeed, it is clear that this is a vision of a world which believes it is better for old people to die than to put financial burdens on the economy or their families, and this is a culture willing to subtly coerce individuals to accept and act on that belief.

Plan 75 reveals an interesting point at the heart of the MAID (Medical Assistance in Dying) debate. One of the primary reasons that MAID is so attractive is the ability to take back control of one’s life and death, yet what happens when that seeming control isn’t really within the individual’s own control at all? For Plan 75, what is marketed as giving control back to older people, is really just a twist on a more sinister political policy to pressure individuals to sacrifice their “burdensome” lives for the greater good. Of course, this is a common argument for rejection of assisted suicide. This is the dangerous ‘slippery slope’, where MAID begins as an option only for those who desperately need it to relieve intense physical suffering. Yet it quickly becomes a tool to remove people whose lives no longer seem worth living due to societal expectations and opinions, rather than any objective reality.

Do we ever truly choose to die totally independent of the expectations of those around us?

For many, this problem can be appeased through strict legal controls over MAID – as long as the powers that be are regulated, MAID is still OK. As long as it is the individual who maintains control over their own death (and not the state), the goal of personal autonomy is maintained and all is well. And yet this perspective fails to ask the question - is such control over our own death ever actually possible? Do we ever truly choose to die totally independent of the expectations of those around us? In a world which places so little value on old age, can older people really make choices unaffected by that (deeply flawed and inhumane) logic? And, indeed - the elephant in the room – no matter how much we try to control death, in the end is it not death that ultimately controls us? As fundamentally finite beings we can never escape it completely – it will always find us one way or another. Ultimately, we will all have to face the reality of death when it comes to us. Complete control and autonomy are never truly possible.

In light of this unveiling, the possibility that complete choice and autonomy around death isn’t really an attainable goal, what better options might we pursue?

Where previously we would find comfort and hope in being loved, known and held by others in our death, now all too often this isn’t the case.

One thing is clear in Plan 75, the isolation and loneliness of older people in a society that has rejected them is deeply problematic. The movie primarily follows the stories of Michi, who lives alone with no family and Yukio Okabe, an older man totally estranged from his remaining family. Both face life, and are facing death, alone. We live in a world where increasingly we are forced to face death alone. When our final days and hours rarely happen in the family home, surrounded by our loved ones, but in faceless institutions devoid of lifelong meaningful relationship the sense that we are no longer doing death together as a society is acute. Where previously we would find comfort and hope in being loved, known and held by others in our death, now all too often this isn’t the case.

At the same time, there is no doubt that our modern world is unceasingly committed to the ideal of individual personal agency and autonomy – “She led a good life on her terms”. As a myriad of philosophers and theologians have commented, belief in human autonomy has come to replace belief in God. And MAID is one area which reveals this to be the case most acutely. Where previously we would turn to God to find comfort in the face of our finitude, instead now we turn to ourselves – the last hope we find in the face of death is our individual ability to control it.

Death and health should be a corporate phenomenon – when one person is ill, all of society is ill.

The German theologian Eberhard Jüngel described death in this broken world as “the occurrence of complete relationlessness”. In fact, Jüngel suggests that as human beings we are first and foremost made up of our relationships – we are truly human not by how we self-define in isolation but how we relate – how we relate to the God who made us, and how we relate to other people. This need for relationship is found most acutely in the face of death. As Ashley Moyse points out in his book, Resourcing Hope for Ageing & Dying in a Broken World, death and health should be a corporate phenomenon – when one person is ill, all of society is ill. And so, as death increasingly becomes the journey of the individual – when we face death in isolation from others and in isolation from God no wonder we feel such a strong desire towards control, towards ending our lives prematurely, towards science to help us avoid any more pain than we can bear alone.

In Plan 75 we see glimmers of hope in the possibility of relationship. As Michi and Yukio find rare moments of human connection with a long-lost nephew, with a young person working for Plan 75, with another older person going through the same questions around mortality you can’t help but feel deeply uncomfortable with their choice to apply for the scheme. It is in the hints of love, physical touch, smiles exchanged, even a simple conversation shared between two people that suddenly MAID seems so disconnected with the hope that life still has to offer through relationship. Perhaps if we could imagine a world where death became no longer an occurrence of complete relationlessness, but a locus for relational dependence, for familial connection, for leaning on God and not ourselves, the need for MAID would feel a little less necessary. It would be a world with a little more hope.

Article

Culture

Death & life

Digital

Easter

17 April 2025

4 min read

Do you have a right to be remembered?

Our desire to be in control might not survive our demise.

Jack Nicholson

Jack is a graduate of Peterhouse, University of Cambridge and Blackfriars, University of Oxford. He writes, and also works in local government.

A composite show a smiling woman next to a small illustrate of someone walking off into the distance.

Kristyna Squared.one on Unsplash .

“Madam, those that are about to die salute you.”

Words attributed to Roman captives and criminals fated to die before the emperor, were used (ironically) by Councillor Kieron Mallon at the last Council meeting of this term of Oxfordshire County Council last week. ‘Madam’ was the Council’s Chair, wishing everyone well. Elections are on the way.

Easter is also on the way, and in the period leading up to the commemoration of the resurrection of Christ from the dead, nearly 2,000 years ago, Christians are invited to think about their own mortality. ‘Remember that you are dust, and to dust you will return’ were words my priest intoned to me as he marked a cross with ashes on my forehead on 5 March, Ash Wednesday.

Ash already emblemizes a belief in rebirth, even before the power of the story of the Christ’s resurrection is considered. I for one felt immensely hopeful on Ash Wednesday this year. Having just secured a new place to call home, and one year into my job as Democratic Services Officer to Oxfordshire County Council, looking after the likes of Councillor Mallon, life felt pretty swell.

My priest and I spoke about the ways in which death and hope are joined at the hip. The ancient Greeks believed that a phoenix obtains new life by rising from the ashes of the one before it. So do we. I have found myself, so far this year, visiting people and places I strongly associate with former lives, from friends I lived with as an undergraduate to a town I went on holiday as a child to the beach where my late Granny’s ashes were scattered. ‘Ashes to ashes, dust to dust.’

More specifically, the Christian believes that ‘whoever loses their life for [Christ’s] sake will find it’, in the sense that true self-discovery arises when we let go of the ego, when we allow ourselves to be changed. Thinking about mortality, therefore, changes life, in so far as we are better equipped to surrender and salute the Saviour. That worldview has shaped public servants in years gone-by.

An overwhelming majority of people in the course of human history have been forgotten.

I recently heard Dr Ian McGilchrist, the psychiatrist, describe the desire to control everything in life as the ‘besetting sin’ of the age in which we live. The desire to be remembered, rather than reborn, captures it better in my mind. Mankind has always wanted to remain in control. Souls will always be reluctant to surrender. However, what we have now is a world in which people feel uniquely entitled to make impact.

People feel that they have a right to be remembered, but it is not so. An overwhelming majority of people in the course of human history have been forgotten. Moreover, the past can be especially compelling when we have a window into a world in which people did not necessarily expect to make any kind of worldly impact whatsoever. Theirs was a happier place.

The twentieth century was described by Philip Rieff in 1966 in terms of the ‘Triumph of the Therapeutic’. He wrote, ‘Religious man was born to be saved’, but ‘psychological man is born to be pleased.’ ‘Psychological man may be going nowhere, but he aims to achieve a certain speed and certainty in going’. Therapy enables that objective. But therapy to what end?

Counselling can be construed as a device to regain control. The counselled, if fixed, can go about trying to change the world, trying to make an impact, resuming the rather pleasing but never-ending mission to be remembered. For anyone of a religious sensibility, however, that is not the objective. Rather, new life is given only for the whole resurrection story in our own lives to be repeated.

Around the time that Rieff wrote his book, the historian Herbert Butterfield, a Christian, wrote this. ‘Those who lived when the world was static – when the silhouette of the ploughman against the horizon hardly changed in the passage of a thousand years – may have something to teach us, who only know a breathless, rapidly changing world and who seem to be having to pluck what we can from life while running at full speed.’

Social media has surely exacerbated this condition because it connects us to others at the cost of contemplation about what life – and death – really entails. It is a place where we try to evidence to others the impact we are having, where we write our own eulogies and our own epitaphs and have access to the whole world whom we expect to read the same.

Life changes to a much greater extent these days, in this place, than it did for the ploughman in the passage of a thousand years, or captives and criminals in the Roman world, including Jesus Christ who was identified as one such. However, if we can somehow create conditions to focus less on having impact in and on a volatile world, and being someone who ought to be remembered, we will find that we have more hope.

In turn, we will change the world for the better, but despite ourselves, and for me that is what this period leading up to Easter is all about. We may find that others who are about to die salute us too, for the good deeds we have done that may well be forgot.

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