The two great contemporary debates about dying – assisted suicide and advance directives, or living wills – are both informed by a passion for personal autonomy: for control. LET ME DIE The idea of the advance directive is superficially attractive. At the end of life, modern medical care is often unthinking and futile. Families and doctors sometimes collude – with the best of intentions – in subjecting those with no hope of recovery to painful, prolonged and ineffective treatments. The default setting of modern medicine is full intervention, unless you are instructed otherwise. Families and patients, moreover, may lack the necessary education and medical knowledge to make truly informed decisions. Very often, for example, when trying to nudge a family towards minimal intervention in the case of an acutely ill, very old person, I am told: ‘Just do everything you can, Doc.’ Frail old folk are commonly sent from nursing homes to Emergency Departments, where it is not unknown for them to die alone, on a trolley, in a busy corridor.
