20 SEPTEMBER 1969, Page 11


Layman's dilemma


Some weeks ago, I was attacked by a pain- ful and humiliating infection of the bladder, the precise details of which I shall with- hold. It is enough for my purpose to state that my complaint was in no way either scandalous or uncommon, having been caused by a bug which usually inhabits the bowel (where it is harmless) but had strayed into my bladder instead. The result was that I was stretched on my back for two whole days—except for the frequent occasions when I had to leap for the loo—with a high temperature, a low morale, a bellyful of drugs and a complete lack of any appitite whether physical or intellectual. Being unable even to read, I listened to light music on the wireless and amused myself (if that is the right word) with thoughts which went somewhat as follows.

Here am I (so I pondered), a useless sack of poison and misery, a burden to myself, a pitiful nuisance to those about me, and a mere comic absurdity to any level-minded observer. But if, as I have been assured, I shall soon be sound again, no great damage will ensue. The doctor can be paid, attendants thanked and rewarded, and my enforced idleness speedily redeemedi. I shall be in nobody's debt and fully able to resume my beneficent business of fabricat- ing entertainments in English prose for such of my fellows as wish to peruse them. My illness, in short, will have been per- sonally, socially and economically viable.

But suppose (I said within my heart) that by some quirk of nature my condition should prove permanent and totally irremediable? How long, in my present case, do I wish to survive? And how long will it be worth the while of society at large to assist me in surviving? True, for some time I can pay my own diseased way; but eventually money will run out, insurance policies will expire, and I shall become a charge on the state. To what end? I asked myself. That one dreary day may succeed another until they have made up some biblical or statistical norm? That I may compose my relations with a God in whom I do not believe? Or that men of science may experiment and record? No, no, no, I said. Unless the' medical profession can restore me to proper capacity, I do not wish to live and neither society nor my friends should wish it on me. Better death than a life dependent on antibiotics and confined to Family Favourites.

At this stage, a further grim notion occurred to me. Suppose, I thought, that my bladder should prove incurable but that modern surgeons should be capable, at huge expense, of inserting a secondhand one? For if people can have secondhand hearts, why not secondhand bladders? Or artificial ones, come to that. If I assume the medical feasibility of this, then the next question is plain: can I afford it? Answer: most improbable, BUPA notwithstanding. Then should the state pay for it? Answer: only if I am worth it.

So here was the 64,000 dollar question. Could I honestly pretend to myself that my talents as a writer were such that the preservation of the carcass which contained them was worth the disbursement of a fortune from the public coffers? Answer:

. No. For there are dozens of men living. I told myself, who do what I do as well or much better, and there is a limitless supply of younger men coming up. No one, but no one, is indispensable. 1 shall leave no gap in my profession which will not be filled within minutes; and as for my personal friends, well, better they should think of me as safely dead than worry themselves sick lest the next drink they offer me goes clean through the wall of my secondhand bladder, thus making for an awkward scene in their favourite restaurant. It is both more dignified and more comfortable, I affirmed from my sweaty pillows, to obey one's Fate when it calls than to subject oneself to the grotesque improvisations of a presumptuous science.

Oh, how rational, how objective, how stoical I was in my decisions. And how false. For of course I was doing neither more nor less than posturing to myself on the strength of unwarranted hypotheses. I knew perfectly well that my condition (wretched as it might be) was temporary, and that I should have no need of a surrogate bladder. Because of a few hours' discomfiture, I was authorising myself to pronounce on questions which, merely theoretical to me. are to some men deadly realities. It was all a sickening performance, a callous and contemptible charade.

And yet . . . The trouble is, you see, that I still think I was right. For what it all comes down to is this: how much of our time, resources and energy can we afford to spend, do we wish to spend, in an already over-crowded and over-complicated country, on shoring up bodily and mental failure? To mend the familiar flaws of basically sound organisms we can doubtless afford to expend a good deal: but on irredeemable failure, in cases which can never yield any returns . . . ? And what about the situation I posited (so ignobly) for myself, that in which a person can be restored to (roughly) normal function at an abnormal cost? If only nothing could be done, of course, there would be no problem; the doomed would die, and there an end of it. But doctors have learned, in part, to delay doom, to defy 'the black fate which cometh to all', and there are strong motives of vanity and scientific interest to encourage them. So the first question for the layman must be this: do we, the paying customers (for in one way or another we all contribute our money), wish the doctors to continue in their present officious role; or

would we prefer them to recognise that, when proper function has ceased for good. the failure must be taken as finally lethal?

To my mind, nobody need think twice about the answer: human vegetables are obscene and the 'life' in them should no' be preserved. But we arc still left with the problem, brought dramatically to the fore by the recent heart transplants, of whethe or not we should spend sums of money. which range from the substantial to the astronomic, in sustaining or simulating ar approximate form of life for people who are diseased or handicapped to the extent that they can function only with massive artificial aids. A few years ago they would have died; now many of them survive, in a sort, to cost the taxpayer millions of pounds a year and those around them incessant labour: is this, or is it not, a desirable state of affairs?

The contemporary moral judgment, as near as I can assess it. is that such people must at all cost be kept alive because the human happiness which they may experi- ence, while doubtless limited, yet increases the general sum. But is this really true? What about the loss of happiness, what about the grinding inconvenience and the slowly clinkering despair which must often be the lot of the families and friends who are responsible for servicing such invalids. and their hideous props'? What about them tortures suffered by those who can never leave their charges for more than an hour without a feeling of guilt or return to them without a feeling of dread?

The correct thing to say is that the administration of such care is in itself a kind of happiness, and this message is often prominently proclaimed by the dedicated in the 'uplift' passages of tele- vision documentaries, etc, which deal with the topic. My instinct is, however, that there are many more people, trapped by the sick in horrible skeins of moral black- mail, who would proclaim something very different if only they dared. Thus, even hour of 'happiness' enjoyed by the grossly i" or malformed child (whose life 'the doctors fought to save') must be reckoned against the suppressed tears, the secret disgust and the close confinement of the dutiful parents while their health and their youth dwindle. and the wide and curious world, from which they might have had such joy, remain-- forbidden and unexplored. An addition to human happiness? No; just a great deal of unnecessary and avoidable suffering.

When I was young. I was often treater' to improving stories of local spinsters why had given up full lives and interestinf careers because their families hac' summoned them home to take care of widowed and ailing mother. I thought then and I think now, that these pious daughter (so gaunt and brave behind the wheelchair in the High Street) were misguided in them selves and viciously exploited by otherm They did what they could to sweeten live- that were, in practice, finished, at the cos: of absolutely ruining their own. My fear i, now that this whole country is turning itselt in a sense, into just such a spinster daughter neglecting its proper business and pleasure in order to take care of Mother . . . i.e of the mass of human detritus which ough to be dead and buried but which doctor (who do not have to suffer the cons- quences) insist on keeping alive. Here, in word, is the layman's dilemma: how I persuade or if need be to compel the medi cal profession to abate its zeal for showing off and let the dead lie still.