Cultural Understandings of End-of-Life Issues

The first case of assisted suicide tried in a court in Canada took place in 1963. The trial was located in a northern community where Kolitalik, a leader for forty years among the Inuit, asked members of his tribe to help him die. Kolitalik had contracted measles, and because the Inuit had little exposure to this disease, he was left, after some months, very weak and frail with no sense that he would recover. No court transcripts or records remain of the trial itself; what is known is what remains in the memories of members of that community. ^[25]

“Assisted suicide,” is, admittedly, a modern term that is being applied to a much older practice. Helping elderly and sick persons in their wish to die was understood to be a noble and honourable act. Not only did this practice implement a release from a life that was no longer pleasurable, it was also deemed an essential and practical answer to the inevitable difficulties faced by the community in sustaining someone aged and dying within a very harsh environment.^[26] Spiritually and culturally, this practice was perceived as a way of treating the elderly with dignity and respect. But it is important to keep in mind that for communities such as the one in which Kolitalik lived, bringing about the death of a weak, sick or old person is not longer a matter of corporate survival.

Anthropologists Charles Hughes and Alexander Leighton,^[27] in their study of the Yuit Inuit of St. Lawrence Island near the Bering Strait in the 1940's, described the customs they observed concerning assisted suicide. They reported that when Inuit individuals decided they wanted to die, they made their request to the community three times. Traditionally, families would not consent to this wish after the first request, but would strongly dissuade the individual who wanted to die. Throughout this process, the community would make their value of that individual known and would grieve with them over the loss that would occur if the individual left them. Only after a third request would the community comply and assist in the individual’s death. It should be noted that in the case of Kolitalik, it was only after he threatened to put a curse on the whole community that the three hunters agreed to assist him with his death.

The account of this Inuit practice and the trial which was the result of Kolitalik’s death in particular does bring to our attention the probabilities of clashes between different cultures and their values. During the 1960's and 70's, the encroachment of the more dominant Judeo-Christian culture and the values it represents has infiltrated even the farthest reaching northern communities. This has led to a dramatic decrease in many traditional First Nations cultural practices. Advancements in technology have also changed the ways the Inuit and other cultures interact with their environment, making the practical aspects of assisted death less plausible. Since the death of Kolitalik there is no record of another Inuit assisted suicide.

The Inuit are one of many indigenous societies who have practiced assisted suicide. These include other North American First Nations groups, South American Indians, Sami (Lapplanders), Siberian Native Peoples, African tribes, and South Pacific Islanders. Although, as with the Inuit, the practice of assisted death among these societies has diminished or disappeared from public scrutiny, it would be erroneous to assume that the basis for the beliefs which informed these practices have not left their influence on contemporary attitudes. It is also important to recognize that within the history of the dominant culture in Canada there are vestiges of earlier cultural versions of the practice of assisted suicide.

The custom of assisting someone to die was not only evident in tribal societies, but was also widely embraced in both Greek and Roman societies.^[28] There is evidence of over seven hundred years of discussion regarding this topic ^[29], beginning with Xenophon, who used haireo thanaton, a Greek term meaning, “to seize death.” Plato theorized about hekonein haidon (going voluntarily to Hades,) and the Stoics recorded the idea of eulogos exagoge (a happy or sensible removal.) There exist first and second century A.D. descriptions of autocheira (to act by one’s own hand,) autoktonia (self-killing,) and mors voluntaria (voluntary death.)

Perhaps it was in opposition to the beliefs of their Roman and Greek oppressors that followers of the Judeo-Christian religion developed a striking abhorrence for suicide. This repulsion was exhorted to the extent that, until recent times, the remains of those individuals who had taken their own lives were not allowed to be buried in community church graveyards.

Other faiths proscribe, to a degree, self willed death. In Islam, the bringing about of one’s own demise to escape illness was and is viewed as over-ruling the will of the Divine.

Buddhist belief teaches that one of the Four Noble Truths is suffering, and one cannot avoid suffering by taking one’s own life - it will only follow into the reincarnation of the next life by way of the individual’s Karma.

Voluntary death was widely practiced for many centuries by the Hindus and Jains of India. According to Jainist belief, persons who were elderly, sick or disabled could announce their intention to be liberated through self-willed death, which was carried out through the practice of fasting. Members of their communities would assist these individuals to accomplish their goal. This was common until the eighteenth century, when the British Raj outlawed the practice.

Euthanasia, in its modern sense of a doctor assisting in the death of a patient, was first documented as a practice in the 1870's in Britain. The term itself was coined by Dr. S.D. Williams who stated, “in cases of incurable and painful illness, doctors should be allowed, with the patient’s consent, and taking all necessary safeguards, to administer so strong an anaesthetic as to render all future anaesthetics superfluous...a sort of legalized suicide by proxy.” ^[30]

The following year, when concerns were voiced about potential abuses that could result if euthanasia were allowed, another doctor, L. Tollemache stated, “if we rejected all reforms which might lead to contingent and remote evil, no reform would ever be passed.”^[31] Euthanasia was seen by many at that time as being a highly appropriate practice.

1901 brought about a more sinister development when a proposal was made to the Willesdon Medical Society of Britain that a committee of experts should decide the fate of any “imbeciles and monstrosities” who were deemed “absolutely incapable of improvement.”^[32] Less than forty years later, the Nazis of Germany proposed much the same thing.

In 1935, the Euthanasia Society was established in Britain. This group attempted to usher in a Parliamentary Bill that would outline a set of regulations to oversee the practice of doctor assisted death. This was defeated a year later; one of its strongest opponents being Lord Dawson of Penn, the personal physician to King George V.^[33]

Records of historical Canadian medical practices indicate that in the 1920's and 30's, any discussion regarding euthanasia was limited to reports of what was taking place in Britain. In the U.S.A., Reverend Charles Potter, representing a group of New York intellectuals, established the Euthanasia Society of America in 1938, but any attempts to legalize the practice were defeated in Congress. Following World War II, there was a world wide hiatus on any attempts to decriminalize assisted death in light of the revelations of monstrosities which occurred in the Third Reich’s euthanasia programming. Nazi policies encouraged and implemented the extermination of thousands of individuals with disabilities or congenital illnesses because they were viewed as a “blight” on society that posed a threat to one of Hitler’s goals, namely, the improvement of a more physically and mentally superior species of the human race.

Applying these historical lessons to our contemporary discussion helps us to identify the risks and abuse present in any practice involving deliberate death. Adhering to the rights of individual choice at all costs does not guarantee that depressed or ill individuals won’t sense their own lack of value and place of belonging within society. For this reason alone, many succumb to the idea of engineering their own premature death. At the other end of the spectrum, putting the perceived needs of a dominant society first before the needs of an individual orchestrates the potential for certain persons within that society being viewed as expendable and candidates for killing. It is for these reasons that determining any future legislation regarding how and when we die must be done with great care; any discussion preceding such decision making requires the representation and input from any and all members of our society who might be directly or indirectly affected by such laws. Key to this is the recognition that the voices of persons with disabilities are not being represented in the decision-making process.

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25	For more detail on this and other accounts of different cultural understandings of assisted death, see Mullen, Anne. Timely Death: What We Can Expect And What We Need To Know. Toronto: Random House, 1997. 53 ff.
26	It would be interesting to obtain the perspectives of those within these cultural settings who felt pressured into making a decision to end their lives. No research indicating such a position was located for this study, but that is not to say that such coercion did not exist.
27	IBid. 54.
28	IBid. p 58.
29	Anne Mullens makes direct reference to the writing of Paul Carrick, author of a dissertation on Medical Ethics in Antiquity. The historical overview presented in this paper is drawn mainly from Carrick and Mullens.
30	Mullens, Anne. 60.
31	IBid. 60.
32	IBid. 60.
33	Ironically, in 1994 it was revealed in Dawson's diary that fifty years prior, when summoned to the bedside of the King as he lay dying of respiratory failure, Dawson recorded that he decided to determine the time of the end of the King's life to occur late in the evening. He injected the King with a lethal dosage of morphine and cocaine. Dawson admitted he'd taken this action because he felt the announcement of the Monarch's death should first appear in "The Times," early the next morning, rather than later, in the more lowly afternoon papers.

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