This March marks two years since Spain joined the group of countries that have regulated euthanasia (or “medically assisted suicide”). To request it, the affected person must “suffer a serious and incurable illness or a severe, chronic, and disabling condition” that causes “intolerable suffering.” The approval of this new law in our country reflects an important social change in the concept of life and death, which emphasizes the individual freedom to take control over one’s own death.
At the same time, in this context, there are still scenarios – such as mental illness or advanced dementia – that continue to generate controversy. Moreover, in recent years, there has been a debate in the Netherlands about the possibility of extending euthanasia to the elderly who request it because they feel “tired of life.”
This debate, which addresses the complex limits of respect for autonomy and freedom, calls for a profound reflection on extremely delicate questions. To be clear, we are talking about people who are not seriously ill or suffering from intolerable physical pain but who are tired of living: is it a question of helping those who consider that they have “lived enough” to die, and to whom should this be done? Beyond the plurality of opinions, the Netherlands has brought to light a question of universal, transcendent, and current interest: the desire of some citizens to cease to exist.
One of the twentieth century thinkers who most reflected on this issue was Viktor Frankl, who proposed existential logotherapy as a way to address the crisis of meaning and free people from the weariness of life. Frankl coined the concept of “existential emptiness” from his experience as a psychiatrist. His premise was that every human being desires to live a meaningful life or a meaningful existence. When one suffers from existential emptiness, one sees no possibility; one feels only limitations and barriers.
I have been a palliative care psychologist for 25 years, and I regularly interact with people who “would not mind dying.” Some suffer from periodic existential crises, while others recognize that they “think” of suicide as a valid alternative, to put an end to what they feel is unmanageable existential fatigue. I recently saw Alberto, a 48-year-old Spanish patient in the hospital, a quadriplegic, referred by his doctor for “emotional management of life fatigue” of more than a year’s evolution. In the presence of his wife, he recounted that cursed day when he fell from the roof of his house trying to fix the television antenna. Since then, he said, “my life hurts.” A week later, I met Marcos, 74 years old, divorced, and an emigrant from an Eastern European country, who was terminally ill. His only daughter, who lives and works on the outskirts of Madrid, can only come to visit him on Sundays. He spends his days on his cell phone, waiting for death in solitude.
Life fatigue as a clinical problem, in my opinion, is poorly posed if we do not refer, in precise terms, to a specific moment in the individual life of a specific human being. It is not the duration of a human life that determines the fullness of its meaning but the richness of its content. This is not a novelty nor is the error of referring to biological death as a synonym for biographical death.
Someone once said that we are mortal not because we are going to die but because we know we are going to die. Perhaps some people suffering from life fatigue would prefer to live but in other conditions. Or maybe not. What seems clear is that a great deal of moral lucidity is needed to address problems whose transcendence far exceeds the mere emotional management of people. We need a greater awareness of the challenges of our time. We need more freedom, understood as autonomy, in the face of circumstances. But we also need to face the fear of talking about death. Although all cultures have honored their dead, there has always been a fear of death and of talking about it. The time has come to change this. Everyone, including you and me, is dying. Let us talk about it naturally, because if we are not careful, we might end up convincing ourselves that our death will be, like all other things, due to chance. And it would not be.
