Making a Song and Dance About Assisted Suicide

Picture the scene: a young couple are walking hand-in-hand across the stage. The girl’s red dress swishes about her thighs as she sashays around the boy. They start to sing. It’s a sweet, romantic number about growing old together. What will happen if she becomes wheelchair-bound, the girl asks. What about if she gets a terminal illness, or so incapacitated she can’t hold a spoon? ‘Please put me down,’ she sings, imploringly.

Initially uncomfortable, her boyfriend soon agrees, and asks the same in return. The song turns into a sweet duet with one promising to hold a pillow over the other’s face, and the other responding ‘I’ll hand you the pills, and plastic bags just in case’. It’s laughable – and horrific. They’re supposed to be in love. How can they even imagine that the most loving thing to do might be to kill each other? But that – without the swelling violins – is the picture of Assisted Suicide that our culture loves to paint.

And Liz Carr wants to change that. Liz is an actress, best known in the UK for her role in the crime drama Silent Witness. The song I’ve described above is from her ‘TED Talk with show tunes’ Assisted Suicide: The Musical, that I saw last week.

The message is coming at us day after day in all kinds of ways. One recent example is the hugely successful book and film Me Before You, showing a young man paralysed in an accident choosing to end his life – despite the pleas of his family, his friends and the girl he loves – at the Dignitas clinic in Switzerland. This, I think, is partly why Liz decided to make a piece of musical theatre about the subject, to present a counter-argument to an audience that maybe doesn’t listen to The Moral Maze or follow parliamentary debates.

She covered a lot of ground in the two-hour show, including the following:

Choice

Choice, of course, was a key theme. The first song was called ‘I’m Choosing Choice’, and was a chirpy number about the “neo-liberal, consumerist” (her words) value that seems to be our highest touchstone in the 21st century Western world.

There was clear mockery in the song, but Liz never fully explained what the problem is with it, other than pointing out that legalising – and normalising – certain choices for some people can limit them for others. Once the door is open for terminally ill people to get medical help to end their life, and death becomes one of the available ‘treatment options’, it could make it much harder for patients to choose the more expensive option of treatment for their illness or palliative care. This is a particular concern when, as was partly expressed in the song, people fear being a burden on their family and friends, and on the already stretched state.

Ironically, despite using a swear word to describe ‘choice’ in this context, in a later song she defended abortion as being “about choice” – apparently without noticing the disparity. Why is ‘choice’ vilified as a neo-liberal, consumerist reason for ending your own life, but vaunted as a perfectly valid, appropriate one when it comes to ending a life that is entirely dependent on you? If she’s concerned that having Assisted Suicide available as an option would limit the choices for some people, why does she not even notice the fact that a woman choosing an abortion limits absolutely the choices available to the life growing inside her?

Hmm.

Dignity

Closely linked to the arguments about choice are those about dignity. In a world where we have been trained to see ourselves as independent, free, autonomous beings, making our own decisions and determining our own paths, the loss of that independence can seem like intolerable suffering in itself. Having to rely on someone else to do everything for you – even the most basic of personal hygiene tasks – sounds unbearable, but Liz, herself in a wheelchair, said:

Not being able to do those things on my own doesn’t render me undignified. Not being able to wipe my own bottom doesn’t mean my life is not worth living.

There are, of course, undignified ways to treat people with disabilities, chronic illnesses and incapacity due to old age, but there can also be great dignity in the way care is given. The indignity comes through the treatment and the attitude of the carers, not the fact of needing care.

Before we had had long to absorb this idea, though, it was on to the next.

Fear

This time it was a whistle-stop of the question of fear. Liz pointed out that “Imagining our limitations is always much worse than the reality.” “I can’t be the only one here,” she continued, “who as a 16-year-old thought that being thirty or forty was going to be far worse than it actually turned out to be?” This was the context of the song I mentioned above; when you’re young you think that being old and limited will be unbearable, but the reality is usually much less awful than our imaginations have painted it. Research has shown that people’s fear of certain conditions far outweighs the pain or indignity that sufferers actually experience. For example, an article for the American Psychological Association in 2004 noted that:

in some living wills, people specify that if they ever reach a point at which the quality of their life is very low, they do not wish to receive any special medical attention that would prolong their life. However, when medical researchers interviewed people who were slowly dying and experiencing a very low quality of life, such people almost unanimously reported that they would go to great lengths to add even a few days to their lives.

Sharing some statistics or anecdotes along these lines would have really helped Liz make her case.

Palliative Care

One reason these conditions turn out to be more bearable than expected is because in almost all cases they can be managed and relieved by palliative care. This was Liz’s chance to really sell the alternatives to death, and I was disappointed that she spent much more time showing the negative perception of care than explaining and praising the world-leading care we have in the UK. She had made a ‘mockumentary’ parodying the kind of messages we hear about how hopeless life is for the disabled, and featuring a monumentally bored, apathetic and unresponsive nurse. As a demonstration of the positives, on the other hand, Liz had one of her actresses come on and fix the loose arm of her wheelchair and speak kindly to her. And that was it.

Well, not quite it. As an illustration of how we can improve the image of palliative care, the actress then stripped off her nurse’s uniform to reveal a much shorter, skimpier version, and performed a suggestive song called ‘Palliative Claire’ in which she promised to take care of all your needs. It was probably meant to be funny and appealing, but it came across as quite sinister in parts. She steered clear of actually suggesting she might be willing to perform sexual acts, but that was what the body language, outfit and tone suggested.

I have read elsewhere that we in the UK have the best palliative care in the world, with more research being done all the time to find out how it can be even better. Liz could have addressed and allayed a lot of fears, but instead, for me at least, she heightened them.

Protection

Probably the most powerful moment of the show came at the end when Liz spoke – and sang – from the heart about her own situation. She understands the fears, she explained. Her mind ‘likes’ to go there. She often ponders, ‘What if I can’t cope? What if it becomes unbearable? What if my life becomes worthless?’ Sometimes she wishes it would just end. And that, she said, is when she’s most grateful that we don’t have the option of Assisted Suicide, because in her darkest moments, she would take it. She would have taken it already. She wants that door shut and locked so that when she feels low we – and the law – can be her strength, and help her to go on. She wants protection – not from slippery slopes, not from evil bigots out to rid the world of disabled people, but from herself.

Conclusion

I feel as though I’ve been very negative about this play. I did enjoy it – many of the songs were very clever, and Liz is a passionate and knowledgeable speaker, which is always compelling to listen to. It was a good, high-level overview of a lot of issues, but I suspect it left a lot of heads reeling. Also, the lack of understanding of or compassion for those she disagrees with would, I suspect, leave them feeling their perspective was being dismissed and even sneered at, rather than wrestled with, understood and countered.

I don’t know what the equivalent of an editor is for playwrights, but if I were Liz’s I’d advise her to restructure Assisted Suicide so that it had two halves, and put her ‘protection’ song just before the interval. Make it real, make it personal, leave the audience to ponder it over their mini tubs of ice cream, then bring them back in and talk carefully through some of the issues and the possibilities. Leave them with a sense that something needs to change in our attitudes to end of life care, a desire to change it, and the tools to take the first steps.

3/5 Stars: A disappointing play on such an important topic.