The Inevitable Quotes

“There was no purpose to pain at all. “I don’t believe in suffering.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“Seneca quote: “I shall not abandon old age, if old age preserves me intact for myself, and intact as regards the better part of myself; but if old age begins to shatter my mind and to pull its various faculties to pieces … I shall rush out of a house that is crumbling and tottering.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“Kant was the champion of autonomy. He is the one we have to thank for the idea of autonomy in our society.… But he said, don’t kill yourself. That would be putting all your autonomy to an end.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“Why expect her to suffer, heroically, in the service of—what? Some far-off social welfare revolution? Some wild dream that if thousands or millions of people suffered just like her, and people found out about it, the for-profit healthcare system would correct itself accordingly, or implode, or be burned down by the exasperated masses?”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“Dr. Sherwin Nuland observed that, by the logic of hospital administrators and Department of Health and Human Services guidelines, “it is illegal to die of old age.” Instead, “everybody is required to die of a named entity”: cancer or heart attack, stroke or traumatic injury. Plain old age—the natural wearing down of systems, the exhaustion of finite cellular life spans, the loss of internal equilibrium—did not count as a cause of death and was never a checkbox option on official paperwork.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“the fineness of that dividing line. Why did it make sense that a patient had to wait until he was almost dead and suffering terribly—and sometimes unable to express his own desires—before he could get relief from his doctor? And once a doctor was committed to providing relief, why did it make sense to go through an elaborate charade of titrating morphine until the patient fell asleep? Why couldn’t the patient just ask for what he wanted and get it? It seemed to Lonny that the system was designed to keep patients and doctors from being honest with each other, lest either side say too much and expose the double effect charade too clearly.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“One man had terminal cancer but said he really wanted to die now for financial reasons. He was a Vietnam War vet, he said, and he couldn’t stop thinking about the Agent Orange attacks against Vietnamese farmers. He wanted all his savings to go to Vietnamese victims—not to pay his way through some shitty American nursing home.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“the only reason any of us are alive is because we haven’t figured out how to die.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“In the Netherlands, where euthanasia now accounts for more than 4 percent of total deaths in the country, the law goes further. There, a patient with very advanced dementia can be euthanized at an agreed-upon moment, if he has left written instructions in an advance healthcare directive—and if he appears, to his physician, to be “suffering unbearably” at the time of his death. The moment might vary from patient to patient: when he has lost the ability to speak, say, or when he does not recognize his wife. Dutch doctors are allowed to euthanize a patient by injection, even if he is “no longer able to communicate.” According to the Dutch euthanasia review committee’s code of practice guide, a doctor in this situation must “interpret the patient’s behavior and utterances” and watch for any physical signs “that the patient no longer wishes his life to be terminated.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“in September 2019, a parliamentarian named Pia Dijkstra announced that she would push forward an assisted-dying bill designed for elderly people with “completed lives.” When I asked Dijkstra about her motivations, she answered me with typically Dutch blasé: “We think that people have the right to decide, themselves, when their life is complete. They should not have to take actions that are nasty, like putting a plastic bag over your head so you suffocate.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“In the Netherlands, where euthanasia was legalized in 2002, some legislators have argued that the law should go even further, so that all people above a certain threshold age can receive a physician-assisted death, even if they aren’t suffering at all. In 2016, the country’s health minister, Edith Schippers, proposed a measure that would have allowed elderly people with “a well-considered opinion that their life is complete” to qualify. This, she said in a statement to parliament, would help “older people who do not have the possibility to continue life in a meaningful way, who are struggling with the loss of independence and reduced mobility, and who have a sense of loneliness, partly because of the loss of loved ones, and who are burdened by general fatigue, deterioration, and loss of personal dignity.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“Carried further, was it possible that as Medicare budgets dried up—as the population aged and the oft-cited “gray tsunami” landed on American soil—Americans might start to consider rational suicide for the elderly as an act of social responsibility, carried out by older people who understand themselves to be drains on the system and inhibitors of opportunity for the young? Already, about a quarter of Medicare spending each year is directed to patients in their very last year of life.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“the ages. The Epicureans, he wrote, felt that suicide was justified when life became unbearable. The Stoics approved of it, too. There was that brilliant Seneca quote: “I shall not abandon old age, if old age preserves me intact for myself, and intact as regards the better part of myself; but if old age begins to shatter my mind and to pull its various faculties to pieces … I shall rush out of a house that is crumbling and tottering.” In Irwin’s chronology, it was vapid Christian theologians who pulled common sense away from this reasonable position, with their insistence that suicide was self-murder, and so a kind of murder, and so a sin. Still, there were always brave thinkers who believed otherwise. Thomas More, in his 1516 book Utopia, wrote that in a true utopic world, a man who was suffering from an “incurable but also distressing and agonizing” disease, who had become “a burden to himself, and a trouble to others,” would “free himself from this bitter life.” When he did, it would be more than an act of prudence; it would be “a pious and holy action.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“Nevertheless, by the 1980s and ’90s it was clear that immortality was not in fact around the corner and the assurances of the medical profession grew somewhat more modest. Most researchers no longer spoke of curing old age, but, instead, of “compressing” it: of shortening the natural period of ache and pain and disability and dementia that precedes active dying. The idea was that instead of experiencing long stretches of senescence, we could mobilize the forces of science and medicine to let us live our best lives until—snap. Our abrupt end. There was, Nuland wrote, “a nice Victorian reticence in denying the probability of a miserable prelude to mortality.” Today, even this compression of morbidity seems illusory. In truth, increases in life expectancy have been accompanied by more years of age-induced disability. Aging has slowed down, rather than sped up. Still, and in spite of evidence to the contrary, the heady promise of a curtailed old age endures in the popular imagination. “Compression of morbidity is a quintessentially American idea,” the physician and bioethicist Ezekiel Emanuel wrote, in a viral 2014 Atlantic essay called “Why I Hope to Die at 75.” “It promises a kind of fountain of youth until the ever-receding time of death.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“They had promised things they couldn’t deliver: an end to sickness, then an end to aging badly, then an end to aging. They had treated and treated and overtreated, until their mission to extend life had transformed into a system for prolonging death.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die

“As any reporter knows, the story changes as soon as she appears with her notebook & recorder, no matter how unassuming she is or how delicately she navigates the scene.”
― Katie Engelhart, The Inevitable: Dispatches on the Right to Die