It Takes a Family: A Bioethicist Explores How to Live and Die Well

The 1992 novel The Children of Men by P.D. James is perhaps best known for its dystopian vision of a world without babies—when the novel opens in 2021, the world has not heard an infant cry in 25 years. The effects of such an infertility plague on society are devastating in every sphere of life, from those that readily come to mind (e.g., schools are shuttered, playgrounds have disappeared, population and economies have shrunk) to those that are less obvious. Among the latter is society’s increasingly bleak view of death and dying.

What is a human life worth, and what makes it worth living? In James’s novel, the answer centers on quality of life. For those whose quality of life is no longer desirable because of old age or illness, such as dementia, the state-supported Quietus offers an elaborate ritual that amounts to murder by drowning. To be sure, the ritual is dressed up in the language of choice and human dignity: all those who receive it must consent. And there are ritual gowns, lovely songs, and fancy ships to which those about to die are shackled after being thoroughly drugged. 

Fine, a naïve reader might say. This is fiction—dystopian fiction, to boot. Except, here we are, in Anno Domini 2025, living it. I don’t mean the infertility plague, although births per woman in America have been in decline for a while. Rather, I am referring to the increasingly dystopian approach our society takes to death, especially in the expansion of physician-assisted killing. But our views of death speak volumes about our views of life, explains Catholic bioethicist Charles Camosy in his new book, Living and Dying Well: A Catholic Plan for Resisting Physician Assisted Killing. A good death and a good life go hand-in-hand, he argues, and both revolve around family. 

'Physician Assisted Killing' in Canada

As a society, we are living in a crisis of isolation accompanied by an increased idolization of self-sufficiency. Camosy opens the book with devastating stories from Canada’s MAID (Medical Assistance in Dying): of individuals who opted for MAID when they couldn’t get medical care they needed, or when they couldn’t get adequate housing, or when they were experiencing severe depression. The Netherlands has allowed Physician Assisted Killing (or PAK—Camosy’s term in lieu of the more euphemistic “physician assisted suicide”) since 2001—and has made it available to kids since 2003. 

Charles Camosy shows that both living and dying well are about family and community.

The role of doctors in PAK is devastating and ironic: isn’t the job of doctors to save lives, rather than destroy them? The problem, as he writes, is that “physicians rate the quality of life of their disabled patients worse than the patients do themselves. Something similar has been found in their attitudes toward disabled or sick adolescents and their families.”

In other words, while those with chronic illnesses still find joy and worth in their pain-filled lives, their doctors sometimes do not. Indeed, Camosy has previously documented this very issue in physicians’ (sometimes aggressive) recommendations for expectant parents to choose abortion for potentially disabled children in the womb. Add to all this the contemporary trend of isolating the sick and the dying from loved ones in hospitals. Lydia Dugdale, a physician and bioethicist, argued a year and a half ago that “It’s Getting Harder to Die”—referring to this very phenomenon of overly medicalized deaths alone in hospitals. Added all together, the perfect storm for PAK is firmly in place in the US. 

A Practical and Spiritual Solution

Camosy wants us to understand how we got here—and so incredibly fast. But his main reason for writing the book is to offer solutions. This is crucial right now, as 12 states currently allow PAK and 17 others are considering it this year (ironically, the most complete and clear map I could find of this in action is from a website that is actively promoting PAK under the label of “death with dignity”). P. D. James’ Quietus is our own new reality.

The solutions to such a crisis of devaluing human life must be not only practical but spiritual, he argues: 

"It is no accident, again, that our slouch toward physician-assisted killing—and the throwaway culture that has led to it—has coincided with the erosion of Christian assumptions and institutions in our secularized culture. We need to engage the embarrassment of cultural riches from our ancient traditions in order to relearn how to live and die well.”

In particular, “Jesus’ life calls us, his followers, to live out what Pope Francis called a culture of encounter and hospitality directed at these populations—one that serves as a Gospel-shaped antidote for a throwaway culture that would prefer that these populations simply didn’t exist."

The job of physicians is not to isolate death but to make it possible for those who are nearing the end to die well—at home, if possible, surrounded by loved ones rather than sterile walls and beeping monitors. 

Indeed, it is important to recognize PAK for what it is: the declaration that some lives are not worth living, that some people are a waste of resources and time and space, and that some people simply shouldn’t exist. This, of course, means also a declaration that the value of human life is conditional—and the set of conditions can vary, expanding or contracting depending on such factors as availability of wealth and resources or their absence. Does an elderly woman with dementia deserve to live? What if she doesn’t have sufficient savings for a care facility? What if she doesn’t have any family nearby? 

In Canada, this scenario would qualify the woman for MAID. Is this where we want to go as a country as well? To say no, though, is difficult, because it requires direct action from us—it obligates us to participate directly and personally in solutions that choose life. 

This is, in fact, a situation my in-laws had to navigate with an elderly woman in their church a couple of years ago. In her 80s, she was widowed for a decade, and her only child lived across the country and was not available to care for her. Several members of the church visited her multiple times each week, bringing groceries and helping with household tasks and basic home maintenance as her mobility declined—mowing the lawn, taking out the trash. At last, when her dementia made living alone unsafe, members of the church helped her move into a care facility, visited her there multiple times a week, and continued to care for her in various other ways. When she died, it was, yet again, church members who planned the funeral and helped her child clean out her home and sell it.

It Takes a Community

Camosy would approve. Indeed, the opposite of PAK is not better healthcare but family—not only biological family, in this case, but other institutions that function as family and networks of loving care, especially churches. Families should take care of their own—those who are well and those who are unwell, including the sick and dying. The job of physicians is not to isolate death but to make it possible for those who are nearing the end to die well—at home, if possible, surrounded by loved ones rather than sterile walls and beeping monitors. 

Ultimately, Camosy shows that both living and dying well are about family and community. Both are about people who love each other navigating every stage of life, caring for each other with the conviction that while there is no true dignity in the kind of death PAK provides, there is, as Leah Libresco Sargeant argues in her new book, true dignity in dependence. We were not meant to live alone. And we were certainly not meant to die alone. 

Nadya Williams is a homeschooling mother, Books Editor for Mere Orthodoxy, and the author of Cultural Christians in the Early Church, and Mothers, Children, and the Body Politic.