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ONDYING WITH PERSONHOOD: SOCRATIC DEATH VAN RENSSELAER POTTER* For older adults, dying with personhood is better than living without it in a nursing home at $4800 a month. As noted by Norman Cousins, "Death is not the ultimate tragedy of life. The ultimate tragedy is depersonalization " [1] . As I approach the end of my ninth decade of a good life devoted to cancer research and bioethics, I am led to ask about the nature of a good death. Unable to prevent the deaths of my closest colleagues (Harold Rusch, Elizabeth Miller, Charles Heidelberger, Howard Temin, and Helen Iverson) , who suffered bad deaths as a result of cancer, I am led to wonder about the possibility that people might have more choice in their final days. We need to call on all the personhood we can muster as we hope to manage death in the context of "dying well." The concept of dying with personhood might very well be called Socratic Death. In the remarkable and authoritative book Death, Dying and the Biological Revolution: Our Last Çhtestfor Responsibility, Robert Veatch concludes with a chapter on "Natural Death and Public Policy" [2]. His purpose was "to affirm that deciding in individual cases that the struggle against death need not continue is not incompatible with a more general social commitment to a public policy that sees at least some deaths as evil, that promotes research to overcome them." But throughout the book and, indeed, in all the contemporary discussions known to me, the idea that "the struggle against death need not continue" is in the context of patients who are terminally ill and/or beyond help from medical technology. Here we may ask what about the individual who is in full possession of personhood, not terminally ill as presently defined, but on the threshold of the frailties of advanced old age—total incontinence, loss of mobility, loss of personhood —all subject to what amounts to a kind of terminal illness: confinement in a nursing home. This is the person who wishes to die retaining personhood to the end: what I shall call "Socratic Death." "McArdle Laboratory for Cancer Research, 1400 University Avenue, Madison, WI 53706.© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4204-llll$01.00 Perspectives in Biology and Medicine, 43, 1 ¦ Autumn 1999 103 Fig. 1.—Socrates Drinking the Cup of Hemlock (Historical Pictures). The Time to Die Although Socrates had taken the position that "Man is a prisoner who has no right to open the door ofhis prison and run away. ... A man should wait, and not take his own life until God summons him," he did in fact end his own life by drinking poison when he had no other choice. In 399 BC, at the command of the Athenian tyranny, he was condemned to death by poison after being accused of corrupting the youth ofAthens with his philosophy. But he maintained his personhood to the end, talking with his friends during his last hours before finally drinking a cup of hemlock. Then he lay down on his couch and died in peace, or so we are told (Fig. 1 ) . And he was apparently ready to die: According to Veatch, Socrates was said to remark that "When man has reached my age, he ought not to be repining at the approach of death" [2, p. 297]. (Socrates had reached the age of 70, according to estimates of his time of birth.) For Socrates, the choice of "the time to die" was made for him. For others who wish to die with personhood, the problem is a little more complicated , but a clear-cut sign can be imagined. For me, if not already cut down by events beyond my control, the time will have arrived when my family, personal physician, and social worker agree that there is no other choice than to place me in a nursing home. That is the day for me to die with personhood. Appropriate medical organizations need to examine the philosophy of a social policy that results in the expenditure of huge sums of money for long-term care ofolder adults in nursing homes, while 43.4 million people, including...

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