Section 5

Four positions

Four readings of care at the closing. Each catches something real. The structure is a fifth.

Today’s debate on care at the end of life gathers around four positions. The structure places itself among them, not only against the old principle.

Sanctity of life

The larger structure must preserve the corridor wherever the means exist. Whatever the person reads at the threshold.

What it gets right. A life is not a resource to be spent when convenient. A hasty exit is not the same as a considered one. And the larger structure has real reasons to lean toward preservation. Where the person’s reading is not stable. Or where it is being shaped by conditions that can be remedied.

Where it falls short: it folds the person’s authority into keeping the corridor going. The structure agrees that preservation is the default. It does not agree that the default overrides the person’s reading at the closing, where the closing has been honestly read.

Autonomy as absolute

The person’s authority over their own body is complete, at the threshold too. The larger structure’s only role is to honour the person’s reading, whatever it is.

What it gets right. The operator is real. The capacity to choose holds at the closing. And no one else can read a person’s corridor for them.

Where it falls short: it treats the person’s reading as the only fact at the threshold. The structure agrees that the reading carries the weight. It does not agree that it is the only thing the closing requires to be honestly read.

Three more facts stand beside it. Whether the corridor can still be widened. Whether the operator and the narrator have come apart. Whether the dignity-floor has been supplied. The larger structure must read these honestly too. They do not fold into the person’s reading.

The slippery slope

Once the right to exit is in place, it will wear away the commitment to preservation. In cases it was never meant to cover. The disabled. The depressed. The elderly whose corridors the larger structure finds inconvenient to keep open.

What it gets right. Any commitment, once built into institutions, can be bent by pressures the commitment itself does not endorse. Pressure on resources can make institutions drift in how they read the conditions the right requires.

Where it falls short: it treats the drift as a reason to refuse the right. The structure agrees that drift is real. It agrees that guards against capture are required: guards that stop an institution bending the right to serve its own pressures. The book calls them anti-capture protocols.

It does not agree that the answer is to refuse the person’s authority at the closing.

The answer is to put the authority in place with its conditions intact, and to audit the institutions for drift.

Palliative care is enough

Where palliative care is properly supplied, the right to exit is not needed. Anyone whose pain, fear and need for support are properly met will not want to commit to the closing before it arrives.

What it gets right. The dignity-floor carries real weight. Proper pain relief changes how a person reads the threshold. And many requests to exit can be answered at levels one to four, with care the larger structure has not yet supplied.

Where it falls short: it treats enough palliative care as always within reach. The structure agrees that palliative care is an obligation. It does not agree that palliative care, however well supplied, removes every person’s reading of the closing.

Some people will read the closing and commit to exit. With full support. With a decision that holds steady over time. With the pattern of their whole life intact. The structure does not pretend palliative care removes this case. It sets the conditions inside which the case can be honestly read.

The fifth

Four positions. Four readings of what care at the closing is. The structure gives a fifth.

The person’s authority at the closing. With the closing honestly read. With the operator’s reading told apart from the narrator’s. With the larger structure holding the floor, never overriding.

It takes the strongest version of what each position gets right. And it places it in the four conditions, where the operator meets the end of the corridor.

Source. Ø Applications, Chapter 9 — End-of-Life Care and the Right to Exit. The book in full: the420code.org/Applications.pdf. The short edition: the420code.org/models/applications/09-end-of-life-care-and-the-right-to-exit/. The film, The structure’s unpaid debt: the420code.org/films/applications/. Its kill switches: APP-9.1 to APP-9.5.