Ethics are easy. Or rather, most of the moral dilemmas that transfix society not only lack Aristotelian profundity; they are also less complex than ordering groceries on the internet or building sideboards from Ikea flatpacks. The chief conundrum in the case of Miss B, who is paralysed from the neck down and wants to die, is how such an uncontentious matter ever got to court.
Miss B, left quadriplegic after a blood vessel in her neck ruptured, is a social care professional aged 43. Her intelligence is unimpaired. Doctors and psychiatrists agree that she is highly competent to choose, as she tried to six months ago, that the ventilator keeping her alive should be turned off. At this point, medical discretion runs out.
The BMA's ethical guidelines say that 'a voluntary refusal of life-prolonging treatment by a competent adult must be respected'. Legal action, the code continues, 'could be taken against a doctor who provides treatment in the face of a valid refusal'. Yet Miss B has had to litigate to die. Last week, she spoke of her anger and distress as the High Court (hospital visiting division) convened around her bed.
It seems certain that Dame Elizabeth Butler-Sloss, who has handled the case with compassion, will rule, in a reserved judgment, for the patient. None the less, Miss B has seen her privacy and dignity, the last shelters of the dying, violated. Blame doctors who play God, some say, but her treatment was tainted less by autocracy than by confusion.
In telling the court that they could not pull the plug on a woman they had known for a year, doctors moved the debate, disgracefully, from the patient's best interests to their own. Like a below-inflation pay rise or a confetti of targets from Alan Milburn, Miss B's demise would be bad for staff morale. Such reasoning is a modern take on John Donne's view that an individual's death casts a wider chill: 'Never send to know for whom the bell tolls; it tolls for thee.'
Not if we can help it. The average life expectancy has gone up by almost 10 years in the last half century, pension funds run dry and, by 2025, there will be two million more pensioners than children. In a post-ageing era, wrinkles are for rhinos and Julie Christie hardly looks older than Joan Collins's latest husband. But longevity is also a tyranny. Medical science keeps the sick alive but increasingly in thrall to machines and carers. Some, like Miss B, long in vain for Donne's bell to toll.
Carelessly, we have forgotten how to let people die. Death is unfashionable, even taboo. Long after the fading of religion removed its purpose as the conduit to the afterlife, the secular compact - that individuals' lives, unmortgaged to church or state, are theirs alone - has not been ratified. The flipside of scientific progress is that death is seen almost as an outrage.
Francis Bacon thought it was 'as natural to die as to be born'. The journey from Petri dish to morgue is less simple now. Diane Blood, pregnant with her second child, had to overcome the highest hurdles of law and ethics before being allowed to go abroad to use her dead husband's sperm. Diane Pretty, who has motor neurone disease, must trek to Europe to ask that her husband can help her die without facing criminal charges.
In the recent case of the Siamese twins, 'Jodie' and 'Mary', critics abominated the supposed murder of what was actually a large tumour killing a child who is, no thanks to some lawyers and most churchmen, now alive and flourishing. Some of these cases were easier than others. All were treated with dinosaur clumsiness. Why does society get dying so wrong?
Partly because death, an institutionalised affair, has been simultaneously invested with secrecy and stripped of privacy. When I was a junior reporter biking round to ask the recently bereaved for details for an obituary, there was often a coffin in the front-room. 'Would you like to see him?' a new widow would sometimes ask. How ghoulish. But how odd, too, that now, when three-quarters of people die in hospital, the squeamish may go through an entire lifetime without confronting the calm reality of death.
When life is cheap and short, then mortality looks different. Montaigne, who lost several children in infancy, accorded them the sort of mourning currently deemed suitable for guinea pigs. Now every baby must live, however grim its prospects. Neither indignity nor pain easily outweigh the imperative of an unwanted, cabbage existence for the old.
Science and affluence have rendered life so long that Bill Clinton, announcing the results of the Human Genome Project, gave Leo Blair 25 years of extra time. Some pundits talk of a 150-year lifespan and dream of 1,000. Whether we want Swift's nightmare of extruded existence is moot. Already, as Miss B's case has shown, when death is hard to acquire, it may become a luxury to be craved.
Her plight, rare as it is, highlights other issues that are barely faced. As Dr Richard Nicholson, editor of Bulletin of Medical Ethics, has said, some developed countries spend half their health budgets treating people with six months to live. The terminally ill should never be denied the care they need. Nor, obviously, should the old be helped to die unless that is their certain wish. But, sometime soon, society must address the politics of death.
It is time, for instance, to legalise mercy killing. In Holland, Belgium and Oregon, the tiny numbers choosing euthanasia counter the notion of a licence for granny-culling. Such objections are often floated by those who think all life sacred and who cloak religious prejudice in legal quibbling. But many Christians, of whom Miss B is one, see their God as a post-Copernican pragmatist willing to absolve the faithful from a living hell.
So why the emphasis on life at any price? Through fear of litigation, partly, and because cutting-edge science gets blunted by rusty ethics. In Saudi Arabia, doctors boast of soon being able to give women new wombs. In Eire, they can't even offer abortions, except to the suicidal. In birth, as in death, the chasm between morality and technology grows.
Too easily, death becomes a failure - of science or the human will. Miss B and others are supposed to achieve like Stephen Hawking or to hope like Christopher Reeve. Why should they? Wishing to die, far from being negative, only affirms the preciousness of worthwhile life. Miss B has no children whose needs might vary her choice. The law is on her side.
Even so, her death has become a circus. Such events will become more common, as a morally neutral Grim Reaper gets superseded by mortal agents with off-switches they decline to flick and plugs they do not care to pull. Miss B is the first of many, harder tests of a society that has not yet grasped that suffering is much more tolerable for onlookers. As prolonging existence gets easier, it is vital that individuals, not courts or doctors, get to choose the moment when life becomes less merciful than death.
