In May of 2006, philosophy student Clayton Schwartz embarks on a Pan-American motorcycle trip for the summer before law school. He is 30 years old and in peak physical condition.
He makes it as far south as Acapulco in Mexico before crashing into a donkey that had wandered into the road.
On Sunday, February 24, 2008, he commits suicide.
In the year and a half in between, he writes Two Arms and a Head, his combination memoir and suicide note.
Writing under the pseudonym Clayton Atreus, he lays out in excruciating detail how awful it is to be paralyzed, and how his new life is but a shadow of what it once was. He concludes that his life is no longer worth living, and proceeds to end it.
Along the way, he addresses the obstacles that society has put in his way of dying on his own terms—the biggest of which is the fact that physician-assisted suicide for his condition is illegal at the time.
But there are other factors. Smaller, more insidious roadblocks. Our society doesn't just condemn suicide; we do a great disservice to newly disabled patients in refusing to let them voice their misery and grief about being disabled. The book is a scathing indictment of how our society enables the lifelong disabled at the expense of the newly disabled and terminally ill.
Looking back from ~15 years in the future, when we have a patchwork of states and countries that have legalized physician-assisted suicide, Clayton's story stands as a cautionary tale for why it must become—and stay—legal.
Being Paralyzed Sucks
As a student of philosophy, Clayton is heavily influenced by the writings of Nietzsche and Camus. He analyzes the experience of being paralyzed primarily through the lens of Existentialism. It’s hard to imagine a more apt philosophy for interpreting body horror.
Two Arms and a Head comes from one of those rare moments in history when an individual’s circumstances so perfectly intersect with their skills that they leave a mark on the world. What better cosmic tragedy than to have a strong, fit, arrogant philosophy buff suddenly find himself paralyzed? His memoir is an exploration of what it means to exist in a body that is no longer entirely his own.
The full ramifications of being paralyzed are rarely discussed in polite company. Rest assured, he omits no details:
Everything below my nipples is no longer me. Hence the title of this work, “Two Arms and a Head”. [...] I am two arms and a head, attached to two-thirds of a corpse. The only difference is that it’s a living, shitting, pissing, jerking, twitching corpse. [...] What was once my beloved body is now a thing. [...]
Two arms and a head. Period. Additionally, I will be using a sort of shorthand in this book when I refer to parts of “my” body. So when I say “my penis”, for instance, what I really mean is “the unfeeling, alien piece of flesh that used to be my penis, but is now just part of the living corpse I will push or drag around forever until I am dead.” [...]
As far as I feel about my body, who do you love more than anyone else in the world? Think of that person. Now picture being chained to their bloated corpse—forever.
No, Really, It's Way Worse Than You Think
I had limited exposure to paraplegics until I read this book. Growing up, I only knew them from pop culture—usually as side characters who would appear on Very Special Episodes of Saturday morning cartoons. Professor X. The glider kid from that one episode of Avatar. The main character from the other Avatar.
The tropes gave me a mental model of being paraplegic that boiled down to "you can't use your legs, so you have to drag yourself in and out of a wheelchair to use the toilet. But you're still an ordinary person sitting upright in a wheelchair."
Clayton wastes no time in dispelling this myth:
To start off, that means that he has no use of the muscles that hold him upright.
Clayton still has to deal with all the logistics of life, despite two-thirds of his body being a hunk of corpse-flesh. He dedicates huge swaths of the text to all the little time-wasting tasks he now has to do. How much of his life is ticking away with every delay, every piece of effort, every task that is trivial for an able-bodied person but monstrously difficult for him. Something as simple as getting out of a car is an entire production—let alone running errands, cleaning, doing laundry, cooking.
Since the lower two-thirds of his body no longer sends pain signals to his brain, he must proactively tend to all of its physical needs. Complications include pressure sores, infections, and a high chance of blood clots. Aside from suicide, the leading causes of death among paraplegics are all related to poor circulation.
I had limited exposure to paraplegics until I read this book. Growing up, I only knew them from pop culture—usually as side characters who would appear on Very Special Episodes of Saturday morning cartoons. Professor X. The glider kid from that one episode of Avatar. The main character from the other Avatar.
The tropes gave me a mental model of being paraplegic that boiled down to "you can't use your legs, so you have to drag yourself in and out of a wheelchair to use the toilet. But you're still an ordinary person sitting upright in a wheelchair."
Clayton wastes no time in dispelling this myth:
> I am devastatingly, cataclysmically physically disabled. [...]Spinal cord injuries affect everything downstream of the injury—not just "the legs" but also the pelvis, bowels, genitals, and abdomen. Depending on where the injury occurs, that can include all the trunk muscles that keep someone sitting upright. (...)
> There is a tremendous difference between me and an able-bodied person sitting in a wheelchair. Tremendous.
To start off, that means that he has no use of the muscles that hold him upright.
Nothing keeps me sitting up—no hip flexors, erector spinae, hamstrings, or abdominal muscles. I am arms-and-a-head on a column of Jell-O.He can't put both arms out in front of him, lest he fall over. He has to continuously prop himself up with one arm while doing anything at arm's length. After only 1.5 years of being paralyzed, this has already caused significant repetitive strain injuries in his elbows, shoulders, and ulnar nerves.
Clayton still has to deal with all the logistics of life, despite two-thirds of his body being a hunk of corpse-flesh. He dedicates huge swaths of the text to all the little time-wasting tasks he now has to do. How much of his life is ticking away with every delay, every piece of effort, every task that is trivial for an able-bodied person but monstrously difficult for him. Something as simple as getting out of a car is an entire production—let alone running errands, cleaning, doing laundry, cooking.
Since the lower two-thirds of his body no longer sends pain signals to his brain, he must proactively tend to all of its physical needs. Complications include pressure sores, infections, and a high chance of blood clots. Aside from suicide, the leading causes of death among paraplegics are all related to poor circulation.
In addition to the loss of conscious sensation and muscle control, problems with the autonomic nervous system—heart rate, orthostatic blood pressure, temperature regulation—are common. This is even more pronounced in cervical spine (neck) injuries. Some quadriplegics black out or the blood rushes to their head when being moved from lying down into reclining in a wheelchair. A spinal cord injury wreaks havoc on the body's functioning. (...)
The Decision to Die
Reading this book should prompt a moment of introspection. If you disagree with Clayton’s list above, then reflect on what does give your life meaning. No, seriously, make a list: family, friends, partners, children, hobbies, skills, etc. Write them down.
Cross out one entry at random. How would you feel if you lost that entry? Would you still have enough left over to carry on? Probably.
Now cross out a few more. Lose your partner. Lose your children. Lose your parents. Your siblings. Your best friend. Your favorite hobby. How do you feel? Still worth it?
Add in some physical negatives: chronic pain. Constant nausea every time you eat. Losing feeling and control of your bowels, your legs, your genitals, your diaphragm, your non-dominant hand, your dominant hand, both arms. What about loss of sight? Hearing? Speaking? Communicating at all? (...)
How much would you have to lose before your life stops being worth living?
That list—and the dividing line between "worth it" and "not"—is different for everyone. The decision to end one's life is deeply personal. Clayton happened to draw the line at a particular point. Others may agree or disagree, but Clayton’s judgment was his own.
Decision in hand, next comes the hard part.
I am absolutely and heartbreakingly in love with life. But this is not life. [...]Clayton does not come to this decision lightly. He considers it exhaustively and systematically. When deciding whether to keep living, he starts from the premise that there is some amount of suffering past which life stops being worth it. He evaluates where that dividing line is by examining the sources of meaning in his life. (...)
For those who like to say this one: “Suicide is a permanent solution to a temporary problem.” I reply that suicide in my case is a permanent solution to a permanent problem. [...] I have only one serious problem in life and it’s being paralyzed.
Reading this book should prompt a moment of introspection. If you disagree with Clayton’s list above, then reflect on what does give your life meaning. No, seriously, make a list: family, friends, partners, children, hobbies, skills, etc. Write them down.
Cross out one entry at random. How would you feel if you lost that entry? Would you still have enough left over to carry on? Probably.
Now cross out a few more. Lose your partner. Lose your children. Lose your parents. Your siblings. Your best friend. Your favorite hobby. How do you feel? Still worth it?
Add in some physical negatives: chronic pain. Constant nausea every time you eat. Losing feeling and control of your bowels, your legs, your genitals, your diaphragm, your non-dominant hand, your dominant hand, both arms. What about loss of sight? Hearing? Speaking? Communicating at all? (...)
How much would you have to lose before your life stops being worth living?
That list—and the dividing line between "worth it" and "not"—is different for everyone. The decision to end one's life is deeply personal. Clayton happened to draw the line at a particular point. Others may agree or disagree, but Clayton’s judgment was his own.
Decision in hand, next comes the hard part.
The Roadblocks
I did not want much from the world in dying. To be able to put my affairs in order without fear of being taken prisoner and treated like I was insane. To say goodbye to those I loved without the same fear. To die a painless death without worrying about leaving behind something gruesome. And to be comforted as I died. When a person has absolutely nothing left and is facing annihilation, all he wants is not to be alone.For Clayton, killing himself is not a simple matter. At the time only one US state, Oregon, had any kind of “Death With Dignity” law on the books. However, this law only allowed assisted suicide for terminally ill patients with less than six months to live, while Clayton’s condition was stable.
The slightest whisper of suicidal ideation would have gotten him locked up in the psych ward. He has to write his book in secret, he has to lay his thoughts out for the world in secret, and he has to die in secret.
Becoming paralyzed destroys him on two fronts—the disability itself, and the fact that he is completely, utterly, devastatingly alone with his feelings. He writes Two Arms and a Head because he needs to show the world how agonizing it is to face death alone and how important it is for physical-assisted suicide to become—and stay—legal.
How empty to exist in this universe and share your feelings and experience with nobody! But that is how you, the world, have left me to die, alone. But what you don’t realize is this: in turning your backs on me, you have turned your backs on yourselves. [...]The State of MAiD
Someday you will be on your deathbed and maybe you will remember me. What I say to the world is that if you don’t do something about the way death and assisted suicide are dealt with, you may someday find yourselves in an unimaginably horrible situation with no way out. [...]
Beware! There could be a horrible fate waiting for you and if you don’t all get together, look each other in the eye, recognize the insanity, and change the laws, you could wake up tomorrow as a head on a corpse with no way out for the next thirty years. (...)
Medical Assistance in Dying (MAiD) is currently legal in a patchwork of countries and US states.
The exact rules, restrictions, and methods vary. In most places that have legalized it, the patient’s condition must be considered terminal (i.e. death is expected within six months) to be eligible for MAiD. The procedure itself is typically either an IV injection administered by a nurse, or a prescription cocktail of benzodiazepines, digoxin, and opioids which patients drink themselves.
In Canada and the Netherlands, MAiD is also available to patients with a disability that does not present as immediately terminal. The Netherlands currently includes severe treatment-resistant mental illness as a qualifying condition, and Canada will follow suit in 2027.
So it sounds like Clayton got his wish, at least in Canada and parts of Europe. Now, when a Canadian ends up in a terrible accident, they have a choice in the matter of whether they want to spend the next few decades as a quadriplegic head-on-a-corpse. Phew.
However, it’s not all smooth sailing. It seems like every few months there’s another horror story in the press coming out of Canada or Europe. Two news stories came out in quick succession in late March/early April 2024—one from Canada, the other from the Netherlands. (...)
The exact rules, restrictions, and methods vary. In most places that have legalized it, the patient’s condition must be considered terminal (i.e. death is expected within six months) to be eligible for MAiD. The procedure itself is typically either an IV injection administered by a nurse, or a prescription cocktail of benzodiazepines, digoxin, and opioids which patients drink themselves.
In Canada and the Netherlands, MAiD is also available to patients with a disability that does not present as immediately terminal. The Netherlands currently includes severe treatment-resistant mental illness as a qualifying condition, and Canada will follow suit in 2027.
So it sounds like Clayton got his wish, at least in Canada and parts of Europe. Now, when a Canadian ends up in a terrible accident, they have a choice in the matter of whether they want to spend the next few decades as a quadriplegic head-on-a-corpse. Phew.
However, it’s not all smooth sailing. It seems like every few months there’s another horror story in the press coming out of Canada or Europe. Two news stories came out in quick succession in late March/early April 2024—one from Canada, the other from the Netherlands. (...)
Not Dead Yet
Clayton had a particular amount of ire directed at one prominent anti-MAiD disability rights org: Not Dead Yet.
Not Dead Yet (NDY) was founded in 1996 by the same people who lobbied to get the Americans with Disabilities Act passed a few years prior. As the name implies, they reject the notion that death could ever be an acceptable response to living with a disability.
When terminally ill patients get polled on why they are choosing MAiD, it turns out that avoiding pain isn’t the primary motivation. In Oregon, where MAiD is only available for the terminally ill, every patient fills out a questionnaire when they apply for the program. Tallying up all the surveys from 1998–2023, to top reasons are:
- “Losing autonomy” (90%)
- “Less able to engage in activities” (90%)
- “Loss of dignity” (70%)
- “Losing control of bodily functions” (44%)
- “Burden on family” (47%)
- “Inadequate pain control, or concern about it” (29%)
- “Financial implications of treatment” (7%)
This isn’t surprising when considering that palliative care is legal in all 50 states. If someone’s condition is judged to be terminal, as Oregon requires, they already get a bottomless supply of morphine. Pain is not really the problem anymore.
The problem is that a failing body is, well, failing. Patients become weak and frail. They struggle to walk and use the bathroom. They may become dependent on a feeding tube or a respirator. Somewhere along the way they might lose their minds to dementia. All of these are serious, debilitating symptoms that can suck the meaning out of life, so many patients choose to die before they get to that point.
Not Dead Yet condemns this status quo.
There’s a lot to unpack here. NDY is starting from the premise that the desire to end one’s life is always and necessarily the product of an irrational mind, Claytons of the world be damned. Medical professionals, given that they’ve sworn an oath to protect life, have an obligation to treat all suicidal ideation with “suicide prevention” care (i.e. involuntary commitment until the patient comes to their senses).
A society that has legalized MAiD still extends this preventive care to the able-bodied who want to die, but then turns around and gladly assists disabled patients in ending their lives. This is discrimination! Doctors are murdering the undesirables! (...)
Un-Assisted Suicide
The final argument that anti-MAiD proponents fall back on is that anyone can just commit suicide; why do they need help from doctors?
The glaringly obvious answer is: because patients cannot “just” commit suicide.
Clayton could not “just” ask for help putting his affairs in order. He could not “just” say goodbye to his loved ones. He could not “just” die peacefully without anyone trying to stop him. He could not “just” publish his memoir before his death—not if he wanted to avoid being committed.
Young people would prefer not to think about such things, but what everyone does not see is that those old people are you. You are them, it’s just a matter of time.Until we defeat death in the glorious transhumanist future, it’s coming for all of us. Some of us may die suddenly in a tragic accident. Some may be diagnosed with a terminal illness that kills in a matter of months.
But most of us will die by very slow decay.
The counterfactual world—where the elderly are kept alive as shriveled husks for years, slowly withering away—is gruesome and ghastly.
by Anonymous, Astral Codex Ten | Read more:
Image: uncredited
[ed. When you see someone suffering, someone you've loved all your life, and your only hope is that they die as soon as possible, you'll understand why this issue is so important. It doesn't appear much will change soon (until Boomers start going in greater numbers), but hopefully in another generation or two the barbaric idea of preventing people from leaving peacefully on their own terms will just be a shameful artifact of the past. You can read the complete version of Two Arms and a Head online here.]
