Exkarnieren Anhang 7

Vergleich: Siehe: Anhang + Anhang 2 (Interview mit Gian Domenico Borasio/Johannes W. Schneider) + Anhang 3 (Interview mit Rosina Sonnenschmidt) + Anhang 4 (Paolo Bavastro/Aktive Sterbehilfe) + Tod Repertorium: (Mirilli) + Anhang 5 (Birgitt Bahlmann/Anna von Münchhausen) + Anhang 6 (‡ Floris Reitsma ‡/ Boudewijn/Chabo) + Anhang 8 (Elisabeth Kubler-Ross/Lia Bello/‡ M.Girke ‡) + Anhang 9 Sterbebegleitung (Jakob Simmank) + Organspende (Rosina Sonnanschmidt/‡ Hinrich Baumgart ‡) + Psychopomp/https://hpathy.com/homeopathy-papers/death-final-frontier/

Interview: Tina Hildebrandt und Martin Spiewak

Ein Gespräch mit Karl Lauterbach "Krebs lehrt mich Bescheidenheit"

Seite 3/3: Der größte Risikofaktor ist das Rauchen

DIE ZEIT: Die Pharmaindustrie rechtfertigt die Preise mit den hohen Investitionen, die notwendig sind, um ein neues Medikament zu entwickeln.

Lauterbach: Die gigantischen Entwicklungskosten sind gigantisch übertrieben. Die Pharmaindustrie gibt -selbst großzügig berechnet- nicht einmal 5% ihrer Umsätze für die Grundlagenforschung aus. Das ist weit weniger, als die Firmen ins Marketing stecken. Die Pharmafirmen sind nie ohne hohe Preise ausgekommen, die Gewinnspannen bei

den neuen Krebsmedikamenten aber sind ohne Vorbild.

ZEIT: Ohne Pharmaforschung gäbe es die neuen Medikamente doch gar nicht.

Lauterbach: Auch das ist eine Form der Hochstapelei der Pharmalobby. So gut wie alle entscheidenden Fortschritte in der Krebsforschung stammen nicht aus der Industrie, sondern von Wissenschaftlern meist US-amerikanischer Universitäten, die dort oft mit öffentlichem Geld arbeiten. Die Pharmafirmen dagegen investieren in der Regel in risikoarme Forschung. Sie suchen den Schlüssel nicht im Dunkeln, sondern dort, wo schon Licht brennt. Dabei beschäftigen die Firmen viele fähige Krebsforscher, die in

der Grundlagenforschung fehlen. Das ist fast noch schlimmer.

ZEIT: Dass man von Ihnen Positives über Big Pharma hört, ist nicht zu erwarten.

Lauterbach: Ich bin in dieses Buch nicht als Pharmakritiker eingestiegen. Aber genauso, wie es jetzt auch viele amerikanische Onkologen tun, die zum Teil sogar eng mit

den bekannten Firmen zusammenarbeiten, sehe ich die Pharmaindustrie tatsächlich auf einem unguten Weg. Eine wirksame Krebstherapie wird so lange nur ein Versprechen bleiben, wie die großen Arzneimittelhersteller ihre Forschungsstrategien nicht ändern und die Politik nicht bei der Preisgestaltung eingreift.

ZEIT: Wann rechnen Sie denn überhaupt damit, dass die entscheidenden Medikamente auf den Markt kommen?

Lauterbach: Für einige wenige Krebsarten wie den schwarzen Hautkrebs, das maligne Melanom, zeichnen sich Therapien schon heute ab. Die großen Durchbrüche erwarte

ich dagegen leider erst in zwanzig bis dreißig Jahren.

ZEIT: Was kann so ein armer Babyboomer denn machen, um sein Schicksal zu verbessern?

Lauterbach: Mit dem Rauchen aufhören.

ZEIT: Und was noch?

Lauterbach: Mit dem Rauchen aufhören. Nein, wirklich, der größte Risikofaktor ist das Rauchen in jeder Form und Dosierung. Und zwar nicht nur für den Lungenkrebs, sondern auch für viele andere Tumorformen, wo man es früher nicht vermutet hatte, wie etwa Blasenkrebs, Nierenkrebs oder Brustkrebs. Wahrscheinlich steckt im Kampf gegen den Tabak die Hälfte des gesamten Vorsorgepotenzials. Erst mit großem Abstand folgen dem Rauchen andere Risikofaktoren wie Übergewicht, Bewegungsmangel

und eine Ernährung ohne genügend Früchte und Gemüse. Ich bin deshalb dafür, die Tabaksteuer erneut massiv zu erhöhen und aggressiver über die Gefahren des Rauchens aufzuklären.

ZEIT: Haben Sie Ihre Lebensweise nach dem Buch umgestellt?

Lauterbach: Das brauchte ich nicht. Ich habe nie geraucht, schon immer viel Sport gemacht und esse kein Fleisch, dafür viel Obst und Gemüse. Zudem habe ich geradezu Probleme, an Gewicht zuzunehmen. Aber ich mache mir keine großen Illusionen. Selbst wenn sich jemand sein Leben lang optimal verhält, kann er sein Risiko, an Krebs

zu erkranken, um vielleicht 30 - 40% gegenüber demjenigen senken, der im Sinne der Krebsprävention alles falsch macht.

ZEIT: Wie wollen Sie damit umgehen, wenn Sie im Alter an Krebs erkranken?

Lauterbach: Das kommt auf den Krebs an und darauf, wann er entdeckt wird. Ich habe mir aber vorgenommen, keine Medikamente in Anspruch zu nehmen, die mir nur

einen Aufschub von ein paar Wochen oder wenigen Monaten gewähren.

ZEIT: Das sehen viele Patienten anders.

Lauterbach: Weil sie den Nutzen der Präparate häufig falsch einschätzen. Wenn Patienten gut erklärt bekommen, dass die betreffenden Medikamente wahrscheinlich nur wenig Lebensgewinn bringen, entscheiden sich viele von ihnen dagegen. Das Frappierende ist ja: Menschen im Endstadium, die statt weiterer Medikamente eine Palliativbehandlung wählen, leben häufig sogar nicht nur besser, sondern auch länger. Eine unabhängige Patienteninformation wird deshalb eine der großen Aufgaben

der Gesundheitspolitik in der Krebsmedizin sein. Das ist viel wirkungsvoller als jede Art der Rationierung.

ZEIT: Der ehemalige Chefredakteur des British Medical Journal, Richard Smith, schrieb vor einiger Zeit, an Krebs zu sterben sei der beste Tod: Man könne sich auf ihn vorbereiten, von den Angehörigen Abschied nehmen und das Ende mit Liebe, Whiskey und Morphium erwarten.

Lauterbach: Nein, so stelle ich mir mein Ende nicht vor. Ich ziehe das schnelle Sterben ohne Leiden doch vor.

[Johannes W. Schneider]

‡ A new field of research developed in medicine and psychology during the second half of this century is thanatology, the study of the dying process. This concerns not the moment of death but a process that often takes a long time. Previously, death was only seen in negative terms, as the extinction of life. Now people

are asking if there are characteristic stages which form a distinct entity and which have to be understood

not only in the light of preceding life but also of impending death. Phases in the process

Dr. Elisabeth Kubler-Ross: her book “On Death and Dying” was a pioneering effort in this direction.

She found the dying process to be in five typical stages.

1. the sick individual is, for the first time, seriously considering that death may be the outcome of his illness. The idea may still be suppressed, but deep down the individual knows what is coming.

2. knowledge of approaching death can no longer be suppressed but keeps coming to conscious awareness.

The dying person then wants to prove to himself and others that he still exists. He tyrannizes family and

nursing staff and refuses to see visitors.

3. the individual realizes that he must die - but not yet. He begins to negotiate with his physician, with God. Yes, he has not lived a good life until now, but if he could only be given a few more months he would make better use of them.

4. it becomes clear that death is approaching not just in general terms, but now. This causes depression, and self-reproach

5. the sick individual fully accepts death. He grows peaceful and may even be able to comfort those who must remain behind.

Evidently the 5 stages will not be equally well developed in every case, and patients may even go back to an earlier stage if their condition improves. The above progression is, however, typical, and experience shows

it to be so, with many variations.

Elisabeth Kubler-Ross made careful observations not only of the symptoms of dying but of the dying individual himself. It is most fortunate that the beginning of modern research into dying was marked not by cool, objective interest in the subject but a caring attitude toward the human being. Concepts developed in the human sciences are only in accord with reality if they come from such a caring attitude.

Modern research into dying has another important precondition. To understand dying, we must think in terms

of processes. It is not enough to describe facts, but we must see them as steps along a road. The scientist

must follow the road taken by the dying individual with understanding.

It is a great help to the dying individual if a caregiver understands the dying process. Then he does not

feel left on his own.

The dying individual is not the object of pity but is accompanied with insight and understanding.

Finally, there is a third precondition for the study of the dying process. It is that the evolution has to

be considered in light of its ultimate goal, which is death. Death influences and shapes the final part of

life. The depression seen in the fourth stage of dying can thus be seen as a preparation for the approaching separation. Coming closer to the threshold of death the sick individual abandons his egotistical attitude and gradually develops a new, sovereign view of the value of life. It is part of the characteristic nature of human development that new capabilities often appear first as their negative counter image. Values that have applied until now are destroyed, making room for a new stage in individual development. Just as the independent thinking and insight which develops in our young years tends to present first as the negative counter image of a critical attitude to society, so the peace of dying first shows itself as depressed feelings about the life lived so far. This depression can only be understood if we know it will be followed by the stage when life coming to its close is contemplated in peace.

Elisabeth Kubler-Ross distinguishes 5 stages in the dying process, noting above all the changes in the dying individual's relation to the world around him.

If we consider the changes in conscious awareness, four stages may be discerned in the process.

The first signs may be characteristic dreams as the individual approaches the threshold of death. The dream images will rarely show openly what they imply:

a funeral, a coffin, a grave stone, or seeing one's own dead body. (It may be noted in passing that images

of death in dreams do not usually refer to actual death but more often to the dreamer's state of exhaustion

or separation from someone near and dear.)

A student dreams he is walking through the local cemetery and looking at the beautiful grave stones.

He is about to turn and leave when his eye catches a stone with his own name; the date of birth is correctly stated, the date of death partly obscured by some moss covering the last digit for the year. Wanting to scrape off the moss, the dreamer wakes up in a state of agitation but, in the process of waking up, has the feeling that it is the current year. These are two of the themes that come in genuine death dreams. The dreamer wants

to escape before the essential theme of the dream, his own grave stone, appears and yet feels drawn to this dream content. He also wants to know the year of his death, but the dream stops, and on waking up the student merely has a feeling that it is the current year. The other typical feature of a genuine death dream is that

it casts a veil over an essential element which the dreamer would really like to know once he has awakened.

It would be tremendously important to him to know the year and day of his death. A third typical theme did not appear in this dream: knowledge of one's own death brings peace and, sometimes, even happiness.

Generally speaking, however, the theme of death is hidden, presenting in symbolic form. The 19^th Century German dramatist, Friedrich Hebbel, described such a dream dreamt of a friend, von Engelhofen, an official at the imperial court in Vienna. He was walking through a landscape he had never seen before, finally coming to a

large river, the opposite bank of which was shrouded in mist. He offered money to a ferryman to take him across but was refused. The dream returned for eight more nights. The ninth night, however, the dreamer was allowed

to enter the boat and was taken across the river "swiftly as an arrow". There he saw a palace, and his father (who had died earlier) standing in front of it to welcome him. Mr. von Engelhofen knew his dream to have been

a true one when he awoke but interpreted it as predicting a diplomatic mission to be undertaken that might earn him an decoration or promotion. We note that wishful thinking came in, drowning out the subtle language of the dream. The river is the image of the border between the realm of the living and the dead not only in dreams and in mythology. The dead father represented the world beyond the threshold of death which awaited the dreamer. Symbolic dreams of death almost always leave the individual free to interpret them in another way and so may easily be misinterpreted.

When we are close to death, symbolic images appear not only in our dreams but also in waking consciousness, interspersed with the images we gain from sensory perception. The inner image will often fill the center of

our field of perception, with optical perceptions remaining in the margins. The dying individual sees himself

in a dark, damp cave. A crevice appears in the rock, opening out onto a magnificent wide landscape in bright sunlight. The eye is drawn to the rich green of the meadows. The dark cave is clearly one's own sick body;

the landscape outside is the world after death which seeks to draw the dying individual to it. The fact that

the eye is drawn to the landscape indicates that an activity is already coming in from outside.

The same theme may appear in a completely different image. The dying individual may feel himself to be sitting in a train that is rushing faster and faster through a tunnel. The light illumining the landscape outside is already visible on the tunnel walls. The tunnel corresponds to the cave in the other dream, the light to the green landscape, and the accelerating speed of the train to the eye being drawn from outside.

For the dying individual, the inner image often has the same inner reality as the optical perception.

Together they are the reality in which he lives. Thus a dying man might ask the niece sitting at his bedside: "Where did you get on, and where are you going?" The niece, having no idea of train or tunnel, sees this as

the beginning of the mental confusion that is often said to precede death. But the dying individual knows very well that his niece arrived yesterday to nurse him and has asked neighbors to look after her two children.

He merely does not realize that the tunnel and the train are inner images that others do not share. Thinking based on memory is quite intact but grows uncertain when it comes to observation of natural laws. The person fails to realize that a rock will not open up to reveal a landscape.

1. stage of changing consciousness, thinking begins to let go of its bonds with the physical world (which also happens in the transition to dreaming) but does not abandon the logical sequence of life's memories, whereas dreams may link different remembered elements in a quite arbitrary way. The individual continues to identify with his physical body, remaining in the cave, but a view opens up on existence outside the physical body.

The inner image is already more powerful than the optical image, pushing it aside and taking up the center itself. The individual is beginning to let go of the body; the endeavor to do so is apparent in the behavior

of a dying person. He'll kick the bedclothes aside or want to leave the room, perhaps even by the window.

Yet it is not really the room he wants to leave but his body. He still experiences himself in his body but

this has become a burden. If the patient still has sufficient physical energy, he has to be watched at this stage, for he distinguishes as little between the soul leaving the body behind and getting out of bed as he

does between inner and outer image.

2. the change of consciousness begins when the dying individual no longer identifies with his body but sees

it from outside. In a car crash, the passenger is thrown out into the road where he lies motionless and seemingly unconscious. He is looking at his own body from a point about two meters above his neck. He knows himself to be severely injured but not dead. He sees other cars stopping, people standing around him and hears one of them say: "He's dead." The "unconscious" person is afraid that people will not consider his injuries but treat the body as a corpse. Incidents such as this show how much unconscious or dying people take in of what happens around them. I know a physician who always tells an unconscious patient what he is doing: "I am giving you an injection. I am taking your temperature. .." This shows great wisdom in caring. Maybe those words do not reach the unconscious mind, but they may equally well help the patient not to become estranged from his body

as he lies unconscious. In any case, the physician is taking him seriously as a human being, and this in itself is sufficient justification.

In the accident case just mentioned, the injured individual experiences himself at a particular point in space that remains the same, close to his body. The conscious mind has separated from the body, but the familiar, point-centered concentration of the conscious mind continues. Separation progresses when the feeling of being close to the body ceases and the dying individual feels himself to be sitting in a plane, for instance, looking down at his home town. Now the point in space is in motion, and attention is no longer focused only on the body but on the whole life sphere. It is still focused on a particular point on earth, however. This final limitation of the conscious mind disappears when the dying individual feels himself to be floating freely in cosmic space, now fully free of the burden of body and earth. Now, the content of consciousness is no longer determined by the physical body but by the buoyancy of the excarnating human being.

Growing beyond the confines of the body may also be experienced in another form that is less buoyant.

It is the experience of getting bigger. Even an overtired person may feel the head growing larger than the skull. The familiar experience of one's physical form is overlaid with perception of the life organism, with

the physical body no longer able to keep it within its boundaries. Close to death the experience may grow stronger and extend to the whole body.

There is another way of experiencing the body from outside that belongs to the same stage. The dying person thinks he hears a cracking, crashing or groaning sound, either from unknown far away places or, if it is localized, usually from below. He will say the people in the flat below are hammering or that a bed spring must have creaked. These sound images reflect him bumping into his own body, touching it from outside. Optically, this may take the form of a dark shadow suddenly cast on a beautiful landscape prospect. This image also occurs in dreams, shortly before waking up.

In the two above stages, the dying person's conscious mind is still directed to the world he is about to leave.

3. the earthly world has vanished, and he meets figures from another world. The simplest way in which this may happen is that the individual feels called by name. It may be the voice of his mother or some other familiar person, but it may also be a chorus of voices. Nor does it have to be his name; it may be something like "Come and join us". The experience may condense into the vision of a loved person who has died; the eyes of that person make the strongest impression with a seeking, asking look that draws the other to it.

A young child comes to be at home on earth on eye contact with its mother. In the same way the dying individual finds his new home as he feels someone is looking at him. This theme also comes in dreams when someone is close to death. The individual is walking through a beautiful meadow where the plants have eyes instead of flowers, big eyes that look at him unblinkingly, hundreds of eyes. Or the individual is in a domed hall, the vault above him a blue mosaic.

The keystone is a huge eye looking down on him. or he is walking in a misty park and sees a rock in the distance; as he comes closer this assumes the form of someone dear to him who has died and now gives him a penetrating look.

Close to the threshold of death the perception of being looked at also occurs in waking consciousness.

The 19^th Century Swiss poet and novelist, Gottfried Keller, said the night before his death that he saw two knights in golden armor next to a cupboard in his room who looked at him unwaveringly for a long time.

The eyes do not merely rest on the dying individual but enter deeply into him. They do not look but see through the person and judge him. Not the way one person might look at another and form a judgment, but in such a way that the look already is the judgment. There is nothing alien about this judgment, however, and the dying individual feels: if I were completely honest with myself, I would have to feel the way those eyes do.

The strangest experience of this kind is the appearance of the "Mongolian" who comes to the dying individual

as a totally alien figure, his features immobile, giving no indication of a particular age. This unapproachable expression is in striking contrast to the look in the eyes which is like the dying individual meeting himself, reflecting his own judgment on himself. Keller's two golden knights showed, in an almost mythical way, that they did not belong to the earth world - we don't wear armor any more, and only heavenly beings wear garments of gold - but with the "Mongolian" the supernatural character is almost hidden. The strangeness and unapproachability show that on and beyond the threshold the human being no longer sees himself the way he does in life. We are often quite surprised to find out what others think of us. This might, of course, be because they do not judge us rightly. We can evade this. But the experience on the threshold of death is inexorable, with all self-justification dying on our lips. The human being comes to see: This is I.

People who are dead may also appear, and the dying person may have a conversation with them; or figures of pure light appear, their glory drawing the dying individual to them. Dying people often give a name to those figures of light, calling them Christ or angels. Caution is indicated here, for they often merely indicate that the dying person always imagined Christ or an angel to look like the figure he now meets. The one thing that is certain is that this is not one of the dead but a more-than-human spirit. This will usually be all one is able to find out. If the dying individual returns once more to a quiet reflective mood, he may get a feeling for whether this figure of light came to meet him as a very personal gesture related to his own inherent nature, perhaps protectively enveloping him in light, which would suggest an angelic encounter; or, if the gesture

is more than personal, addressing his human nature and he was simply being received as a human being in the throes of death, which suggests one of the less frequent Christ encounters. We should not always think immediately of the most sublime that may happen to man.

These encounters show characteristic differences in dying children compared to older people. Even when long illness or advanced age has made the individual's thoughts turn to death for some time, perception of the

figure of light comes as a surprise. The contrast to life on earth is clearly felt, and yet this new experience is usually taken as a matter of fact, confirming something the individual has always known deep down, even if

it went against accepted opinion. When an older person who is dying is finding his way into this world of light, the eyes often show a delicate luster which is perceived by those around him. The other world does not come as

a surprise to dying children. For them, it is like returning to a familiar home from a journey. Knowledge of

the spiritual reality does not come from the depths but is like something not far away that is remembered and will provide immediate orientation.

4. stage of changing consciousness, the dying individual already feels at home in the new world. Not only does he grow calm but he is able to radiate peace and calm, and to comfort or bless those around him. It used to be very important to people to reach a deathbed in time to receive the dying person's blessing. Why is it that the power of this is so rarely experienced today? Is this only due to the dying person or perhaps also those who have to stay behind and do not dare face the reality of death?

The individual gesture of dying

The four stages of changing consciousness were described as part of a typical dying process, as were Elisabeth Kubler Ross's stages. Typical does not mean that every individual has all the experiences. Some stages may be particularly marked, others only hinted at or not even perceptible. The time sequence of the steps is typical. Every human life shows the typical stages of development and also a highly individual form of biography.

This also holds true for dying. There is an ancient saying that we really only know someone if we know how

he died. This individual note cannot be described as a process, a sequence in time; it is a gesture revealing the person's individual nature.

5. The gesture of dying may be wholly in accord with the gesture of the biography or it may give new emphasis

to something. Social individuals may die in isolation. Recluses may gather their friends around their deathbed, perhaps even reconciling them. Some depart suddenly in the midst of an active life; others gradually prepare themselves and their families for the parting. A man in his late eighties, fit and always active, is working

in his beloved garden when he suddenly feels weak and sits down for a moment, never to get up again. Death coming swiftly is not bringing a new note to the biography in this case but is letting the person die the way

he lived, performing the work he has been given.

Another, also in his late eighties, has never been seriously ill, except for being wounded in the war.

Having to depend on others was not a feature in his biography. He suffers a myocardial infarction and is taken to an intensive care unit, where death is imminent a few days later. The machines have been turned off, a

"Do not disturb" sign hangs on the door, and the family is quietly waiting for what has to come. Suddenly,

the patient feels better, wants to eat something, and has two more weeks during which he experiences the dying of his body very consciously; previously irritated at any medical intervention, he now shows great patience

as he allows himself to be nursed and treated. Something has been added to a life that had run its full course, something he can take with him. Not a ripe fruit, but a seed for future development.

Another aspect of the individual gesture of dying is the ordering of one's affairs. Before a sudden and unexpected death, one makes arrangements to make life secure for the family or for the dying person himself

the sense of which only shows itself later. A woman in an old people's home wanted to visit a friend.

She canceled her meals, said good-bye to everyone in the home, and asked the caretaker to repair a lamp in her room while she was away. No one noticed that no taxi arrived to collect her. When the caretaker had repaired

the lamp the next day and was about to leave the flat, he got a feeling that something was not right in the bathroom. He opened the door and saw the dead woman lying there. Here, we see quite clearly a woman unknowingly seeking solitude to die unobtrusively - also making sure that she will be found.

A physician had an incurable disease for a long time. He continued his medical practice in his flat, though

with some effort, feeling responsible for his patients. Shortly before his death, he went into his consulting room where he sat quietly at his desk for some time; he then went to his wife and children, looking at them

long and hard before withdrawing to his waiting room where he sat down in a chair and died. Saying goodbye to something that meant much is a common element in the gesture of dying, especially the deep gaze, as though to take it in once more, lest one forget.

Of course, people are not usually aware of this individual gesture of dying, and we only perceive it in looking back. Characteristically, those who are left behind will hardly note these images or forget them, only realizing their significance when death has ensued. This applies particularly to acts that are like symbols of making farewells, a few hours before his death, a man who had had many appointments in his life and had to organize his time most carefully, took off the watch he had so often looked at. A member of the family reached out quickly to prevent it falling to the floor and put it on the table. When the room was tidied after the man died, the watch was seen lying there. Suddenly it became clear that the symbolic gesture intended to say: time has come to an end - no more appointments.

Acts such as these, indicating a farewell to life, may sometimes be observed quite a long time before death.

For many years my father and I had given lecture courses during the summer holidays. I was only there for

some of the time when my father was lecturing, leaving early to go on holiday. Planning the program for the following year, my father unexpectedly and for no apparent reason asked: "Will you be there the whole time?" Taken aback, I felt for a moment that there was more behind those words than appeared. I planned a shorter holiday but forgot those words again. The next year, my father had a stroke the day after his first lecture.

The 86-year-old, fit and active until then, went down rapidly and died within a few months. It was only after

he had his stroke that I remembered his earlier words.

In the encounter with people who will soon be dying one often has extraordinary premonitions of death. I remember visiting a friend. We said good-bye at the door of his flat, and as I walked down the stairs I suddenly asked myself: could this have been our last parting? I rejected the idea immediately, for neither of us was old, and we were both fit. I did not think of the situation again until the news of his sudden and unexpected death reached me a few days later.

When the threshold of death is nearing people often feel the need to speak of death and what comes after it. They will sometimes initiate the subject themselves, perhaps in very general terms. We always feel our way at first, to see if the other person is ready to talk about the subject. We also know very well whom we can talk

to and whom not. We may feel we'd rather leave it to someone else, who may know better how to handle it if we are thus approached, but we must not evade it for it is addressed to us. Someone who is close to death is not usually looking for new knowledge concerning death but for assurance concerning something he has "known" for

a long time. Of course, we really only know things from direct experience. We shall only know death for what

it is when it reaches out for us. Then, however, it will no longer be a question of knowing about death, but

of knowing its reality. The latest scientific discoveries will, therefore, be of little use to a dying person, he does not need expert opinions but what the person he has asked truly believes. We are addressed as human beings here, not as people with special knowledge.

The question concerning death is often not put in words but asked with the eyes. We enter the room of someone who is dying and become aware of an expectant look. Will you also say: "You'll be all right", which is what my physician, my colleague and my niece have said, or will you admit to something you know, something I also know? Are you going to chat, to meet your own need, or will you talk to me, the person I am now? Not only old people may look for such openness, but children, too. Someone who has been touched by approaching death no longer

needs to be diverted, entertained, the daily routine; he is asking about something that really matters.

People who have as yet no awareness of the approaching threshold, even though close to death, usually also have no desire to talk about death. The thought of what is to come is then not truth to set them free but an alien power that may even destroy their last vital resources. It does not matter at all if that person has said at some earlier time that he would want to know when the end was coming, wanting to die in full conscious awareness. The thought of distant death and the reality of approaching death are two very different things.

Letting go of life

A man of advanced age who had been expected to die any moment for two weeks, was taking difficult breaths;

it was as though he was already far away from his body. A member of the family sitting beside him and holding his hand addressed him by name. The dying man was all there again at that moment, turning his eyes to those

he was leaving behind - eyes from which spoke profound knowledge of the world after death - and he closed his eyes forever. Destiny is favoring someone by enabling them to die like this. To lay the body aside in full conscious awareness, inwardly accepting the end of life on earth and turning to a new world.

A woman of advanced age who had already got in step with the world on the other side of the threshold was able to say calmly and as a matter of fact, as though to reaffirm the facts for herself: "Now I die." In her last hour her thoughts went once more to what had been the essence of her life.

For many who die peacefully it is nevertheless important to hold the hand of someone near to them.

Often with quite unexpected strength. For the moment the body slips away from the dying individual he feels himself to be above an abyss that separates him from the world after death. At that moment the clasp of a

hand is a kind of substitute for living experience of one's own body which had given experience of self until now. Holding the hand of a dying person is often the last act of love we can perform for them. For those of

us who remain behind, it is a tangible experience of the reality of death.

People find it easier to let go of life if they feel it has been fulfilled. It is, therefore, a help for the dying to be told once more what they have meant to others. Fulsome phrases won't serve the purpose, but a

simple thank-you does. People often will not have achieved what they had originally thought life should be.

It is all the more important then to be assured that much has been achieved that may not have been originally intended, life simply demanding that it be done. Many a task has remained half done, and it is a relief to know that others will take it on. This applies above all to a dying mother who is concerned for her children's future. A single sentence making things clear can mean a great deal to her.

Those who are close to death will sometimes be afraid that people will forget them. This is not as surprising

as it may seem at first. For as the physical body increasingly becomes less significant for experience of self, memory content and, therefore, being remembered by others gains in importance. The reassuring words,

"We'll never forget you, gran", do not help much when death is near. Only experiences of reality will serve. Someone about to die knows whether and how the family has so far remembered others who have gone before, on

the day of their death, at the grave or in daily conversation. This, we hope, makes the dying individual feel sure that he, too, will be one of those remembered. The "month of the dead" was an old tradition; it came in

the Fall in some countries and in Winter in others. People believed or felt that the dead took part in the

life of those left behind during those weeks. Some would set a place at table for them, and care would be taken to avoid noise, lest they be frightened. Thrashing of grain and the big family wash day would have to wait until the dead had returned to their own world. In the Swedish calendar, 12 January was called the "day of the angels' departure" well into this century, the "angels" being the dead who had visited their old abode from 13 December.

It is advisable to put down in writing at an early stage who should have the few things with which one has a special inner connection such a piece of jewelry, the handsome vase that was a wedding present, the family Bible, etc. after one's death. Objects that are not really general goods and chattels but like a piece of oneself can become something of a bridge when those who are left behind and to whom they have been given pick them up. Knowledge of such provisions can give a feeling of security when words no longer have much effect.

The dying individual likes to think of being remembered in very real terms.

A key element in letting go of the body is the question: has life been fulfilled? We might say that every human being has the arc of his life span as part of himself, and some are sensitively aware of this. Younger people

in particular will often have a sense for whether they are going to grow old or die young. This deep-down knowledge may emerge clearly at special movements. The German poet, Ernst Arndt, was asked by a friend if he

had considered his age when he started on a major project at age 86. Arndt told him of a dream he had had

20 years earlier. Walking through a cemetery he had seen his grave stone. It did not give the date of death but clearly stated "at the age of 91." He therefore said he had another 5 years to go, and this proved to be true.

You would think that someone dying at the age of 91 would have satisfied his longing for life on earth to the full. That may be so. Quite a few people, however, will say as death approaches: "Surely that can't be it.

I had imagined life to be something else." Or: "I have not really lived my life." This does not mean they have not enjoyed life to the full. A life may have been hard and yet the individual may feel it was his very own.

People may have lived only for others and yet, or perhaps exactly because of this, feel their own life to have been truly fulfilled.

What about those who die young? Can a life be meaningful and fulfilled if it ends in childhood or youth? Looking back, one will often find that such individuals had a real hunger for experiences, as if they "knew" that they had not much time on this earth. Sometimes a strange melancholy clouds such children's experience of the world, or their remarkably active will matures. I remember a pupil of mine who died a violent death before reaching

the age of 14. She had a mature, serious facial expression through which a bright pleasure in life would also show again and again. After the long holidays she always made one big effort and quickly caught up in any subject where she was weak; this was done with a persistence one normally would expect to see only in an adult who is really working on herself. We might say that, in her case, biographic elements that normally come later in life appeared in childhood. She lived life in condensed form.

When life has been fulfilled and death is part of destiny, is there any justification in medical intervention - using all means at our disposal? Every human being has the right to live and to shape his own life. Does he not also have the right to die? This question often leads to demands that incurably sick or extremely old people should be given the freedom to choose active assistance with death, that is, an injection that will quickly and painlessly terminate life. People who think like this fail to consider how easily seriously ill or very old people's will to live is influenced by others around them. Many simply no longer want to live because they feel they are a burden to others. If justification should ever be found for the termination of unwanted life this would open the floodgates, undermining respect for life altogether. It will then be necessary for governments

to establish "objective" standards for the value of a life. We know this has happened before. It is a complete illusion to think people who are in such borderline situations can freely decide for life or death, quite apart from the question of whether we actually have the right to decide. It would be brutal to make someone who is discouraged, hopeless, isolated and despairing make the decision over life or death. It would be a mockery of freedom and self-determination, not respect. The lethal injection would deprive the person of the individual gesture of dying; death would not be his own but something imposed by the will of the family, physicians, or another.

A totally different question is whether life should be maintained at all costs. A physician is obliged to do everything in his power for his patients, including those terminally ill, and it is right to call him to account if he fails to meet his obligations for the patient is the weaker one in this case, is at his mercy, and has

to be protected. The question is, what does "everything" in his power mean? Knowing that he may be called to account, the physician must secure himself. Because of this, means are sometimes used which the physician

really no longer considers appropriate, not in the patient's interest, but to meet legal requirements.

This is not individual, and cannot be so, but takes account of general regulations in clinical medicine.

The doctor-patient relationship is, however, a personal one, or should be. As a patient, I claim the right to chose my own physician and the medical approach he uses. The more effective and real the relationship, the greater the individual and therefore human nature of healing - and of dying. The more sophisticated medical technology becomes, the more sensitive must we be to the individual character of disease and of dying.

Medicine clearly needs reform in this respect, and this calls for initiative not only from physicians but

also from patients.

Is it intervention in destiny to extend life with an organ transplant? Undoubtedly. This applies even to blood transfusions. It is also destiny to live in the 20th Century when such aid is available. When people such as Jehovah's Witnesses refuse a blood transfusion and prefer to face death instead, this is a personal decision

and physicians usually respect it. The problem is that the decision is made in advance, the person concerned (understandably) wanting to make sure his wishes are met even when he is no longer able to decide for himself. It is a decision one does not like to leave to others because it is so very important. Yet in the face of death the situation often looks very different and it may be that a completely different decision is made (not only from fear). If there is a possibility of being unable to decide at a later point, it is generally advisable

to ask someone one trusts - his physician or perhaps a member of the family - to take the responsibility.

It is far from easy to be involved in deciding on the life or death of someone close to you, but it is one

of the responsibilities one has to accept.

What is the situation regarding resuscitation? It is justifiable to fetch someone back across the threshold

of death? Isn't it that a decision has been made which the family has to accept, however hard this may be? Looking at the life people have had after resuscitation, one finds again and again that it held important elements which one would not like to see missing from the biography, and that these people really wanted to live, to work on themselves and on the world, something only made possible by the difficult intervention by the physician.

An extreme example is the following. I knew a child who had been in a coma for nine months after a road accident. The child had been clinically dead and resuscitated 10x. When I was told this before seeing the

child I thought: surely this child wanted to die and has been prevented from doing so. Yet the impression

I gained from observing the child at play was different. The child was still somewhat hesitant and, indeed, clumsy in its movements, but had a marked will to be creative in its play. It was actively making itself part

of the world. Seeing this, I have become very cautious in saying that even repeated clinical death is a definite statement on the part of the human I that it wants to leave the earthly world.

Another child was taken to hospital after an accident. The physician later said to the parents: "The injuries were severe but need not have been fatal. The child did not give us time, however." These words, spoken by

a sensitive individual, show that the child wanted to depart and did not want treatment. Considering the circumstances attending the accident, it is remarkable that the mother, who always took such great care, was

not on the spot at just that moment but was as if tied to her housework, which created the space for the accident to happen. Even during her pregnancy the mother had had a strong feeling that this child would need special care and attention. Talking to her, one felt she had had a premonition of the child's early death.

With children who have died, one often has the impression that they have taken the world in deeply and intensely. Looking back one gets the feeling that the purpose of this life had been to experience the world

with great intensity. Other children's fates cannot be understood at all unless one looks at their environment. They may have been quiet, perhaps attracting no particular attention, but achieved much with their short life and especially their death. They transformed the people among whom they lived. Close observation may show that these children remain close to their families, that they are waiting. If their families do not drown themselves in pain but let the pain be a gate opening up to deeper insight into the world, the dead children are happy,

for their waiting has not been in vain. Their life gains meaning after death.

Death may come early or late, suddenly or after long preparation, due to illness or accident, but it may be that "the time has come". Looking back on the last weeks or months of a life that ended unexpectedly you often recall words or acts that clearly announced the coming departure, though this was not understood at the time. One often finds that important affairs are put in order or a relationship put to rights. Often a word is said, quite casually, that will only later prove vital in understanding that individual's life. The interesting thing is that such words and acts will effortlessly come to mind after the individual's death and then appear highly significant. It seems incredible that no note was taken of them at the time, for seen in retrospect they are

so obvious.

Clearly, death does not always come when a life span has reached completion, and "the time has come."

An early Christian prayer carved over the gate to the city of Miletus addressed seven archangels, asking them

to protect the city and its inhabitants from an "untimely death" - not death as such for that is part of human existence, and even angels cannot change this. However, they may be able to avert a danger when life has not

yet run its course.

It is quite unthinkable that millions of people actually sought an early and violent death in concentration camps or from starvation. As 20th Century people we cannot reject our share of responsibility that easily.

Those terrible events show that human beings can powerfully intervene in destiny, both their own and that of others. Human beings depend on one another today across all borders. The individual is more and more becoming

a member of the human race, and this determines destiny in a way that goes beyond the intention brought with us at birth.

People who feel their life has run its course often feel that others are waiting for them beyond the threshold of death. They may speak frequently of long-dead friends. This is entirely natural in the old, for they often live more intensely in their memories than in the here and now. Their memories are an important affirmation of self for them when the capacities grow less. Relationships with the living may become fewer, and those to the dead grow more important and real.

Living one's memories may condense to a feeling that some of the dead are expecting one. There is a popular tradition that someone who has recently died draws someone who has been close after him. Married people often follow each other quickly. But the simpler and more obvious explanation for this is probably that the one left behind has lost a major purpose in life and may, indeed, long for death, and this loosens the bonds with life

on earth. This is not what we are speaking of, however. We are concerned with people who died long ago and come back to mind again as the individual approaches the threshold of death.

When the dead actually "appear in person" to the inner eye, how can we tell if these are memory pictures or

a present encounter? Memory pictures take us back into a familiar world, perhaps our childhood or youth.

Being thus familiar, they give security, self-affirmation and orientation in a world that may have grown alien. Old people are, above all, happy in their memories. Images reflecting a present encounter with the dead almost always come as a surprise. The dead do not look the way one last knew them but have changed, usually being younger and inwardly illumined. People who speak of such experiences are often unable to say what clothes the dead person wore, even if they have had him clearly before the inner eye for a long time. The question is, what made them recognize him? This is the wrong question to ask, for in a real encounter we do not recognize the dead by something (which is the case with memories), but we know inwardly who it is. Similarly, we may wake still hearing words we know for sure were spoken by someone dead, perhaps even knowing exactly who it was, though actual sound was not involved. This certainty is an unmistakable characteristic of present encounters with the dead. Any doubts as to the reality of the event vanish in the face of that certainty, just as there is no doubt as to the reality of the event when we perceive someone clearly with the senses.

In earlier centuries, death was still experienced within a wider context. In medieval times and the early part of our present age, believers knew they had come from the hand of God to enter into life on earth and would return to God on their death. The term "blessed" was used as an attribute in some languages to indicate that the individual continued to exist and was experiencing a happier existence, unless he had committed grievous sins. It is understandable that in recent centuries, when certainty of life after death had vanished, people wanted

to banish the image of death from their lives. This, however, increased the feeling of death's alien and, indeed, sinister nature. Death was made into a nothing, and so were the dead. They would, of course, be remembered and honored; the question is why, since they no longer existed? Probably because this enabled people to do justice to a deep, inner knowledge of the reality of the world after death without getting into conflict with materialistic ways of thinking.

Modern people are more aware again that birth and death are not absolute boundaries to existence. Wanting to understand their true nature, to express in thoughts what they know deep down in their hearts, they have to

take account in a new way of the reality of existence before birth and after death, not with theories or creeds, but from experience. Attention and understanding must be given not only to the dying individual but also to the dead. It is true, however, that the further away they go in dying and death, the more subtle and intimate their observation has to be if it is still to reach them. Fixed habits of thinking must not impose themselves on observation, and the observer must grow increasingly still. Active stillness is a faculty of the soul that allows access to the intimate experiences we have spoken of in this chapter.

If birth and death are no longer absolute boundaries to existence, the unborn and the dead become real to us. They are part of humanity just as much as the living are. The living shape the world and carry responsibility today. But those who are waiting to enter into life have their eye on them. Raphael showed this in his Sistine Madonna. The clouds behind Mary condense into heads, into the unborn, whose eyes follow the one who has now found his mother. In the same way the eyes of the dead are on those who approach the gate of death.

To think in truly human terms we have to include all human beings, those who are visible and those not visible to the eye. ‡

ZEIT ONLINE

Gesellschaft

[Christian Schüle]

Dieser Artikel stammt aus der aktuellen Ausgabe der "Christ & Welt"

Der spätmoderne Mensch überlässt sein letztes Stündlein nicht länger Gott oder dem Schicksal. Er will das Sterben so gezielt gestalten wie seinen Lebenslauf. Analyse einer Selbstüberschätzung

2. Oktober 2013 17:12 Uhr

Täuschen nicht alle Zeichen der Zeit, so erlebt der zeitgenössische Individualist ein verstörendes Paradoxon: Auf dem Höhepunkt seiner Selbstermächtigung kehrt ausgerechnet der Tod ins Leben zurück. Seit gut einem Jahrzehnt hat ein bemerkenswerter Kulturwandel die Republik erfasst, nicht flächendeckend, aber zunehmend breiter, nicht stürmisch, aber fließend, nicht radikal, aber anschwellend: Im Fahrwasser des ökonomischen Sogs durch Funktionstüchtigkeit, Fitness und Flexibilität gewinnen denkwürdigerweise die letzten Dinge an Bedeutung - Funktionsuntüchtigkeit, Verfall, Vergänglichkeit.

Ein neuer Geist bildet ungewöhnliche Vorstellungen, Bilder und Begriffe von Sterben und Leben aus. Er formatiert die Matrix eines veränderten Todesbegriffs und formuliert bisher ungewohnte Aussagen über Leid, Schmerz, Trauer und Erinnerung. Das paternalistische Denken im Umgang mit Tod und Trauer schwindet, weltanschauliche Ideologien verebben, religiöse Dogmen erodieren. Der Zeitgenosse will Trost im Diesseits, weil ihn ein Jenseits nicht mehr überzeugt.

Im Zenit einer Epoche der Maximalisierung und Optimierung weicht die legendäre Todesverdrängung zunehmend einer Sensibilität für das gute Sterben.

Am gewandelten Umgang mit dem Skandal der Sterblichkeit lässt sich ein verändertes Selbstverständnis der Zeitgenossen ablesen. Das Bild des Menschen ist

im Begriff, sich zu verändern, denn der Mensch von heute nimmt seinen Tod selbst in die Hand.

Fast alles, was wir heute zu tun pflegen, zielt auf Sichtbarkeit. Fast alles, was wir tun, zielt auf Aufbruch. Die allseits konvertible Währung für die Performance des sichtbaren Aufbruchs ist der immerwährende Anfang. Wir leben heute, könnte man sagen, jederzeit im Anfang. Der unausgesetzte Anfang ist der andauernde Aufbruch. Das stets aufbrechende Individuum kommt nie an ein Ziel, nie an die Grenze. Sein aktueller Standpunkt ist immer schon bereits das nächste Ufer.

Ein Ende ist nicht vorhergesehen. Ruhe wäre Stillstand, und nichts verachtet der unternehmerische Geist einer totalen Ökonomie mehr als Stillstand. Wenn von der Ökonomisierung des Menschen und Lebens die Rede ist, ist implizit die Rede von Einsatz und Rückgabe. Der Einzelne investiert sich selbst, um sich selbst aufs Neue wieder einsetzen zu können. Das heißt in volkswirtschaftlicher Logik gesprochen: Jeder Mensch ist seine Aktie. Als Teil des Ganzen besitzt er einen gewissen Wert, dieser Wert wird bestimmt durch sein Können. Der Mensch verhandelt also sein Können.

Die Leistungsethik der zeitgenössischen Ökonomie zielt auf das Ethos des Könnens ab, das ein Können-wollen bereits voraussetzt. Moralischem Sollen unterliegen anerkennungspflichtige Regeln, individuellem Wollen sind subjektive Grenzen gesetzt; Können hingegen ist per definitionem unbegrenzt.

Können scheint unendlich steigerbar zu sein. Können hat nur ein Ziel: noch mehr Können. Die Steigerung um ihrer selbst willen. Das Kapital des kapitalistischen Subjekts besteht in der Potenzialität seines Könnens, wobei dem Können immer schon das Sollen und Wollen vorausgesetzt ist. Was genau Können ist und sein soll, bleibt unbestimmt, und woher der Mensch sein Können bezieht, ist seine Sache - beziehen aber muss er es. Bezieht er es nicht, trägt er selbst daran die Schuld. Können hat prinzipiell keinen Anfang und kein Ende. Können ist die grenzenlose Möglichkeitsform. Die Ökonomisierung des Menschlichen bemisst den Menschen am Wert seines Könnens, nicht am Wert seiner Persönlichkeit, und sie bemisst den Wert eines Individuums insofern am Wert seines Körpers, als der Körper (worin mitbegriffen auch die Psyche steckt) materialer Garant für das Können ist.

Der permanente Sog des Ökonomischen als bestimmende Macht bedeutet, dass alles und jedes auf seinen Ge- und Verbrauch hin betrachtet wird. Der Mensch wird insofern ökonomisiert, als nicht Würde und Wert seiner Persönlichkeit höchste Priorität genießen, sondern seine ver- und gebrauchbare Leistungsfähigkeit. Vielleicht glauben wir an Gott, vielleicht nicht, vielleicht ein wenig. Fast sicher aber glauben wir - als Rendite fürs pure Dasein in der Gegenwart - an die unbedingte Zukunft. Wir sind der Gläubiger unserer selbst und stellen unserem Leben gewissermaßen einen ungedeckten Scheck aus: Vertrauen auf Zeit - verbunden mit dem Zins, der in der Zeit wächst: brauchbares Leben.

Brauchbares Leben ist Leben, das sich einsetzen lässt, um weiteres Leben zu bekommen - eine Form biologischer Rendite. Die Gesellschaftsform einer Ökonomie, die auf der permanenten Bereitstellung von brauchbarem Leben beruht, hat nichts anderes im Sinn als die Addition und Akkumulation brauchbaren Lebens. Alle Energie des Lebens richtet sich nach vorn, um für den ständigen Aufbruch verbraucht zu werden. Das ist das Ideal.

Den permanenten Aufbruch und das undefinierte Können zum Maßstab des Menschen gemacht zu haben ist eine der tragenden Normen des gegenwärtigen Lebensgesamtverwaltungssystems westlicher Marktgesellschaften. Dieses Leistungsethos etabliert ein Menschenbild, das allerdings den Menschen bei der Hälfte zurücklässt, denn Sterben und Tod sind darin nicht vorgesehen.

Um dem Ideal Folge leisten zu können, muss das Anti-Ideal ignoriert oder bekämpft, muss es mit aller Kraft verdrängt und verleugnet werden. Dieses Anti-Ideal zu jeder Steigerung, zu jeder Optimierung, zur exzessiven Selbstermächtigung ist der Tod. Alle Kategorien der zeitgenössischen Lebenswelt - die Imperative der Ökonomisierung

des Humanen - funktionieren nur bei gleichzeitiger Ausblendung und Verdrängung ihres Gegenteils.

Der Mensch wird berechnend, weil er selbst permanent berechnet wird

Für die Verdrängbarkeit von Sterben und Tod wurde die Idee der Optimierung perfektioniert. Optimierung ist zur sozialen Norm avanciert, der man kaum noch entkommen kann, selbst wenn man es wollte. Norm versteht sich in diesem Fall nicht als gesetzliches oder göttliches Ge- oder Verbot, sondern bündelt die herrschenden, womöglich

kaum als solche bewusst wahrgenommenen Alltagspraktiken und thematisiert die Art und Weise, wie das Individuum in seinen Lebenszusammenhängen angesprochen wird. Möglichkeit paart sich mit Nützlichkeit zu einem sozioökonomischen Regime des optimierten, perfektionierten, bestmöglichen aller Menschen; die Ökonomie der Optimierung setzt die Verdinglichung des Menschen voraus.

Medizintechniker sind die Türsteher, Hirnforscher die Gutachter, Ökonomen die Betreiber der Logik jener Verdinglichung, deren Währung in ungeschriebenen Existenzberechtigungsscheinen zu bestehen scheint: Wert hat, wer zu leisten, Mehrwert, wer mehr zu leisten imstande ist. Diesem Denken zufolge hat der Einzelne ein funktionstüchtiges, leistungsstarkes und an seinem Lohn orientiertes Individuum zu sein, das - manchmal vor seiner Zeugung, fast immer kurz nach seiner Geburt - auf

den Weg in die lebenslange Optimierung geschickt wird, dass es stets jung, schön, fit und widerstandsfrei sich durch keinerlei moralische Skrupel an der fragwürdigen Verknüpfung von Selbstwert und Funktionstüchtigkeit ablenken lasse.

Der Mensch wird berechnend, weil er selbst permanent berechnet wird. Alles, was er tut, steht unter Berechnungsvorbehalt, die postwendend die Rechnung präsentiert: Gewinn und Verlust. Das Leben ist nicht mehr einfach Leben an sich, es ist der Vollzug einer permanenten Gewinn-und-Verlust-Kalkulation. Gewinn ist daher immer auch Gewinn an Zeit. Mehr Zeit heißt mehr Erlebnis. Oder anders: Mehr Zeit heißt mehr Können. Mehr Können verspricht mehr Belohnung. Mehr Belohnung materialisiert sich in mehr Lohn.

Weil "Zeit" aber eine künstliche Einheit zur Kontrolle und Berechenbarkeit des Unkontrollierbaren und Unberechenbaren ist, hat sich der planende Mensch schon immer an ihr vergriffen, weil er das Ende seiner Zeit nicht kennt.

Was einst den vormodernen Menschen durch Religion und Mythos überindividuell umflorte - die göttlichen Bedingungen für Anfang, Glück und Ende des Lebens -, hat das selbstbestimmte Individuum der Moderne in sich hineinverlegt. Über die vergangenen Jahrhunderte hinweg wurde der Einzelne aus allen externen Traditionszusammenhängen herausgelöst (oder hat es aktiv selbst getan) und steht nun nackt vor sich selbst.

Die Würde des Menschen - so darf man den Nukleus der Selbstbestimmung lesen - gründet in der absoluten Verpflichtung, nichts höher zu bewerten als das Individuum.

Das ist eine historische Errungenschaft der Freiheit und gleichzeitig eine historische Niederlage des Schicksals. In mythologischen Kulturen wurde dem Schicksal der höchste Wert zugesprochen, im Gegensatz zu früheren Epochen kennt man heute das Schicksal nicht mehr.

Der Geist unserer Zeit kennt nur noch Glück und Unglück. Und beides, insinuiert der zeitgenössische Pragmatismus, sei korrigier-, also plan-, beziehungsweise verhinderbar. Das heißt im Umkehrschluss:

In erster Linie ist die Abschaffung des Schicksals ein fulminantes Misstrauensvotum gegen die Transzendenz. Durch das Leben im permanenten Exzess des Positiven und dem dogmatischen Glauben an die Korrigierbarkeit des Schicksals hat der Mensch das Bewusstsein für die Negation verlernt. Er hat verlernt, dass zum vollständig belichteten Menschenbild beide Seiten gehören. Er hat verlernt zu sterben.

Die so gekennzeichnete späte Moderne unterscheidet sich von allen anderen Epochen vor ihr darin, dass in ihr das Sterben nicht vorgesehen ist. Sterben und Tod negieren Zeit und Gewinn. Sie sind der reine Verlust. Sie sind das Nichtmehrkönnen par excellence. Sterben und Tod lassen sich nicht ge- und verbrauchen. Sterben und Tod sind das Negativ von Leistungsethos, Zeitverdichtung und Schicksalskorrektur.

Sterben und Tod sind die totale Negation der totalen Positiva einer totalen Gegenwart, deren Ziel totale Zukunft als neue totale Gegenwart ist. Da die Ökonomie allein Produktion, Herstellung, Schaffung und Schöpfung dessen im Sinn hat, was sich ge- und verbrauchen lässt, stellen Sterben und Tod in ihrer unproduktiven, unschöpferischen, unbrauchbaren Negativität das Ende jeder Ökonomie dar.

Sterben und Tod stellen nichts weiter her als die Abschaffung des Menschen als Konsument.

Drehte man die wirtschaftsmathematischen Vorzeichen um, müsste es heißen: Das Leben als andauerndes Sterben definiert sich über den Ge- und Verbrauch seiner selbst nicht mit dem Vektor Wachstum, sondern mit dem Vektor Schrumpfung. Im Sterben endet die Leistung, die das Subjekt als Objekt der Gesellschaft anzubieten hat. Tod lohnt sich nicht, und er belohnt nicht. Der Tod ist der totale Verlust. Der Tod ist der definitive Stillstand. Er ist der Exzess des Nichts.

Der Tod beendet alles Können-wollen, alles Streben, alles Aus-sich-Hinausdrängen. Er markiert das Ende jeder Freiheit. Er ist das Antileben, die Antischöpfung.

Er gibt nicht, er nimmt. Er zerstört. Er ist die fundamentalste Fremdbestimmung.

Seit etwa einem Jahrzehnt geschieht hierzulande etwas ganz und gar Unerhörtes: Das Regime der Selbstherrschaftlichkeit überträgt seine Instrumente auf die Instanz der fundamentalsten Fremdbestimmung: Der Imperativ der Selbstverfügung betrifft nun auch Sterben, Tod und Trauer. Als kulturelle Norm kehrt der Tod insofern in die optimierte Lebenswelt zurück, als er als Teil des Lebens anerkannt wird. Sterben und Tod sind heute keine objektiven Tatbestände mehr, sondern subjektiv gestaltbare Prozesse. Der spätmoderne Mensch der Gegenwart überlässt den Tod nicht länger den Kirchen, den Priestern und also Gott. Er überlässt ihn weder dem Schicksal noch

der Natur als solcher.

Im Rausch der Ich-Erhebung erobert sich der heroisch um sich selbst kreisende Individualist seinen eigenen Tod zurück. Er verfügt über die Weise seines Sterbens, er legt

die Modalitäten seines Todes fest, er wählt den legalen assistierten Suizid. Er bestimmt die ihm entsprechende Form seiner Bestattung,

er organisiert die Art der Trauer nach seinem Tod, er verfügt über die Art des Ihm-Gedenkens. Durch große Fortschritte in der palliativen Schmerzlinderung, durch gute Betreuung in Hospizen und durch Anerkennung individueller Willensäußerungen mittels der schriftlichen Patientenverfügung ist der Zeitgenosse mittlerweile in die Lage versetzt, die letzten Dinge ohne Angst vor Schmerz und Leid auf eigene Faust zu bestimmen. Selbstbestimmung und Selbstverfügung sind zum Teil der "guten Sitten" geworden, die das Grundgesetz in Artikel 2 garantiert. Das heißt: Das konventionelle (also nicht juristische) Recht auf einen gelingenden, selbstbestimmten, aktiv gestalteten Tod ist sittenkonform.

Ist es nun nicht an der Zeit, das antike Prinzip des Memento mori in eine gegenwartskluge Übersetzung zu bringen? Der Respekt vor einem selbstbestimmten,

in Freiheit geführten Leben entspricht mehr denn je dem Recht, sterben gelassen werden zu dürfen. Und so geschieht es, denn zunehmend mehr Ärzte, Pfleger

und Angehörige sehen es als Ausweis konfessionsloser Humanität und humanistischer Verpflichtung an, einen irreversibel Sterbenden auch sterben zu lassen.

Das Sterben-lassen-können ist eine humanistische Tugend. Jeder Individualist sollte die Gewissheit haben, im Falle seines Sterbens nach seinen Vorstellungen

in den Tod gehen zu können. Menschenwürde als Sterbenswürde verpflichtet den Einzelnen zur Achtung der Würde des anderen in Sterben und Tod. Mit dem Menschenrecht auf Sterbenswürde gelingt der Tod auf optimale Weise.

Vorwort/Suchen Zeichen/Abkürzungen Impressum