In his sharply observed book The Culture of Narcissism, the American social critic Christopher Lasch remarked that, in modern life, ‘The usual defences against the ravages of age – identification with ethical or artistic values beyond one’s immediate interests, intellectual curiosity, the consoling emotional warmth derived from happy relationships in the past – can do nothing for the narcissist’. In a generation that has forgotten that it stands in the midst of a long line of past and future generations, Lasch noted, many live ‘for the feeling, the momentary illusion, of personal wellbeing, health, and psychic security’.

As Lasch later lamented, his exploration of narcissism was widely misunderstood. In his writing, narcissism referred not to a confident self-centredness, but to the inability of an entire culture to see beyond the corners of itself, to understand the self’s place in history, or to believe in its ability rationally to control the future. Lasch claimed that the survival of the self – not self-improvement – had become the highest aspiration. There is more than a whiff of narcissistic survivalism in the openness of many Western societies to assisted suicide. This was best symbolised by the trip Gill Pharaoh, a healthy, 75-year-old retired nurse, took to the LifeCircle suicide clinic in Switzerland. Pharaoh, who died on 21 July this year, was not ill, but wished to die. She noted in her final blog that she wanted ‘people to remember me as I now am – as a bit worn around the edges but still recognisably me!’.

This ‘snapshot’ sentiment, whereby we preserve ourselves for posterity, is surely illusory. We can neither control how people remember us nor can we preserve a moment in time. There is no perfect moment or ideal physical presence, no ‘real me’, because life is a process, constantly unfolding. We continually learn and change, and the ‘authentic’ self cannot be captured at one specific time. Nor is a ‘perfect’ or merely ‘good’ death meaningful to the deceased. Killing oneself does not preserve anything – it destroys the prospect of further experiences and interactions. Pharaoh resolutely rejected religion; she once complained that she was ‘ignored by the law, which originates from a god in whom we have no belief’. But, in the absence of any broader meaning or belief system, it is almost as if assisted-suicide advocates like Pharaoh are recreating a religion of the self. This is a religion that sees the world as a mirror, that perceives the importance of people in terms of how they are perceived, and that feels no obligation to the previous generations that struggled to make life easier and leave a legacy for future generations. It is this mindset that leads people like Pharaoh to take their own lives. But why would she imagine that those in the future would welcome her decision to sacrifice her life – all because of a fear that it would get harder and less pleasurable?

Pharaoh had been a member of the Society for Old Age Rational Suicide (SOARS), a UK-based group that aims to change existing law to provide elderly, mentally competent individuals, who are suffering from various health problems, with a doctor’s assistance to die. Many of those who belong to these groups see themselves as rugged individuals who blaze their own paths. But this is also delusional. Rugged individualism would surely demand that you do the act yourself, rather than get government assistance to do it. Pharaoh was a nurse who surely knew how to ensure her own death without having to fly to Switzerland. But part of the plea for assisted suicide is always a plea for official validation of suffering. The narcissist feels a constant need to be noticed, to be recognised, to have his or her feelings validated and find some reflection of his or her self in the world. If the narcissist is fearful, then the world must do something about it. The narcissist sees a world that does not feel their existential pain (after all, physical pain does not even feature in the top-five reasons why people in Oregon opt for assisted suicide) as the cause of that suffering.

If this is not narcissism, then why are Pharaoh and other assisted-suicide advocates so vocal about their need, not just to slip away quietly, but to have their decision validated by the state? The drive behind the assisted-suicide lobby is the idea that the world must mould itself around the perceived needs of ‘afflicted’ individuals. None of this is meant as an attack on Pharaoh herself. (Although, as others have pointed out, her plea for people not to judge her decision might have been more convincing had she not courted so much publicity.) In truth, the impetus behind Pharaoh’s decision to take her own life is shared by more mainstream campaigners for assisted suicide.

Fear of the prospect of old age and disability provide the most powerful motivations behind the campaign to change the law on assisted suicide. And it doesn’t just stop at the very old and infirm. In the Netherlands – one of the early adopters of assisted suicide and euthanasia as medical procedure – a citizens’ initiative called Uit Vrije Wil (Out of Free Will) attracted more than 117,000 letters of support in 2010 for its proposal to extend assisted suicide to all persons over 70 who are simply ‘tired of life’. Even the ‘six months to live’ clause in UK MP Rob Marris’s 2015 private member’s bill on assisted dying evoked the fear of physical deterioration in a way that chimes with Pharaoh’s sentiments. After all, ‘six months to live’ is a completely arbitrary measure. We are all, in a sense, terminally ill and life is not more or less meaningful because of the amount of time left in it. As the pioneering author of On Death and Dying, Elisabeth Kübler-Ross, has noted, assisting someone in killing themselves, even if it avoids pain, nevertheless cheats them of experiences, of a part of life.