Incurable Disease and Death with Dignity in 'Game of Thrones'

incurable disease

Jorah’s incurable disease in ‘Game of Thrones’ reignites the debate over physician-assisted dying.

Characters in HBO’s series Game of Thrones, based on the series by George R. R. Martin, are in a constant battle for survival. In fact, Game of Thrones fans should know and follow one basic rule: avoid liking any character, because there’s a pretty solid chance that character will die — probably within the series, possibly within the season, maybe within the episode you realized you liked them.

Viewers are used to bloodshed: in the scene of the Battle of Hardhome, Karsi tells her children she will see them soon while putting them on a boat to safety. Savvy fans would guess immediately that this is pretty much a guarantee that she, or they, or everyone involved, will not make it to the next episode.

Many characters in the show have been around season after season and appear crucial to the plot, but that doesn’t mean viewers should assume they have a future.

As Cersei would say, “When you play the game of thrones, you win or you die.”

Most characters in the show who have passed away didn’t choose their own deaths. Sure, characters like Ned Stark knew the risks, and Oberyn Martell chose to take on a gargantuan opponent, but neither stayed the course without hope of survival.

One hero of the series, Jorah Mormont, faces a different threat. While some are called to defend their homes, avenge their families or even just pursue the Iron Throne until they meet their fates, Jorah is sent on a mission of another sort.

To save himself.

incurable disease

‘Game of Thrones’ episode 55: ‘The Door’ / HBO

Jorah is the rare Game of Thrones character who demonstrates true loyalty. He is in love with Daenerys and stood by her side even as she took other men as lovers. How she feels about him is a mystery — the Mother of Dragons is not about to get sidetracked by a man — but she clearly shows an affection for him.

When it’s revealed that Jorah is infected with greyscale — an incurable disease that will spread slowly through his body until it reaches his mind, driving him mad — Daenerys sends him away with the task of curing himself. Thus a man who dedicated his life to another is forced to place his own well-being first.

Fast-forward and Jorah Morment is a patient of the Citadel, waiting to hear if his ailment might, in fact, have a cure.

What he learns is that even the most promising lead — the tale of Stannis’s daughter Shireen, who was saved from a greyscale infection — is hopeless. With that, the only apparent future for Jorah is a descent into madness.

incurable disease

‘Game of Thrones’ episode 45: ‘Kill the Boy’ / HBO

Acknowledging the oppressive reality of Jorah’s incurable disease, his physician offers him a second option: a sword.

While the gesture fits with the harsh world of Westeros, viewers may feel it resonate with some of the biggest moral questions of human existence. It’s one that has risen to capture the attention of the nation and demands a response from lawmakers and the medical community: When is it OK to choose to die? How should medical-assisted deaths happen? Who should be responsible for orchestrating them?

On November 1, 2014, Brittany Maynard ended her own life. Maynard had been diagnosed with brain cancer. Her illness was terminal. Her pain would only increase. She became the face of a movement for “death with dignity,” a term that manages to lend a positive spin to the idea of ending one’s own life.

At the time of her diagnosis, Maynard was told she had six months to live. The tumor in her brain was inoperable, and her condition would only deteriorate.

She moved to Portland, Oregon, one of the few states that allowed physician-assisted suicide, with the intent of ending her life. She held firm to the belief that she should have the right to choose when and how she died.

She also stressed that she was not choosing to die.

“Cancer is ending my life,” Marynard said in an interview with CBS. “I’m choosing to end it a little sooner and in a lot less pain and suffering.”

incurable disease

‘Game of Thrones’ episode 46: ‘Unbowed, Unbent, Unbroken’ / HBO

Maynard did not want to die, she said in that interview. Given a “magical cure,” she would have taken it.

But there was no such cure, and with that knowledge Maynard took the drugs her physician had prescribed. She had spoken of November 1 as the date, but would follow up, saying that she might very well be alive on November 2. It would be her choice. That was the point of the exercise, and she would not be bound by any deadline.

The storm of papers written by experts in medical ethics on this issue is overwhelming. According to the Washington University School of Medicine, the reason for the shift from the term “physician-assisted suicide” to “death with dignity” has something to do with the decision-making capacity of the person involved. People who are suicidal are thought to have impaired decision-making ability — they are opting to die because of their “despair.” That could mean they are suffering from depression, PTSD or any number of psychiatric illnesses.

To limit the possible reasons a person would commit suicide to mental illness is shortsighted, and to delineate all possible causes would be nearly impossible. The key distinction is the decision-making capacity. “Death with dignity” denotes a rational choice. A patient seeks to end their life because of an incurable disease, and the purpose of physician-aided dying — another term employed to remove the stigma of the word “suicide” — is to lessen their pain. Importantly, the person must be deemed mentally competent to make the decision, and in physician-aided dying, patients administer the life-ending drugs themselves.

While many agree with Maynard on the front of death with dignity, others feel physician-aided dying goes against the duties of the physician. One of the first acts of any young physician is swearing the Hippocratic oath. One translation of the early oath states: “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel.”

What could be more deleterious, or harmful, than aiding a patient in the choice to end their own life?

It’s important to note, however, that the oath has changed — the segment quoted above has been removed, which suggests changes in our sense of morality and has left room for debate over assisting with death. What is more important: prolonging life, or preventing suffering?

incurable disease

‘Game of Thrones’ episode 62: ‘Stormborn’ / HBO

Returning to Jorah, the answer to that question might be the experimental treatment Samwell Tarly offers Jorah as a final hope for survival. The surgery to potentially cure greyscale involves essentially skinning Jorah to remove the infected skin.

As the camera pans across Jorah’s body, viewers see the issue: that is a lot of skin.

While Sam clearly feels a conviction to help save Jorah, whatever it takes, advocates of death with dignity would ask: what if he were to die anyway? The last minutes or hours of Jorah’s life would be filled with unspeakable pain. The torturous procedure would be for nothing.

But if he were to live, what could be more worth it?

Jorah’s story takes audiences through the torment of facing an incurable disease, the desolation of a life that will end too soon and the impossibility of choosing whether to end one’s own life.

That is a lot of conflict, and the question of morality posed is still ignoring the comment from Archmaester Marwyn that would suggest Jorah gets a choice in the matter only because of his class. Adding that issue to the mix here would make for an impossible conflict.

Kent Sepkowitz, MD, of the Memorial Sloan-Kettering Cancer Center, weighed in on the scene, saying that it likely indicates big futures for Sam and Jorah.

If there’s even the slightest chance of living on, should that be reason to try any treatment, no matter the cost?

While within this fictional world, it will be easy to see how the story unfolds and decide whether the “right” decision was made, the choice had to be made without any knowledge of its outcome.

Archmaester Marwyn gave his option: a dignified death.

Sam gave his own: an unproven but potentially life-saving procedure.

The decision lay with Jorah, and that, perhaps, reveals something of the nature of Westeros. Death lurks in every corner, but a dignified death is something to be wished for. end




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