Balance Sheets of Suffering in End-of-Life Care

Abstract

Drawing on recent work in cognitive linguistics and social studies of knowledge practices, this chapter explores the various ways in which the figure of a balance sheet frames arguments and positions in end-of-life care. Across arguments and positions, there are substantial differences in the kinds of matter that are balanced against each other and the values attributed to them, and which items are allowed as entries on the balance sheet and which are not. A common currency on the balance sheets is human suffering. Comparing Norwegian and Dutch end-of-life care practices, the argument is elaborated by looking at (a) the personal balance sheets of cancer patients, (b) the balance sheets of euthanasia, assisted suicide, and palliative sedation, and (c) the balance sheets that set patient’s right to self-determination up against health professional’s right to conscience. Finally, the different ways in which the balance sheets are operated are considered with regard to their impact on the level of constraints that the different end-of-life care policies put on patients and health professionals, and how these shape the material conditions of our dying.