'Men must endure / Their going hence, even as their coming hither' – King Lear. Have we no more active rights over life, birth and death?

Stephanie O’Connor

Winner of the 2025 Hubert Butler Essay Prize

 "Men must endure / Their going hence, even as their coming hither." So speaks Edgar to his blind and broken father, Gloucester, in William Shakespeare's King Lear (Act V, Scene 2), reaching for some scrap of consolation amidst the wreckage of betrayal, madness, and loss. It is a fantastic line. It is a fatalistic line. This is not hope. His words carry the chill of stoic resignation, a frail attempt to impose meaning on the brute finality of death, a comfort as thin as the wind on the Cliffs of Moher. To accept that birth and death lie beyond our control.

I recently witnessed the death of someone I loved very deeply — a moment of quiet surrender, beyond my control, that left an unfathomable gulf in my life. I desperately wanted them to live, and yet, to be there, as they let go, quietly, peacefully, after years of the struggle with ill health, was a profound and beautiful privilege. In that stillness, death felt less like a rupture and more like a final act of grace.

And yet, even after witnessing what is called a "good death" — peaceful, dignified, and free from suffering — I find myself questioning whether Edgar's words still hold true. Can we really, in our modern world, still accept that we must simply endure our coming and going? In an age of reproductive technology and end-of-life planning, it would appear we have long since moved into an era where such a fatalistic acceptance of our helpless arrival and helpless departure is no longer passive, but shaped by choice, by law, and by technology. The question is: are we wiser for it?

I find I cannot consider the question of our active rights over life, birth and death without revisiting the harrowing case of P.P. v. Health Service Executive (2014), a case that personally gripped me, and I suspect many others, and would echo through Irish legal and ethical discourse for years to come, making me wonder: What if Edgar's lines are no longer merely literary, but legal? What if, in our era, death itself must await constitutional interpretation? And what if the body, in its going hence, becomes hostage to a cause it never chose?

In December of that year, a young Irish woman, only twenty-six years old—daughter, partner, and mother of two—suffered a catastrophic brain injury and was declared clinically dead. She was fourteen weeks pregnant at the time. Her heartbroken family, already reeling from the suddenness and irreversibility of her passing, was told that her body would be kept on life support—not for her sake, but to prolong the gestation of her unborn child.

For three weeks, the young woman's dead body remained tethered to the apparatus of somatic support, sustained artificially in a state of biological animation, while the medical team monitored the foetus in her abdomen—her heart mechanically pulsing, her organs perfused. Eventually, the High Court permitted what her distressed loved ones had requested from the outset: that the machines be stopped because the woman was dead, and that the treatment was "unreasonable", "experimental" and therefore unethical. There was, the court found, no realistic prospect that the unborn child would survive, and "in the best interest of the unborn child" authorised the withdrawal of ongoing somatic support. She could be allowed, at last, in that long-honoured phrase, to rest in peace.

It is worth pausing to consider how we arrived at a point where such a scenario was not only conceivable, but could unfold in reality, and be upheld in law. The answer, in large part, lies in the legacy of Ireland's constitutional recognition of the unborn's right to life. The now-repealed Eighth Amendment, inserted in 1983, was shaped not only by theological conviction but by the moral anxieties of a devout society. It created a legal equivalence between the lives of women and their unborn, and in doing so, an uncanny ambiguity, where the dead might remain legally ambiguous: both persons and legally bound vessels burdened by gestational obligations. In practice, creating situations such as P.P. v HSE, where legal obligations forced doctors to override death itself in the interest of potential life. Its repeal, in 2018, returned legislative authority to the Oireachtas, allowing for a new ethical framework shaped by legislation and public debate. However, while progress has been made, the fundamental legal and ethical dilemmas at the heart of P.P. v. HSE remain unsettled, leaving open the possibility that such tragic circumstances could arise again.

In a searing editorial at the time, the woman was referred to as a "cadaveric incubator." The term is terrible, and its honesty is unmerciful. For what else, legally speaking, was she during those weeks? She was no longer a citizen. No longer a patient. No longer capable of consent. She had become, by a certain line of reasoning, a resource, one whose utility had not yet expired.

And yet: this young woman had been someone.  Someone who had made choices, who had loves and fears, and who might have left an advance directive had she ever imagined such a grim fate. Her family's grief was compounded not only by her loss but by the State's intrusion into what should have been a sacred and private time of reckoning with death. It brought into sharp focus ethical questions that, while deeply significant, are often approached with caution or even skirted in public discourse—What is life? Who owns death? Who decides its terms? And does the unborn's fragile spark of potential outweigh the dignity owed to the dead?

The High Court, to its credit, ruled with sobriety and deference to expert medical consensus that there was no reasonable prospect that the foetus would survive to viability. But it still took weeks of judicial intervention to affirm that a woman who was clinically dead should not be subjected to experimental prolongation.

I revisit the case here not to reopen wounds, and indeed, I thought long and hard, hesitant to write at all out of deference to those who lived its reality. But then I recalled something Hubert Butler once said of another historical silence, when atrocities in Yugoslavia went unmentioned because naming them would mean naming our own complicity: "..silence did not help me… It became increasingly difficult to be silent." And so, it is here. We must speak with clarity and compassion about where medicine, law, and human dignity intersect—and where they diverge. 

In this instance, we were forced to ask ourselves whether a dead woman could be called upon to continue a pregnancy she could no longer consent to, whether she could, as some bioethicists starkly put it, "be used". The question was no longer whether the unborn had rights; instead, it was whether the dead had any rights left? 

It is important to stress here that no argument was presented to diminish the moral status of the unborn. Rather, the arguments were made to try and assert the indivisible dignity and bodily integrity of the already lived life, and the rights of families to mourn without being conscripted into bioethical theatre. In cases such as this, when all evidence points to futility, continuing life support is no longer an act of care—it is an act of fear, driven by legal shadows, not moral light. And it seems, we are no longer mere witnesses to birth and death; we are, increasingly, their stewards.

Modern medicine has given us powers that previous generations could never have imagined — the ability to keep bodies functioning after the mind is gone, after death, to intervene in birth and delay death. But these powers have brought with them difficult questions: just because we can act, does it mean we should?

In cases such as P.P. v HSE, where a woman declared clinically dead was kept on somatic support for the sake of her unborn child who has no chance of survival, and against her family's wishes, we see how the boundaries between life, death, and duty blur and just how complicated these questions can become. When we ask if we have no more active rights over life, birth and death, but instead are forced to confront the clash between medical possibility, legal obligation, and human dignity. Is this not best answered by opposing principles, but by turning toward the moral terrain where those principles collide: a space requiring not only legal interpretation, but imagination, conscience, and care.

This is not a simple clash between religion and secularism, or between tradition and progress. Nor is this tragic paradox in any way confined to Ireland. This case is only one of a number of rare, tragic, high-profile, and contentious medico-legal cases, which have gone before courts around the world in recent years. Some are cases where pregnant women, have been clinically diagnosed as brain-dead but are kept "alive" artificially, to preserve the life of the unborn until such time that a caesarian section can be carried out. In such cases of maternal-foetal conflict, the pregnant woman's interests conflict with the interests of the foetus because clearly, to allow the mother's death would result in the unborn dying because its intensive care support would be withdrawn. Again, I stress that what I write here is in no way a debate about the moral status of the foetus, nor a contest between the right to life and the right to die. It is, instead, an attempt to consider how we act when the old moral frameworks no longer fit — and how we honour the living and the dead when the answers aren't written down.

For while P.P. v HSE may bear the peculiar imprimatur of our constitutional and religious legacy, the underlying conflict is something more intimate and harrowing—between technological capacity and moral restraint—the redefinition of the human identity in an age of technical possibility. And across Europe and beyond, similar cases have arisen to highlight the global resonance of these issues and underscore the universality of the dilemma: the collision between medical capability and moral uncertainty, between the language of law and the needs of grief. Instances where medical possibility outpaces ethical consensus, and where law, unsure of its footing, stumbles into the most private regions of life and death. 

In Texas, the high-profile case of Marlise Muñoz in 2013 echoed with chilling familiarity: a brain-dead woman, pregnant, was kept on life support against her family's wishes due to state laws protecting the unborn. In Germany, the debate continues over how to balance prenatal life with posthumous dignity in the absence of explicit legal directives. Even in secular France, the Vincent Lambert case in 2019, though not involving pregnancy, laid bare the painful entanglements of familial love, legal ambiguity, and medical endurance. These are not the accidents of jurisdiction, but the growing pains of a civilisation increasingly unsure how to interpret the sacred in the age of the mechanical. 

The principles of medical ethics—autonomy, beneficence, non-maleficence, and justice—known collectively as the Beauchamp and Childress framework, form the quiet architecture by which medicine seeks to balance power with compassion, and are not merely philosophical ornaments. They are the scaffolding by which we try to uphold the human spirit in a world increasingly seduced by the procedural and drawn to the utilitarian. Each principle carries distinct weight and, when in tension, reveals the intricacy of end-of-life decision-making:

Respect for autonomy, in the context of P.P. vs HSE, becomes paradoxical. It affirms the individual's right to have meaningful agency and moral authority over the most fundamental aspects of their existence—how they are born, how they live, and how they die. This includes making decisions about their own body and life, including the choice to refuse life-prolonging treatment or to seek medically assisted death. It means honouring a competent person's wish to die with dignity, even when that wish contradicts societal norms or professional instincts to preserve life using systems that neither knew us nor will mourn us. But the dead have no will—they once had one. Is it beyond our moral imagination to give it voice and let it be heard?

Interest Theory allows for the possibility of posthumous rights, including, for example, the right to have one's remains treated with dignity, the right to have one's wishes regarding burial or cremation respected, or the right to protect one's reputation from posthumous defamation. But in the age of technology, has society chosen to limit the principle of posthumous autonomy and posthumous moral and legal rights? The right to die a natural death is supported by the right to respect for autonomy. But many states, including Ireland, invalidate a woman's advance directive if she is pregnant because of the compelling legal right to life of the fetus. Often, irrespective of whether the woman's wishes are known or not, courts will use a best interests test or substituted judgment standard.

Some will argue, understandably, that beneficence—our duty to do good—extends most urgently to the vulnerable unborn. But beneficence, if severed from context, becomes blind and can even lead to tyranny. In trying to preserve a hypothetical life, we may violate an actual death. In doing so, we may dishonour both.

Regarding non-maleficence, a dead person experiences no physical harm from continued somatic support because they are dead. However, if we consider posthumous rights, it could be argued that somatic support of a decomposing dead body potentially violates the cultural norms of dignity and respect that society confers to dead human bodies. 

Regarding the principle of (social) justice, intensive somatic support is expensive and it is arguable that the State should not direct such limited resources, for an indefinite time to the care of one dead individual, even when balanced against the costs of caring for a baby for a prolonged time in a neonatal intensive unit care if gestation were not delayed to allow the fetus to mature further in utero.

When making decisions, particularly in situations involving maternal-fetal conflict, doctors must balance these ethical principles with professional practice guidelines and responsibilities under the law. But in navigating, we encounter the limits of law in matters that are deeply human.

The law may compel action, but there are moments when law, though meticulously reasoned, proves insufficient to capture the full scope of human experience or embody compassion. Yes, legality can codify duties, define rights, and offer structure to our moral instincts. Still, even the most carefully constructed legal frameworks cannot fully account for love, grief, or the emotional, ethical, moral and familial complexity of life-and-death decisions, let alone the unspoken complexities that shape human lives. In cases like P.P. v HSE, and many others, the boundaries of law meet the raw edge of human sorrow. What follows is not merely a legal question but an ethical reckoning with what it means to honour the dead, to protect the unborn, and to listen to the quiet dignity of those who mourn.

And where competing rights, such as the sanctity of life or the rights of the unborn, are applied as absolutes, is it possible that they can obscure more than they resolve, especially when they collide with the dignity owed to the dead? It raises the question — when we cling to principles too tightly, do we risk losing sight of the person?

As Hubert Butler observed, "Science has enormously extended the sphere of our responsibilities, while our consciences have remained the same size." In an age where the dead can be biologically sustained long after meaning has ebbed away, the question is not just what we can do, but what we should do — and why.

Is there a point at which the machinery of law must yield to the compassion of humanity, where rigid adherence gives way to moral judgment grounded not in statutes, but in empathy, respect, and care? It is in this space — between what the law allows and what decency demands — that our truest responsibilities begin.

Dignity is an elusive but crucial concept. It's not simply the absence of suffering, nor merely the preservation of respect for autonomy. Dignity might serve as a middle path — a humane principle in the absence of consensus, reminding us that medicine is not only a technical craft but also a humane one.

In the bleak world of King Lear, mortal lives are at the mercy of fate and indifferent, as Shakespeare's characters are cast from birth to death with little control, their will overwhelmed by storm, folly, despair and madness. Today, medical ethics, biotechnology, and law offer tools that challenge this fatalism.

Edgar's stoic call to "endure" in King Lear was a balm for despair, but in our modern context, endurance is no longer passive. It is curated, legislated, and medicalised. When endurance means tethering a dead woman to machines for weeks against her family's wishes, it is no longer stoicism—it becomes imposition.

In this, perhaps, Edgar's words still hold — not as a declaration of helplessness, but stripped of its fatalism, it becomes a call to humanity. A reminder of the deep humility required at the edges of human life. Yes, men must endure their going hence—but not in silence, not without dignity, and not without the right to be mourned as more than a vessel.

Whether we are choosing to end treatment, to intervene in birth, or to withhold the breath of a machine, we are not gods. Our agency is real, but it is bounded by mortality, by ethics, and by love. Yes, men must endure their going hence. But we, the living, must also ensure they may go in peace.

Stephanie O’Connor

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