‘O dia em que Eva decidiu morrer’ by Adriano Silva

In the middle of a health crisis, the 74-year-old Brazilian philosopher ‘Eva’ asked for help to call her son ‘Guido’ over the phone (the names are fictional but the people, real). Eva was speaking in disjointed sentences that Guido knew were uncharacteristic of his mom. Living in a different city with his spouse and children, Guido suspected Eva was having a stroke and booked the first available flight. Before Guido arrived, Eva refused help from the paramedics a friend had summoned. It would take one week for Eva to see a neurologist, who confirmed the stroke: a distal Cerebrovascular Accident. Two years earlier, Eva had been diagnosed with arrhythmia and prescribed an anticoagulant, but she soon stopped taking it, determined to avoid the chronic use of any medication. Up until the stroke, Eva was fiercely independent and protective of her privacy – to the point that she would not receive friends or lovers at home. She was also sceptical of technology, opting for physical over digital media and communicating with her students through phone conversations instead of video calls. Eva had constructed her life around minimizing material needs in order to create space and time for intentional engagement with the people and questions she deeply cared about. Yet, she did not have private healthcare, nor any strategy to manage her aging. Eva survived the stroke with her lucidity intact, but was left with: an aphasia that made her unable to work, read books, or watch films; anosmia and ageusia that turned eating into a flavourless ordeal; a risk of convulsion and more strokes if she slacked on a cocktail of prescription drugs that caused debilitating side effects; and a dependency on others to do routine things, from handling money to properly using silverware or brushing her teeth. The autonomous philosopher had suddenly and utterly lost her identity. Even though Guido did his best to help Eva reorganize her life according to her new needs and wait to see how much her brain could recover, she decided to die. Eva remembered the suffering of her own father Leone: after a stroke when he was 80, he withered for two years in what the family describes as ‘intense physical and psychological torture’ (translated from the Portuguese, as all other quotes). Eva was resolved not to end like that.

The story of how Eva decided to die – the first half of her tale – constitutes the opening of Adriano Silva’s nonfictional book O dia em que Eva decidiu morrer (The day Eva decided to die). The second half of Eva’s story details how she went about dying on her own terms: she contacted a Swiss nonprofit (unnamed in the book) that was willing to help, went through the qualifying steps, and prepared to travel to Switzerland while downsizing her life in Brazil. She found a meaningful destination for the books she treasured, said goodbye to close friends, and planned how she wanted the news of her passing to be communicated. At some point, Guido asked Eva’s permission to record her story, ‘for there were many suffering under the silence of that enormous taboo’. Eva responded it was up to him – and Guido’s account forms the basis of Silva’s book. Eva died in an apartment managed by that nonprofit in Switzerland, after activating a valve that welcomed a pentobarbital solution into her veins. Present were Guido and two nurses, who video-recorded Eva’s autonomous and conscious answers to the questions mandated by the Swiss Voluntary-Assisted-Death protocol. Between the two halves of Eva’s story, Silva summarizes eight other assisted-death cases that influenced legislative changes in different countries, including those of: Brian Ameche, who inspired Amy Bloom’s memoir In Love; and Lisette Nigot, who dialogued for years with Philip Nitschke, the creator of ‘Sarco’ (see related Assisted Lab entries). Grounded in these stories, the last third of Silva’s book breaks down arguments for and against assisted dying and evaluates the legal efforts for the right-to-die in Brazil. Thus, Silva’s journalistic commitment to report on Eva’s assisted death as objectively and thoroughly as possible also informs his activism. Whilst objectivity may be an elusive ideal, Silva’s journalistic writing – detail-oriented, fact-checked, and narrated in third-person – fosters trust; and Silva banks on this trust to promote an agenda that links the right-to-die with self-determination. While a critic from GZH recognizes that ‘the book is not impartial’, Silva’s work has been widely praised for its informational qualities: the Eu Já Estive Em blog highlights the abundance of data that makes it a reference for people interested in the subject, regardless of their opinions; and the Folha de S.Paulo underscores the importance of Silva’s detailed research to ‘present real and profound people, with qualities and defects’, that ‘well suits a work broaching a taboo’.

Adriano Silva’s efforts to harness the power of stories to change the law go beyond his book. He has founded BoaMorte (GoodDeath) and co-founded Eu Decido (I Decide), two interest groups dedicated to promoting debate and advancing legislation on the right-to-die (another co-founder of Eu Decido is the journalist Vitor Hugo Brandalise, author of O último abraço, also reviewed by Assisted Lab). Silva sees interviews as opportunities to educate the public on terminology, distinguishing ‘suicide’ as an impulsive ‘act of violence against oneself’ from ‘voluntary assisted death’, which he defines as a rational and ‘legitimate desire to end suffering … accomplished in a safe manner, under medical supervision, in a serene environment’. Eu Decido, where Silva serves as vice-president, has published a manual to help Brazilians create a living will with advance directives for medical decisions. Although Brazil’s Federal Council of Medicine has recognized the right of patients to refuse treatment (a.k.a. orthothanasia) since 2006, the Ministry of Health blocked that resolution (no. 1.805) until 2010 and only in 2024 started implementing a National Policy of Palliative Care. However, Silva points out that resolutions are not laws, and a bill that would enshrine the right to orthothanasia has been stuck in Congress since 2009. Silva scrutinizes these legal ambiguities and states that ‘what is certain is that Brazilians die badly’, citing a 2015 survey by The Economist that placed Brazil in 42nd place in terms of ‘Quality of Death’. That explains why Eva resorted to Switzerland – as well as Antonio Cicero, whom Silva mentions as ‘the most famous case of self-affirmation of the right-to-die involving a Brazilian.’ Silva often emphasizes the importance of Cicero’s goodbye letter to bring the issue of death with dignity to everyone’s attention in Brazil, a country he deems to be thanatophobic. Silva adds that, from Cicero, we only had the letter – and hence the motivation to tell Eva’s full story.