Review: Lionel Shriver’s alternate-reality novel Should We Stay or Should We Go highlights how government paternalism, NHS bureaucracy, runaway inflation and other statist disasters make end-of-life decisions worse

Here’s a review of Lionel Shriver’s Should We Stay Or Should We Go, which became a Prometheus Best Novel finalist:

By Michael Grossberg
Life, aging and death are difficult enough for most people to deal with, even when we strive to think and plan ahead and make the best choices we can about our senior years – including the possibilities of assisted living and even euthanasia.

Exploring those increasingly vital and common 21st-century issues in her kaleidoscopic 2021 novel Should We Stay or Should We Go, shrewd contrarian British novelist Lionel Shriver underscores how much worse the outcomes can be when oppressive laws, obtrusive welfare-state bureaucracy, socialized health care, forced medication, involuntary hospitalization, virtual imprisonment, anti-suicide laws, other bad government policies, abuses of power and even today’s dangerous trends of exploding federal debt and rising monetary inflation can damage lives further while undermining our ability to make our own decisions about end-of-life matters.

Cleverly structuring her timely novel using the science-fiction trope of alternate realities and different time lines, Shriver imagines 12 parallel universes, all starting in the 2020 present of COVID-19 and Brexit and extending into future years or decades in the United Kingdom and all revolving around an aging married couple of medical professionals messily facing these issues and much more.

Kay and Cyril Wilkinson are a long-married, pretty-normal, relatively happy and typically flawed British London couple, well-educated, cultured and prosperous enough, who make a pact in their early 60s to commit suicide together at 80. They want to avoid the indignities of later life, when they’ve lost most of the ability to enjoy the amenities of living and might be too far gone into senility or dementia to retain control of their lives and deaths.

In scenario after alternate scenario, Shriver shows that all too often, despite our best efforts, people can’t fully predict or control their own futures. Yet, Shriver also ultimately makes a nuanced case for giving people as much control as possible over their decisions, since even the best-intentioned bureaucratic and regulatory systems of government predictably and largely make things worse by undermining liberty.

Some of Shriver’s parallel universes evoke dystopian and authoritarian futures evoking the horrors of libertarian psychiatrist Thomas Szasz’s cautionary warnings about the Therapeutic State or the monstrosities of cruel and petty hospital tyrants dramatized in Ken Kesey’s classic One Flew Over the Cuckoo’s Nest.

Others are more optimistic about the possibilities of long life, workable cryogenics and a drug that unexpectedly cures aging. Yet, even these standard sf scenarios involve trade-offs and have multiple and unpredictable consequences, some not so good.

Shriver dramatizes even such seemingly utopian visions with her distinctive brand of droll realism, undergirded by her sober recognition of mortality, the messiness of life, the inevitability of accidents, life’s undeniable trade-offs, and how impossible it is for anyone to truly control their future.

Although written with the tone and tropes of a mainstream contemporary novel of conventional middle-class aspirations and domesticity, especially as Shriver sets up her story and establishes her structural ground rules in the shorter opening chapters, the alternate-reality, multiverse-style plot fully places this story within the realm of science fiction, albeit with a firmer grasp of everyday reality and current politics than many sf works tend to contain.

Each scenario is brought to brief but vivid and compelling life in the brisk and varied novel – a quick read at only 266 pages, divided into 13 chapters or pretty much one future timeline per chapter. Some chapters are grim, some more satirical or ironic, some hopeful but all are sharply sketched with sobering realism and tragicomic undercurrents.

Her central characters are comfortable and educated Londoners  whose attitudes and assumptions as medical professionals fully reflect today’s mainstream elite class of progressive academics and professionals. The Wilkinsons take the modern welfare state, with its paternalistic and controlling philosophy and corresponding bureaucracy, for granted as a normative ideal. In England, where the UK’s National Health Service seems as entrenched as Westminster Cathedral, Cyril seems almost reverent toward the institution, which which he’s worked virtually throughout his nearly-ending career.

That framework makes it all the more eye-opening, compelling and persuasive – perhaps even or especially to readers who share those beliefs – when Kay and Cyril discover to their surprise and dawning horror, in timeline after timeline, that the consequences of such welfare-state bureaucracy and the logic of the evolution of power can be, tragically or tragicomically, so brutal, sad and even deadly.

Like some modern progressives who naively assume that their politics retains some basic elements of classic or true liberalism, when in fact there are very real tensions between today’s ascendant progressivism and declining liberalism (of any variety), Kay and Cyril are flawed and very real human beings who don’t see their own contradictions or foresee the consequences until often too late.

In a natural and organic way, Shriver explicitly introduces the fundamental principle of self-ownership at the foundation of libertarianism and classic liberalism – and poignantly and ironically puts those words into the mouth of Cyril, who paradoxically more than Kay is a slave to the assumptions and apparent good intentions of the NHS.

Here is the telling argument (on page 144) among aging Cyril and Hayley, his controlling adult daughter, and his son Simon:
“Dad,” Hayley said. “Please. You’re eighty-one…. Wanting to put yourself in the way of a killer virus is just one more sign that you need protection from your own destructive impulses.”
“But never mind that our money belongs to us,” Cyril said, returning to first principles.
“Our lives belong to us, whether or not we’re your mum and dad, and it’s up to us how we choose to end them. We may decide, in our wisdom, to stick around until a hundred and ten. Equally, we’d be within our rights to jump off Blackfriars Bridge tomorrow.”
“That’s not how the law sees it,” Simon (their son) said, pained.
“”And that’s not how we see it,” Hayley said triumphantly.

Of course, libertarians are particularly sensitive to respecting every person’s basic dignity and moral autonomy by ardently standing up for their rights to life, liberty and the pursuit of happiness.

So it’s fascinating to see how Shriver – a 2017 Prometheus Best Novel finalist for The Mandibles: A Family, 2029-2047, her plausible dystopian-future saga of a beleaguered family migrating to escape the harmful consequences of an oppressive, collapsing welfare-state future – applies her blend of observant insight, mordant sense of humor, deep understanding of humanity and the economy, and appreciation for classical-liberal principles to these alternating futures.

The scenario that disturbed me the most, midway through the novel, is explored in two alternate variations that I found chilling and almost Orwellian, a la Orwell’s Prometheus-winning Nineteen Eighty-Fourbut also seem all too reminiscent of the corrupt and failing British welfare state depicted by that other prescient British novelist Anthony Burgess in his Prometheus-winning dystopia A Clockwork Orange.

These paired scenarios reminded me of the profound warnings of Szasz, the great libertarian critic of the abuses of power inherent in government laws imposing involuntary confinement, involuntary drug/electroshock treatment and other regulations of the emerging Therapeutic State – also a central reality of Ira Levin’s dystopian This Perfect Day, another Prometheus Hall of Fame inductee.

Shriver writes her story in apparent full awareness of that context and those literary antecedents, and especially how they relate to worrisome trends within the UK’s socialized National Health Service.

Once you become a victim of such insistent “good intentions,” it’s hard to escape.

Shriver’s novel is especially horrific and poignant in its portrait of the aging couple, forced by the British State and its anti-suicide laws into a senior-citizen facility where they are deprived of just about every comfort and choice available in life – with their personal property, clothing, books, Ipads, and smart phones and access to television channels taken from them, making their situation precarious and untenable.

Here’s an excerpt from pages 146-147:
(The old-age home orderly dumps their suitcases out and searches them roughly)
“What is this, airport security?” Cyril asked incredulously.
“Medication,” Lance announced, holding up (a laxative) bottle.
“That’s only over-the-counter sienna,” Cyril objected. “Surely I can be trusted to manage my own bowels.”
“We control all your medication,” Dr. Mimi (the facility’s Nurse-Ratched-like overseer) said.
“If you overdosed on that, think what a mess you’d make for our staff. Speaking of which, Cyrus (Note: Mimi gets his name wrong, again, adding insult to injury) —
“I think I’d prefer ‘Dr. Wilkinson,’ if you don’t mind.”
“Why, funnily enough, I do mind,” Dr. Mimi said, clapping her hands in delight. “All our stakeholders are on a first-name basis, and I’m sure you’ll be with us long enough to get used to the friendly atmosphere! But like I was saying, treasure: when was your last poo?”
“I can’t see why that’s any of your concern,” Cyril said coldly.
“I’ll put you down for an enema then,” Dr. Mimi said sweetly.

You can sense from Shriver’s wording that Dr. Mimi – clearly evoking Nurse Ratchet from One Flew Over the Cuckoo’s Nest, with a gleeful if poisonous spoonful of Dolores Umbridge from the Harry Potter books  – takes fiendish and malicious pleasure in being in control, and that she’s not just a petty tyrant, but monstrous. And when Cyril notices them confiscating all his books and magazines, here’s what happens once he’s put into his separate room in the rigidly controlled facility:

“I would like to request the return of my reading material, please,” Cyril said, and this sadistically jolly glorified lollipop lady couldn’t have appreciated the degree of self-control required to remain civil.
“We find militant political magazines and big, boring books about how terrible the world is, well,” Dr. Mimi said. “They’re a wee bit dark for a self-harmer. The material might also get into the hands of other stakeholders, who could find it upsetting.”
“So what are we supposed to read?” Kay asked with alarm, doubtless anxious about her copy of Margaret Atwood’s The Testaments, which was definitely “dark.”
“I’m sure you’ll find our community activities so exciting, princess, that you’ll be too knackered to read any old books.” (Dr. Mimi said.)

It gets worse from there, including compulsory attendance at meals, with anyone resisting told that “we reserve the right to force-feed. The council has placed your well-being in our hands, and we take our duty of care ever so seriously.” (Note: The “council” is an agency of the UK government, so this is virtually imprisonment – except that today’s actual criminals are treated vastly better in modern prisons.)

The Wilkinson’s plight, the abusive consequence of a paternalistic and increasingly authoritarian government-regulated system, becomes absolutely inhuman when Kay and Cyril, who still love each other, are ruthlessly separated once inside the senior facility. They are forced to live in separate rooms – no shared bed or sex allowed, which was the one thing that the husband most loved about his marriage, especially touching and hugging and just sleeping next to his wife, a point Shriver emphasizes early on more than once.

Other later scenarios also prove intriguing, and go farther into various science-fiction scenarios, some unexpected, with amusing or chilling twists.

Author Lionel Shriver (Creative Commons License)

Overall, Shriver’s novel is not only gripping in its clever structure and smart variations but also illuminating, especially to the growing millions of us who are aging and facing similar issues, from decline to loss of mobility.

Given how important such issues are and will be even more tomorrow, as the average age of the world population continues to rise and many more people continue to live into their 70s, 80s and 90s, Shriver’s novel works as both a cautionary tale and urgent wake-up call.

People may not always make the right or best decisions about their own lives, of course, but when their rights are stripped away, Shriver shows that far more often than not, the outcomes are far worse – and often inhuman.

Her latest novel reminds us that nothing is more important than human liberty and human dignity, even as we near the end of life and face the prospect of losing some of our ability to fully exercise our rights as rational, self-aware individuals.

* Prometheus winners: For a full list of winners – for the annual Best Novel and Best Classic Fiction (Hall of Fame) categories and occasional Special Awards – visit the enhanced Prometheus Awards page on the LFS website, which now includes convenient links to the full set of published appreciation-reviews of past winners.

* Read “The Libertarian History of Science Fiction,” an essay in the  international magazine Quillette that favorably highlights the Prometheus Awards, the Libertarian Futurist Society and the significant element of libertarian sf/fantasy in the evolution of the modern genre.

Join us! To help sustain the Prometheus Awards, join the Libertarian Futurist Society (LFS), a non-profit all-volunteer association of freedom-loving sf/fantasy fans.

Published by

Michael Grossberg

Michael Grossberg, who founded the LFS in 1982 to help sustain the Prometheus Awards, has been an arts critic, speaker and award-winning journalist for five decades. Michael has won Ohio SPJ awards for Best Critic in Ohio and Best Arts Reporting (seven times). He's written for Reason, Libertarian Review and Backstage weekly; helped lead the American Theatre Critics Association for two decades; and has contributed to six books, including critical essays for the annual Best Plays Theatre Yearbook and an afterword for J. Neil Schulman's novel The Rainbow Cadenza. Among books he recommends from a libertarian-futurist perspective: Matt Ridley's The Rational Optimist & How Innovation Works, David Boaz's The Libertarian Mind and Steven Pinker's Enlightenment Now: The Case for Reason, Science, Humanism and Progress.

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