Reflections on the TV show Severance and its application to advance directives

⚠️Editor Note / Spoiler Alert:
This article discusses themes related to memory manipulation, identity and euthanasia—including a real-life case involving dementia and end-of-life decisions, which some readers may find distressing. It also contains minor spoilers for Season 1 of Severance but no spoilers for Season 2. .

It’s a chilling scene: a woman wakes up on a boardroom table. All the doors are locked. A stranger asks her if she will answer some questions for him. She asks what will happen to her if she does. He says that depends on the nature of her answers. She very reluctantly agrees. He asks her name. She cannot remember. He keeps asking questions including the colour of her mother’s eyes. To her horror she cannot remember and screams “What have you done to me?”

What is Severance about?

This is the start of Severance season 1. Without giving too much away, it is about a company called Lumon which develops technology removing people’s memories of their private life when they come to work, and memories of their work life when they go home for the day. The result is, in effect, two different people with entirely different sets of memories and life experiences residing in the same body.

It raises some interesting questions

A lot of people are describing Severance as the greatest TV show of all time. I am not quite sure I would go that far (I at least find it a little slow moving, especially season 2) but it certainly raises some deeply interesting themes, including among other things questions of consent (the moment that the show depicts characters saying in front of a camera that they choose the memory-wiping procedure of their own free will and without coercion the audience is suspicious of issues in that regard) and human identity.

This article is specifically about the application of the ideas explored in Severance to advance directives, not about euthanasia per se

You may have whatever views you wish on that matter. What I wish to draw out is the powerful objection to advance directives re: euthanasia implicit to Severance. I have no idea whether this was within the author’s intention, but to me at least the application was clear.

If you want to watch the show with no spoilers at all, stop here. Otherwise, read on for my reflections. NB: This article contains zero spoilers for season 2.

More detail about the story

***MINOR SPOILERS*** Here it is necessary to provide a little detail about the story. Because of the way the mind-wiping technology works, each day an employee will arrive at work when the elevator opens and immediately lose their outside memories. The reverse is true when they exit via the elevator: they immediately lose their work memories. The effect is that a new person is created who (from their perspective) never leaves work.

Helly is in for a shock

The woman on the boardroom table, who is told her name is Helly, is informed that she is not permitted to communicate with her outside personality. After insisting strongly enough she is eventually able to request that her outside personality resign from the job, thus allowing Helly to escape the impression of being permanently at work. However, her outside personality (“outie”) coldly refuses her request, informs her that she is not a person and that Helly does not make the decisions, thus condemning her to a perpetual existence at work.

The situation is horrific

The horror of the situation is reinforced by the fact that the building has no windows and bare, white, ominous walls which is a recurring visual theme throughout the series. The “innies” have no idea what the names of their spouses or children are, or if they even have any. They are never to see the sky. The company tortures them when they get out of line, and they have no way to complain.

Experiences shape who we are

It transpires that Helly’s outie is a cruel person, while the suffering the innie experiences at work moulds her into a kind and empathetic person. The discrete personalities exist entirely independent of one another within the same body. In this way, the show explores the role that life experiences (and suffering) play in affecting our personalities and decisions, and also the unfairness of allowing the outie to call all the shots, given that the outie is not the one forced into a perpetual existence at work and does not make decisions based on that lived experience.

How is this applicable to advance directives?

And herein lies the application to advance directives. Some years ago in the Netherlands, a 74-year-old woman formally expressed the wish to be euthanised if she were to develop dementia. (This is known as an “advance directive.”) After she was diagnosed with advanced Alzheimer’s and admitted to a care facility, a physician proceeded with euthanasia in accordance with her directive. At the time of the procedure, the woman resisted, and the physician temporarily halted the process. Later, the sedative was added to her drink, and during the administration of the euthanasia, the woman moved, prompting family members to assist in restraining her. The Dutch Supreme Court later ruled that the doctor had acted lawfully, affirming that euthanasia was permissible under such circumstances when an advance directive had been given and legal conditions were met.

Consent is a grey area

A crucial issue that Severance raises is this: it is one thing to say that if you ever develop dementia you want to be euthanised without having been in the shoes of a person in that situation. It is quite another to make that decision having experienced dementia and finding that you’re happy with your life, or with the deeper understanding of the moment-by-moment terror of being put to death on the orders of your previous self that comes from personal experience, while you are attributed no agency.

Conclusion

I agree with this fundamental point of Severance: it is impossible to give informed consent in advance to euthanasia because of the key role that life experiences play in affecting our decisions and forming who we are. That is why I shall be voting against advance directives if the issue is ever put to the New Zealand public at referendum.