Rational Suicide?

Professor of Philosophy at Latrobe University, Jana Thompson, says,

“People sometimes have good reasons for wanting to end their lives: they may be suffering from a terminal illness; they may be experiencing unbearable pain; or they may have decided their life has gone on long enough.”

She argues, “A well-constructed legal framework could ensure Australians who make a rational decision to end their life can get the assistance they need to do so.”

Public discussion about ‘assisted suicide’ or as some prefer, ‘physician assisted death’ raises significant issues for those committed to suicide prevention.

(1) Suicide prevention is founded on the premise that life is always preferable to death

Medical sociologist, Sheralyn Rose lost her husband to suicide after thirty five years of marriage. In her book Suicide Tsunami she provides a very personal account of her journey through this loss. She concludes,

“Suicide sparks polarised opinions. Some people believe that it is exercising an individual right, the right to choose when and how to die. I falter with this concept. To me, it makes the assumption that we are disconnected from one another.”

She says, “The process that leads someone to suicide most likely also makes it difficult for him or her to appreciate the consequences of that action.”

The question that deserves our serious attention is this. “What is our ultimate responsibility to others?”

Author, Jennifer Michael Hecht reminds us, “The whole of humanity suffers when someone opts out.”

 (2) Suicide prevention invites intervention.

It is widely understood suicide is a major cause of premature and preventable death.

Dr. Angela Ho, psychiatry resident at the University of Toronto says, “Society’s ‘overarching desire’ is to prevent death by suicide.’

Research shows that the vast majority of people who die by suicide were struggling with some form of mental disorder at the time. But how should we respond to a person who wants to end their life but their thought process isn’t necessarily disordered because of depression or psychosis?

Clinical psychologist Dr. Martin Heisel concludes,

“We should not say that, if somebody says, ‘I want to hasten death,’ and they don’t suffer from a diagnosable mental disorder, we have no right to intervene.”

(3) Suicide prevention recognises the value of identifying risk factors

It is a wrongly held view that constant and unbearable pain is the primary motivation of patients seeking assistance to end their life.

Ezkekiel J. Emanuel in his article ‘Four myths about doctor-assisted suicide’ found that patients’ primary focus was on escaping the psychological distress: the main drivers being depression, hopelessness and fear of loss of autonomy and control.

The 2014 Death With Dignity Act annual report from Oregon, where this law has been in place for a few years, reached the same conclusion. It found that pain is low on the list of reasons why patients sought to have their lives ended artificially. In fact, pain is not even one of the top reasons: Loss of autonomy; loss of dignity; a decreasing ability to participate in activities that made life enjoyable and an inability to control bodily functions were far more important reasons in the minds of those wanting to end their lives early.

In an article on doctor-prescribed death, Bethany Walker makes the point, “There’s nothing dignified about the despair that someone experiences if they think taking their life is their only option. A person should never feel that he/she will lose his/her value or dignity because of disease, illness or dependency.”

An awareness of the risk factors that may lead a person to consider ending their life empowers us to be supportive, to offer help in addressing some of these issues, and to provide practical ongoing care.

(4) Suicide prevention understands the importance of restricting access to means

We are all aware of the transitory nature of life. Death is the one thing in life that is inevitable.

Dr. Matthew Miller, the associate director of the Harvard Injury Control Research Center at the Harvard School of Public Health says,

“There are two ways to reduce suicide: You can make it harder for them to die in an attempt, or you can heal underlying distress.”

A number of studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline. This has been demonstrated in a number of areas: reduction in firearms, bridge barriers, detoxification of domestic gas, pesticides, medication packaging, and others.

Those on favour of the ‘right to die’ argue for physician-assisted death. This generally refers to a practice in which the physician provides a patient with a lethal dose of medication, upon the patient’s request, which the patient intends to use to end his or her own life.

The contrary approach to physician-assisted death undermines efforts to reduce access to means. It creates a dialogue that is inherently confusing.

(5) Suicide prevention appreciates that the message of promoting life needs to be clear and unambiguous

Peter Saul from the University of Newcastle argues that suicide may be rational (that is, it may have clear and understandable reasons) but should we accept it? Surely attempting to prevent suicide is a greater good than making it safer and more accessible.

Science journalist, Robyn Marantz Henig highlights the far-reaching impact of rational suicide. She says,

“But how do you distinguish “rational suicide” in the aged from suicide in a younger person that grows out of pain, mental illness, and despair? And who makes that distinction? “

Ben Sledge reflects on the “Death with Dignity” debate. He says, “We all know someone who has gone through horrific circumstances – pain, mental anguish, depression, or physical abuse.  Should we be telling them that if your situation is hard enough and painful enough, it’s okay to take your life?“

Sledge argues that we can repurpose pain and allow it reshape our lives in a positive way. He concludes,

“… we’re all terminal anyway. And when we lose hope, other people lose hope. But when we give hope, other people find that too.”