ON SUICIDE WHILE OF SOUND MIND
15th October 2003
This article is not about suicide while deranged; it is not about any form of euthanasia that requires the active or passive participation of any other person. Neither is it a matter of sacrificing heroically one's life for others or for a perceived good cause. It is about a calmly considered decision (by oneself and of oneself) well in advance of the act - perhaps even years in advance of the act - a decision that for many of us, in the course of ordinary unheroic life, might well be there for the taking.
The question being raised is "Can suicide while of sound mind ever be an accepted right or duty?" The answer suggested is "Yes, considering recent and probable future advances in life-support capabilities."
It is rational to proceed logically from explicit assumptions to valid conclusions. Those conclusions cannot be acceptable unless both the assumptions and the logic are acceptable.
ASSUMPTIONS
(In what follows the words 'life' and 'death' and 'survival' and 'bereavement' etc refer to humans).
1) each of us will die sooner or later and death usually gives rise to bereavement.
2) there is such a thing as a life not worth living.
3) bereavement is a sad experience.
CONCLUSIONS
1) suicide is a right - not a sin.
2) common humanity requires us, if we so choose, to exercise the right to suicide with sensitive regard to those who would suffer bereavement thereby. Such regard can perhaps even create circumstances in which the exercise of that right might tend to become a duty to be faced and done.
3) given that it is practically impossible to be sure to die (by whatever route - chosen or otherwise) at exactly the most appropriate time it follows that each person has to decide whether death a little too soon is preferable to death a little too late. This is a hard choice but one that is becoming increasingly pressing as a result of advancing life-support technology.
We have to face the probability that we now are coming to have the capacity to inflict survival unjustlly upon defenceless people.
4) with the above in mind, satisfactory criteria for suicide have to be identified.
CRITERIA
1) A life not worth living is one that is without even one relationship that satisfies the requirement of reciprocal life enhancement. By this is meant that the relationship must be of clearly recognised positive value to both parties, Each party must, albeit reluctantly, envisage contemplating life being impoverished by the possible death of the other.
2) The situation that the bereaved will face has to be anticipated carefully and imaginatively and the plan to commit suicide must be made some time - perhaps years - before the act.
A REAL INSTANCE OF A LIFE NOT WORTH LIVING
I knew an old lady in her late nineties who died, probably, in her sleep - the best way to die?
For years she had been living alone, housebound, almost fully bedridden, practically blind and in need of round-the-clock care by her middle-aged married daughter and a number of paid carers. She remained reasonably clear headed and able to engage in rudimentary conversation until near her death. Her quality of life was practically zero during her last few months but her functioning brain must have been clear as to what was going on. As a Christian lady of my acquaintance said at the the time "It must be terrible to lie there thinking that folk around me are simply waiting for me to die".
I would not wish to end my days in the protracted futile way in which that old lady's ended and I would be appalled to see anyone close to me do so. Nobody close to me would wish to see me in anything like that old lady's terminal phase.
There are thousands of comparable cases of mere survival. There are, I suggest therefore, thousands of cases where prior suicide while of sound mind would have been the best outcome, say, a year before death actually occurred. The old lady I knew was a clear case of the worth of suicide while of sound mind. She lived a little too long and neither she nor the people around her derived anything but great and debilitating disadvantage from her so doing.
It is important to understand that this old lady did not provide an example of the value of euthanasia as ordinarily understood. She had no treatable condition such that 'constructive neglect' could have been an acceptable means of procuring death. She was not in great pain and so a huge dose of painkiller that would kill her as well as killing the pain - 'the double effect' - was not an option. The various people around her could not have been expected to conspire to leave a lethal dose of some medicine within her reach in the hope that she would take it. To have the option of suicide while of sound mind was therefore not really open to her. She had survival inflicted upon her by circumstances beyond her control.
The case for the right to suicide while of sound mind, in order to avoid the burden of living a little too long, seems to me to be clear. Would I have the guts and the integrity to do it in good time? I am prepared to be judged on my guts and integrity in this matter.
That is not to say that people should be urged to commit suicide. It is rather that we must hope for a cultural shift towards acceptance of calmly considered suicide - well in advance - as an option. Some people may wish never to commit suicide; that is their right and if they are to exercise that right acceptably then proper hospice services should be much more widely available.
Quite starkly we have to admit that IF, either explicitly, by moral precept, or implicitly, by cultural pressure, we deem it a duty to survive THEN we are in duty bound to provide hospices on a sufficient scale to deal humanely with an aging population. To inflict death for no just cause has always been possible and it has always been morally wrong. Now we can inflict survival for no just cause and I submit that to do so is also morally wrong. The space occupied by moral consideration has been expanded by the awesome fact of technological advance. EITHER Our moral theory must expand to fill that space positively OR our moral sensitivity will wither into a shallow cruel version of the 'pro-life' position.
Death can be a terrible process. A rational decision to take action to pre-empt the more terrible possibilities might be thought perhaps cowardly or perhaps wise? Make up your own mind.
E.S.