Taking Your Life

I want to open up a space for thinking about suicide as a free act that should not be morally reproached or quietly condemned. Simon Critchley

The Ethicist is column published in the Times Magazine every Sunday. Each week the author responds to a question that revolves around a moral quandary.

This year, on January 20th, a 50-year-old woman asked the Ethicist if she should help her sister end her life. She says her sister has a range of serious medical problems including “uncontrolled epilepsy, a stroke that left her physically and mentally impaired, paranoid schizophrenia, to name a few.”

The Ethicist responded that no one has the right to help end another person’s life, sister or not, even if it’s clear it’s not a life worth living. Only her sister has the right to commit suicide, on her own, without the aid of anyone else.

If she was in the Netherlands or Belgium, her plight would be much different. In discussing the life-long struggles of a woman in Belgium, Rachel Aviv (New Yorker, 6/22/15) describes the work of Wim Distelmans, an oncologist and professor at the Free University of Brussels. Distelmans is one of the leading proponents of a “law in Belgium that permits euthanasia for patients who have an incurable illness that causes them unbearable physical or mental suffering.”

It was the phrase “mental suffering” that caught my attention. I had never heard of a nation or state that permits euthanasia for that reason. It isn’t a reason I haven’t thought of before or found as compelling as incurable disease. But I had never imagined a law permitting it.

According to Aviv, Distelmans has euthanized more than a hundred patients who claimed they were simply tired of living or unable to find a reason to continue.

Her article dwells on the controversy over the law, the case of one woman and her son, in particular, and the situation in other countries, as well as the United States.

The Belgian Council of Ministers appointed Distelmans to serve as the chairman of the Federal Control and Evaluation Commission which reviews euthanasia deaths to insure that doctors have complied with the law.

In terminal cases, two doctors need to confirm that the patient’s suffering stems from an incurable illness. For non-terminal cases, three doctors must agree. But doctors have adopted increasingly loose interpretations of disease.

Last year, thirteen per cent of the Belgians who were euthanized did not have a terminal condition, and roughly three per cent suffered from psychiatric disorders.

Belgium was the second country in the world, after the Netherlands, to decriminalize euthanasia; it was followed by Luxembourg, Switzerland and Columbia this year.

The United States Supreme Court has recognized that citizens have legitimate concerns about prolonged deaths in institutional settings, but in 1997 it ruled that death is not a constitutionally protected right, leaving questions about assisted suicide to be resolved by each state.

Within months of the ruling, Oregon passed a law that allows doctors to prescribe lethal drugs for patients who have less than six months to live. In 2008, Washington adopted a similar law; Montana decriminalized assisted suicide the year after; and Vermont legalized it in 2013.

In Oregon and Switzerland, studies have shown that people who request death are less motivated by physical pain than by the desire to remain autonomous. This pattern of reasoning was exemplified by Brittany Maynard, a twenty-nine-year-old newlywed who moved to Oregon last year so that she could die on her own terms rather than allowing her brain cancer to take its course.

While several states in this country currently permit doctor-assisted suicide for terminal illnesses, none do so for mental suffering. To my knowledge, no one has ever proposed such a law and I cannot imagine one will ever be enacted in the near future. That does not mean the issue is not worth considering. Perhaps it is time to begin a public dialogue on the matter in this country.


Dom said...

Reading this thought-provoking blog post causes me to wonder:

1. Why should society overrule a person’s rational decisions? If (X) a person demonstrates that the person has the capacity to make rational decisions, and (Y) the person decides that the expected disadvantages of their present and expected future mental suffering outweighs any expected future benefit from the continuation of living, then under such circumstances why should other people decide that such person should not be permitted to commit suicide, assisted or unassisted?

2. How is society’s best interest served? On what basis is it reasonable for society to believe that it is in the best interest of society to force people to continue living under circumstances where the pain of such person exceeds the benefit of continued life?

3. Who is in the best position to decide? Do the other members of society believe that they are in a better position to, and should have the right to, identify and assess both (X) the nature and extent such individual’s mental suffering, and (Y) the expected future benefit that the individual is likely to receive from the continuation of living?

4. Disregarding a person’s suffering? Or does the society believe that the nature and extent of the individual’s mental suffering is irrelevant or should be disregarded?

5. Who benefits from the continued suffering? Or that the expected future benefit of the individual continuing to live that should be considered be the benefit to society, and not the benefits of the individual?

6. What are the answers that have been given? I wonder where one can go to read if and how others have answered such questions?

It appears to me that people are readily inclined to want to regulate and have power over the lives of others, but are very disinclined to want others to regulate and have power over their own lives.

In other words, society seems to have the view that “I know what best for you and should have the power over you, but you do not know what is best for me and should not have the power over me.” This view troubles me.

Richard Katzev said...

Dom: I appreciate your careful consideration of the blog. In your questions you contrast what a person wants with society's interests. Indeed, they conflict. But that doesn't bother me. It is a simple matter for a person to take their own life without taking into consideration society's views or those of the states, even in those that permit physician assisted suicide. Current views about suicide are largely based on age-old religious views and commands. Individuals vary widely, of course, in how seriously they take them. I've not read a great deal about the specific issues you pose. As always, head for the library or examine the books on suicide. Some deal with the questions you ask; they might be found in legal journals and specific case studies. Your questions lead me to see what I can find. If I do, I will either post them here or email them to you. I want to repeat that cultural, religious, society's views need not influence a person who wants to take their own life. It's their decision, no one else. Richard

Dom said...

My perception is that among the reasons that various people give for their opposition to the removal of legal constraints to suicide, and assisting suicide, are:

(A) religion – as you have stated, religious prohibitions against suicide,

(B) reason – their belief that suicide decisions are by their nature not rational decisions, but irrational emotional decisions, and that others need to be protected against the consequences of making irrational decisions, and

(C) societal best interest – the best interest of society as a whole should prevail over each separate individuals perception of their own best interest.

In brief, my perception is that most, if not all, people believe that they know what is best for others, including society in general, while at the same time believing that others do not know what is best for them or for society. More specifically:

1. Religious prohibition of suicide. My perception is that while “separation of church and state” is widely publicly proclaimed, that if any religious group would ever have the power to impose their principles, beliefs, and will on others that such group would be inclined to do so, including with regard to suicide prohibitions, and believe doing so would be in the best interest of society

2. Irrational decision prohibition of suicide. My perception is that people in general want to both (A) make decisions based upon their feelings and emotions quickly, easily, and simply, and exercise power, both with regard to themselves and over others, and, (B) at the same time justify those decisions to themselves and others as being rational, not irrational, decisions. I perceive that in general the more power individuals and groups perceive that they have the greater the influence of feelings and emotions in this decision process.

3. Best interest of society prohibition of suicide. Many of those who favor prohibitions against suicide, and assisted suicide, appear to me to base their view, and justification, on the belief that people should not be permitted to do things to their body that would be contrary to the best interest of society as a whole.

But if we accept this line of reasoning, then I am left to wonder if there should be any limit on the right or power of society, such as through popular vote, to decide what I can or must do that would affect my body.

For example, should society be permitted to tell me what to eat, what exercise to do, what hours to sleep, etc. if it can be shown that such decisions and actions would affect both my body and society in general? Where can or should “the line” be drawn?

The hyperlink that you provided to information contained in Google scholar pertaining to suicide is both helpful and appreciated. A review of that information left me with the clear impression that there is no worldwide consensus on the justification or permissibility suicide, but that different nations and cultures of come to different conclusions based upon a different factors that they have considered, and how it weighs those factors.

It appears to me that the one thing that they all have in common is that those in power in each nation or culture believe they know what is best for individuals, and what individuals should or should not be permitted to decide for themselves – that society and culture decides is the “default view”.

Linda said...

I remember reading the New Yorker article - and thinking that Wim Distelmans sounded creepily cavalier and god-like. That was a disturbing account of the anger, pain and guilt left in the wake of the woman's suicide. I worry about the potential for abuse. Even so, I agree that suicide is the sole decision of the individual.

Richard Katzev said...

Dom: You raise a number of difficult and complicated questions that are impossible to answer in this blog format. I would reply that you need data to support your views about people's beliefs and suicide.

In addition, there are, of course, many examples of the rights of individuals to regulate their own behavior. They can smoke even though there are warnings about its ill effects. In some states, you are able to terminate your life, if you have an incurable disease with the aid of physicians. The Supreme Court has ruled that the right to privacy under the Due Process Clause of the 14th Amendment extended to a woman's decision to have an abortion.

It is my unsubstantiated belief that individuals do not necessarily believe they know what is best for others. Here is what some data would be helpful.

I would also like to suggest to look into the views of Thomas Szasz on the rights of individuals verses the best interests of society. You might also take a look at the volume Rational Suicide Irrational Suicide: http://www.amazon.com/Rational-Suicide-Irrational-Laws-Psychology-Law/dp/0199981191/ref=sr_1_1?ie=UTF8&qid=1464530742&sr=8-1&keywords=Rational+Suicide


Richard Katzev said...

Linda: I felt the same way about Distelman. But Aviv only wrote in detail about one family and their opposition to Distelman. Were the families of the other individuals he assisted similarly opposed? It's important to find out in order to fairly judge his actions. And I fully agree with you that each individual has the right to take their own life. Richard

Dom said...

Richard: Thank you for your May 29 5:24 AM helpful suggestion for further research and the hyperlink that you provided.

With respect to your comment that it is your “…unsubstantiated belief that individuals do not necessarily believe they know what is best for others”, it is unclear to me what you mean when you say that you “do not necessarily believe” that individuals know what is best for others. It is not clear to me how to distinguish between (X) what a person does not believe, and (Y) what a person does not “necessarily” believe.

Thank you for your comments. They are always greatly appreciated.

Richard Katzev said...


My language was deliberately vague. Why? How can we know what another person believes and doesn't? We can't be confident of self reports. We can look into a person's mind. We are at the mercy of unreliable data.

By "unsubstantiated," I meant to the best of my knowledge we have no or very little information on the issue.

By "not necessarily," once again I meant we can't be sure.

In either case, it's an epistemological dilemma. How can we Know what a person believes and doesn't believe?


Stefanie said...

You raise an interesting question regarding assisted suicide and mental suffering. I think it is unlikely to be allowed any time soon even in someplace as forward thinking as Oregon. There is still such a societal stigma attached to mental illness and suffering and a belief that therapy and drugs can make it all better. But mental illness/suffering can't always be fixed. Plus I think there is a tendency to believe that people who are suffering mentally aren't in their right minds and can't make rational decisions so we feel right in making the decision for them whether or not our belief is true. It is an interesting discussion to have though and at the very least one can hope that it raises more awareness and promotes better understanding of mental health issues.

Richard Katzev said...

Stefanie: You are right, we are a long way from sanctioning assisted suicide on the grounds of mental illness. Yet, given a life-long struggle with mental suffering, the failure of drugs, therapy or the sheer passage of time to alleviate the suffering, a strong case can be made for assisted suicide for mental suffering. As in any major social change, it's going to take a very long time for the acceptance of this view. Patience is required, a lot of it. Richard