|
Many argue that a decision to kill
oneself is a private choice about which society has no right to be
concerned. This position assumes that suicide results from competent
people making autonomous, rational decisions to die, and then claims
that society has no business "interfering" with a freely chosen life or
death decision that harms no one other than the suicidal individual. But
according to experts who have studied suicide, the basic assumption is
wrong.
A careful 1974 British study, which involved extensive interviews and
examination of medical records, found that 93% of those studied who
committed suicide were mentally ill at the time.1 A
similar St. Louis study, published in 1984, a mental disorder in 94% of
those who committed suicide.2 There is a great body of
psychological evidence that those who attempt suicide are normally
ambivalent,3 that they usually attempt suicide for
reasons other than a settled desire to die,4 and that
they are predominantly the victims of mental disorder.
Still, shouldn't it be the person's own
choice?
Almost all of those who attempt
suicide do so as a subconscious cry for help,5 not
after a carefully calculated judgment that death would be better than
life.
A suicide attempt powerfully calls attention to one's plight. The humane
response is to mobilize psychiatric and social service resources to
address the problems that led the would-be suicide to such an extremity.
Typically, this counseling and assistance is successful. One study of
886 people who were rescued from attempted suicides found that five
years later only 3.84% had gone on to kill themselves.6
A study with a 35-year follow-up found only 10.9% later killed
themselves.7 The prospects for a happy life are often
greater for those who attempt suicide, but are stopped and helped, than
for those with similar problems who never attempt suicide. In the words
of academic psychiatrist Dr. Erwin Stengel, "The suicidal attempt is a
highly effective though hazardous way of influencing others and its
effects are as a rule...lasting."8
In short, suicidal people should be helped with their problems, not
helped to die.
But shouldn't we distinguish between those
who are emotionally unbalanced and
those who are making a rational, competent decision?
Psychologist Joseph Richman, writing
in the Journal of Suicide and Life-Threatening Behavior, notes,
[A]s a clinical suicidologist, and
therapist who has interviewed or treated over 800 suicidal persons and
their families... I have been impressed [that those] who are suicidal
are more like each other than different, including ... those who choose
"rational suicide".... [A]ll suicides, including the "rational," can be
an avoidance of or substitute for dealing with basic life-and-death
issues. ... The suicidal person and significant others usually do not
know the reasons for the decision to commit suicide, but they give
themselves reasons. That is why rational suicide is more often
rationalized, based upon reasons that are unknown, unconscious, and a
part of social and family system dynamics.... The proponents of rational
suicide are often guilty of tunnel vision, defined as the absence of
perceived alternatives to suicide.9
What about those who are terminally ill?
Contrary to the assumptions of many
in the public, a scientific study of people with terminal illness
published in the American Journal of Psychiatry found that fewer
than one in four expressed a wish to die, and all of those who did had
clinically diagnosable depression.10 As Richman points
out, "[E]ffective psychotherapeutic treatment is possible with the
terminally ill, and only irrational prejudices prevent the greater
resort to such measures."11 And suicidologist Dr.
David C. Clark observes that depressive episodes in the seriously ill
"are not less responsive to medication" than depression in others.12
Indeed, the suicide rate in persons with terminal illness is only
between 2% and 4%.13 Compassionate counseling and
assistance, such as that provided in many hospices, together with
medical and psychological care, provide a positive alternative to
euthanasia among those who have terminal illness.
What about those in uncontrollable pain?
They are not getting adequate medical
care and should be provided up-to-date means of pain What about those in
uncontrollable pain control, not killed. Even Dr. Pieter Admiraal, a
leader of the successful movement to legalize direct killing in the
Netherlands, has publicly observed that pain is never an adequate
justification for euthanasia in light of current medical techniques that
can manage pain in virtually all circumstances.14
Why, then, are there so many personal stories of people in hospitals and
nursing homes having to cope with unbearable pain? Tragically, pain
control techniques that have been perfected at the frontiers of medicine
have not become universally known at the clinical level. What we need is
better training in those techniques for health care personnel -- not the
legalization of physician-aided death.
What about those with severe disabilities? What would it say about our
attitude as a society were we to tell those who have neither terminal
illness nor a disability, "You say you want to be killed, but what you
really need is counseling and assistance," but, at the same time, we
were to tell those with disabilities, "We understand why you want to be
killed, and we'll let a doctor kill you"? It would certainly not mean
that we were respecting the "choice" of the person with the disability.
Instead, we would be discriminatorily denying suicide counseling on the
basis of disability. We'd be saying to the nondisabled person, "We care
too much about you to let you throw your life away," but to the person
with the disability, "We agree that life with a disability is not worth
living."
Most people with disabilities will tell you that it is not so much their
physical or mental impairment itself that makes their lives difficult as
it is the conduct of the nondisabled majority toward them. Denial of
access, discrimination in employment, and an attitude of aversion or
pity instead of respect are what make life intolerable. True respect for
the rights of people with disabilities would dictate action to remove
those obstacles -- not "help" in committing suicide.
Opponents of legalizing assisting suicide
say it will lead to non-voluntary euthanasia.
Aren't these overblown scare tactics?
Absolutely not. As attorney Walter
Weber has written in the Journal of Suicide and Life-Threatening
Behavior,
Under the equal-protection clause of
the Fourteenth Amendment to the U.S. Constitution, legislative
classifications that restrict constitutional rights are subject to
strict scrutiny and will be struck down unless narrowly tailored to
further a compelling governmental interest. ... A right to choose death
for oneself would also probably extend to incompetent individuals. ...
[A] number of lower courts have held that an incompetent patient does
not lose his or her right to consent to termination of life-supporting
care by virtue of his or her incompetency.... [T]he ["substituted
judgment"] doctrine authorizes-- indeed, requires -- a substitute
decision maker, whether the court or a designated third party, to decide
what the incompetent person would choose, if that person were competent.
... Therefore infants, those with mental illness, retarded people,
confused or senile elderly individuals, and other incompetent people
would be entitled to have someone else enforce their right to die.15
Thus, if direct killing is legalized
on request of a competent person, under court precedents that have
already been set, someone who is not competent could be killed at the
direction of that person's guardian even though the incompetent patient
had never expressed a desire to be killed.
1. Barraclough, Bunch, Nelson, &
Salisbury, A Hundred Cases of Suicide: Clinical Aspects, 125 BRIT. J.
PSYCHIATRY 355, 356 (1976).
2. E. Robins, THE FINAL MONTHS 12 (1981).
3. See, e.g., Dorpat & Boswell, An Evaluation of Suicidal Intent in
Suicide Attempts, 4 COMPREHENSIVE PSYCHIATRY 117 (1964).
4. See H. Hendin, SUICIDE IN AMERICA 223 (1982); Jensen & Petty, The
Fantasy of Being Rescued, 27 PSYCHOANALYTIC Q. 327, 336 (1958); K.
Menninger, MAN AGAINST HIMSELF 50 (1938); Rubinstein, Meses & Lidz, On
Attempted Suicide, 79 A.M.A. ARCHIVES NEUROLOGY AND PSYCHIATRY 103, 111
(1958); & Stengel, SUICIDE AND ATTEMPTED SUICIDE 113 (1964).
5. Jensen & Petty, supra note 4; Rubinstein, supra note 4, at 109; &
Stengel, supra note 4, at 73.
6. Rosen, The Serious Suicide Attempt: Five Year Follow Up Study of 886
Patients, 235 J.A.M.A. 2105, 2105 (1976).
7. Dahlgren, Attempted Suicides 35 Years Afterward, 7 SUICIDE AND
LIFE-THREATENING BEHAVIOR 75, 76, 78 (1977).
8. Stengel, supra note 4, at 113-14.
9. Joseph Richman, “The Case Against Rational Suicide,” Suicide and Life
-Threatening Behavior, Vol. 18, No. 3 (Fall 1988): p. 285, 285-86.
10. James H. Brown, Paul Henteleff, Samia Barakat, and Cheryl J. Rowe,
"Is It Normal for Terminally Ill Patients to Desire Death?" American
Journal of Psychiatry, Vol. 143, No. 2 (February 1986): p. 210.
11. Joseph Richman, Letter to the Editor, "The Case against Rational
Suicide," Suicide and Life-Threatening Behavior, Vol. 18, No. 3 (Fall
1988): p. 288.
12. Flora Johnson Skelly, "Don't dismiss depression, physicians say,"
American Medical News, September 7, 1992, p. 28.
13. Id.
14. Pieter Admiraal, “Euthanasia in the Netherlands - A Dutch Doctor’s
Perspective,” (speech presented at the national convention of the
Hemlock Society, Arlington, VA, 1986).
15. Walter Weber, “What Right to Die?” Suicide and Life-Threatening
Behavior, Vol. 18, No. 2 (Summer 1988): p. 181-96. |