“The debate over the right to end our own lives is not a matter of medicine or so-called mental health.”

I wanted to highlight this great comment by reader Claudia54.

As a woman, I wonder that I can terminate a life growing inside me based on others’ volatile opinions about what constitutes “viable life,” but I cannot terminate my own life.

Whom do I belong to that someone else’s feelings, opinions, and perceptions are more important than my own as far as the continuance or termination of my life is concerned? I can make all manner of so-called horrible life errors, and society tells me that they are all my responsibility. That is the cost, I’m told, of being an adult. I can smoke. I can over-indulge in alcohol. I make unhealthful dietary choices. I can engage in unprotected sex with many, many high-risk partners. Once I’m a legal adult, I can refuse to continue my education or get a job. I can become homeless, suffer the sexual and other physical depredations of others, and die slowly and torturously. All these things, though nearly everyone agrees they’re unwise choices–mistakes, I’m free to do.

Why? Because I’m a legal adult and I am responsible for my own life, terribly “mistakes” and all. The regrets of others who’ve pursued, or been on these paths, never justify another forcing me to act “wisely.”

Yet I cannot end my own life.

Why do the suicidal deserve special protections, while the vast majority of society’s derelict do not? Just about everyone who matters — friends, family, politicians, doctors, lawyers, judges, police — tells the societally lost they made mistakes and must now pay for them. Many of them will die painfully, abandoned, and that’s just life. But I cannot end my own life, as many seem to argue, for my own “good”? How is that reasoning at all consistent with our culture’s principles of personal autonomy and responsibility?

Speaking, too, as a licensed physician, even when I am confident a patient would benefit from additional treatment, I cannot force her or him to accept treatment. Even when the prognosis with treatment is statistically “good,” I can only present patients data–survival rates by years from diagnosis, side effects from treatment… Even if death is imminent without treatment, I cannot impose my will on a (non-minor) patient. So I do not believe the justification mental health professionals give, that acting against patients’ wills is justified based on the clinician’s superior knowledge of the disease state, or on the patient’s lack of clear thinking, or on the regret others who’ve attempted an act but failed at it later express over having attempted at all. At the root of the unique treatment modalities for mental health, in particular suicidal ideation, is an unjustifiable belief — not scientific fact — that life is always better than death. Other scholars in philosophy and medicine have written broadly on why this viewpoint is fallacious and never objective. Just as several European countries have finally concluded that life value can only be determined by a person living life, the rest of the world will eventually follow. The modern mental health therapeutic belief system is wholly untenable since it relies, like religion, on others believing the same principles as clinicians and mental health policy lobbyists — all who have a clear stake in the game.

Lastly, on a practical note, study after study links quality of social life to depression risk. We’re all advised to have healthy and sufficient connections with others we care about and who care about us. But, who doesn’t want quality social relationships? A mentor of mine from my residency commented about the health protection of friendships that what counselors usually fail to acknowledge is that every relationship requires two people. There are very many reasons outside an individual’s control for her potential isolation. Clinical psychology fails to address how persistent these may be despite therapy, drugs, or other interventions. You can only hope to change an individual, not the others she must interact with. So the clinicians who are adamantly against the right of the patient to choose death, will they commit to being with each patient throughout the week, the day, the night, when loneliness sets in and these people feel abandoned and desperate? Can the clinicians guarantee that whatever treatment-du-jour will overcome the early-life formative experiences we know literally mold neurology so that these patients feel radically different, more inclined to stay alive? Will clinicians guarantee patients’ communities will put aside classism, ageism, scathing prejudice based on body habitus, or any of the other myriad prejudices that isolate over a lifetime? Or will clinicians be there, day after day, to provide the intimacy of a hug, holding those who need frequent reassurance? Or can clinicians guarantee a more equitable or hospitable world in general — especially regarding the sometimes monstrously callous or patently malignant mental health system itself?

I think not.

So, if clinicians cannot guarantee sufficient quality of life we understand is so crucial to “mental health,” neither should they be entitled to condemn the humans they cannot help to lives patients actually living those lives find to be hellish isolation and hopelessness simply because of clinicians’ assessments of their own lives, life in general, or even other patients’ lives.

The debate over the right to end our own lives is not a matter of medicine or so-called mental health. We already know this since every day patients whose imminent deaths could be forestalled by medical intervention are permitted to reject medical care, and insurance companies are entitled, based on finances, to reject necessary procedures the medical literature tells us are likely to extend patients’ lives significantly. The debate over the right to end our own lives is shockingly rooted in biased value systems — “shockingly” because other people in this arena uniquely get to command otherwise legal adults not to act on our own bodies.

To me, there is no greater a contradiction to the concept of personal freedom than this.

4 thoughts on ““The debate over the right to end our own lives is not a matter of medicine or so-called mental health.”

  1. Theunis April 15, 2017 at 12:08 Reply

    Suicide is, on my view, a reasonable response to some but not other features of the human predicament.

    Death does not solve the problem of life’s cosmic meaninglessness and will often (but not always) diminish the kind of meaning that is attainable. Suicide is thus not typically a solution to deficiencies of meaning. By contrast, suicide can bring relief from suffering. When life becomes so bad that continued life is not in one’s overall interests, and there are no other overriding considerations, I see suicide as neither immoral nor self-indulgent, but as a reasonable response to one’s circumstances. These circumstances are not restricted to the final stages of terminal diseases. It may well be reasonable for individuals to set the threshold for a life worth continuing lower than that. However, even in such circumstances, suicide comes at a cost, both to the person who dies and to his or her family and friends, which is why, even when it is clearly reasonable, suicide remains tragic.

  2. Valery April 15, 2017 at 21:24 Reply

    I wholeheartedly disagree that “suicide is in direct opposition to fundamental biological imperative.” Biology, like physics, is a process. Consciousness, as best we can understand it empirically, arises emergently out of the complexity of information processing, part of the dynamics of the process of biology. There is no “imperative.” There is process.

    I also do not place much credence in the evolved lexicon of the profession of psychology. Stanford University recently held a critical colloquium on modern psychology in which a crucial criticism was levied: “modern psychology is deeply, culturally and professionally biased in the way research questions are posed, the way data is analyzed, and the meanings professional psychologists impose on results.”

    That suicide is considered the exemplar of psychopathology is an opinion — granted one held by those who profit in various ways from the human study and definitions of psychopathology, not an objective fact. And again, there is no natural reason anyone must submit to others’ feelings on private choices, and no one has offered a sufficient argument why the consistent personal choices of some in this regard should be denied because of the FEELINGS and worldviews of others. To the extent we insist on doing this, our culture denies adult citizens personal freedom.

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  4. Victor April 18, 2017 at 04:17 Reply

    I think suicide is terribly misunderstood. If I could simply fall asleep and never wake up again, I’d choose that in a heart beat. My life isn’t bad. I have problems but they’re not all that terrible. I simply don’t enjoy living and I don’t think that that’s crazy or even mildly out of whack.

    I don’t like life. There I said it. When I look back, even to my early childhood, I can never remember looking forward…. to anything. Nothing interests me on any kind of profound level. I find life to be boring and bland at best, extremely tedious and painful at worst.

    That said, why should I be forced to participate in something that I don’t enjoy or desire? All of life’s pleasures disgust me. I hate the sound of people eating, it makes me sick. I hate the notion of sex, let alone the act. It’s disgusting. I frequently feel that I simply can’t be the only person who feels this way.

    I’m not depressed. Depression takes a degree of passion. Depression speaks of some level of disappointment. I don’t feel that way. I have in the past, but that’s not what this is. What I feel now is a complete inability to muster up the energy to care to relate. Books put me to sleep, quickly. Movies, especially modern ones, are unwatchable and stupid. Music has become a chore to listen to. I’ve just outgrown it. Food is annoying. I eat very well, but the act of getting food and then having to eat it is just a chore. I don’t wish to die because of any intense self loathing, or hatred of mankind or anything like that.

    I simply wish that either the death that awaits me would show up very quickly, or that I be afforded to walk out on this boring movie of a life that nobody would ever…. EVER watch.

    And I’m fine with that. Since I was very young I can remember, clearly, wishing that I could just fall asleep and not have to be bothered to awaken.

    Is that really so much to ask?

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