What's Wrong with Making
Assisted Suicide Legal?
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. A similar St. Louis study, 1 published in 1984, a mental disorder in 94% of those who committed suicide. There is a great body of psychological evidence that those who attempt suicide are normally ambivalent, that 2 3 they usually attempt suicide for reasons other than a settled desire to die, and that they are predominantly the victims of 4 mental disorder.
Almost all of those who attempt suicide do so as a subconscious cry for help, not after a 5 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.
A study with a 35-year follow-up found only 6
10.9% later killed themselves. 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.
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
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. As Richman points out,
"[E]ffective 10 psychotherapeutic treatment is possible
with the terminally ill, and only irrational prejudices
prevent the greater resort to such measures."
And suicidologist Dr. David C. Clark observes that
11 depressive episodes in the seriously ill "are not less
responsive to medication" than depression in others.
Indeed, the suicide rate in persons with terminal illness
is only between 2% and 4%.
Compassionate counseling and assistance, 13
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.
They are not getting adequate medical care
and should be provided up-to-date means of 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.
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 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 non-disabled 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 non-disabled 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.
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.
References
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.
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.
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