On Assisted Suicide

There are many that may take umbrage with there mere title of this piece. It has been deemed as ‘disrespectful’ to refer to the issue at hand with such a term; even by MPs during the debate on the issue in the House of Commons. Instead, the term ‘assisted dying’ has been considered more appropriate. In Canada it is referred to as MAID (Medical Assistance in Dying); having the acronym allows for one not even to have to use the word ‘dying’. Whilst respectful dialogue and compassionate understanding are important, there has been little honest discussion on the issue. There has been much word play and sleight of hand to distract us from the core issue of what we are discussing: a State sanctioned resource for an accessible and pain-free suicide. This doesn’t automatically mean that I am correct in seeing Assisted Suicide as nothing short of a moral black hole, and there are weighty arguments against my position. But dishonesty about what we are talking about has stifled thorough discourse on the debate. Some will find some of my terminology in what follows offensive, and for this I make absolutely no apology. I find the entire premise of the Bill an offence to nearly everything I believe but rather than cowering, I take it head on and formulate a response; if you can’t do the same, I’d encourage you to leave the conversation to those of us who can conduct ourselves emotionally until you are ready to rejoin. One thing that both sides clearly agree on is that death in and of itself is offensive to us as human beings, we need to engage with this issue head on; pussy-footing around sensitive issues and formulating opinions based on fantasy is no way to conduct a proper discussion.

Philosophically, suicide has mixed opinions. Due to the belief in the sanctity of life, the majority of religions are naturally against the idea of suicide with the Catholic Church even holding it as a mortal sin (with the caveat of the individual being in a mental state where they can make the decision, accommodating for the tragedy of mental illness where the individual is not of sound mind). Although there are religious people who do support assisted suicide, these aren’t people who are representative of their religions and are instead better seen as predominantly influenced by a secular culture who in turn try and twist their religions into justifying their existing opinions. Outside of a religious-based philosophical outlook there is an array of different perspectives. For the Stoics, processing life through the management of emotions via logical thought, one could come to a decision that life was no longer worth living. The Stoics emphasised coming to peace with death and reflecting on it’s inevitability; in a way, counter to my previous paragraph, overcoming being offended by death. Nietzsche somewhat concurred, although he would dynamically wrestle with the apparent futility and meaningless of life; his writings display a wrestle with this: looking into the void, overcoming it to create ones own meaning. Though Nietzsche had an intense drive for life, he still appeared to admire suicide as an ultimate decision which one could always used, and even wrote of taking comfort in the idea of suicide being an option. 

Camus starts his famous work The Myth of Sisyphus by stating ‘there is but one truly philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy’. Strangely, Camus didn’t give an optimistic picture of a wonderful, flourishing and pain free life in his answer. Rather, he used Sisyphus condemned to forever by Zeus to push a boulder up a hill only for it to roll back down. Why stay alive? Well, Sisyphus could find purpose in carrying on; much comparable to Stoic philosophy, to rise against the emotional toll of adversity, but to choose life instead of succumbing to suicide, accepting, embracing and finding meaning in what may be done. Camus doesn’t condemn the act of suicide, but like Nietzsche stares suicide in the face and decides to push through rolling the boulder of life; our freedom is in how we come to terms with what Heidegger would describe as being ‘thrown’ into the world. This freedom for Nietzsche, Camus and the existentialists is best used by formulating meaning within what is outside of our control, which Sartre described as our ‘facticity’. Many philosophers today adopt a utilitarian view of suicide (usually only when assisted), abstracting the focus of the individual emotional and existential wrestle to a calculation of what would produce the least suffering; Peter Singer would argue that suicide for those who live with acute pain and distress would amount to the least suffering, and would thus be the right course of action. Kant, too abstracts the conversation from the experience of the individual human wrestle and argues that we are duty bound to not pursue suicide. Whereas the utilitarian perspective would compare human suicide to that of putting down a pet who was in distress, Kant argues for the special status of humans and is repulsed by the comparison as for the human being ‘if he disposes of himself, he treats his value as that of a beast’. Singer would disagree, seeing humans as no more valuable than any other living creature; seeing our apparent special status as mere arrogance. Even without the assistance of the State, freedom, duty, apparent utility and human value are all aspects of the broad perspectives that lay beneath the discussion on suicide.

The above has strangely been regarded as completely irrelevant in the debate into the Assisted Dying Bill. It has been posited as some kind of medical debate about the availability of a treatment. This is of the highest absurdity and represents a dishonesty of an obscene level to sanitise the issue at hand. In fact there is no definitive reason for a medical professional to be involved at all; a doctors opinion over whether the state should provide someone the means to suicide is no more valid than my own view. The administration of the substance that results in a death given to the hands of a professional who works to sustain life seems at the very least counterproductive: giving someone a pill doesn’t appear to need any degree, and knowledge over potential long term harms is obviously redundant. The Bill has been marketed as “Assisted Dying” as the subjects of the Bill would have to be given a diagnosis with a prognosis of six months to live in order to be eligible. This makes it appear to be a medical treatment option, and thus a medical conversation. However, this is illusory and hides the fact that we are still talking about suicide in this regard. The 6 month cut off point is arbitrary, every human being who has ever lived can expect an exit from this planet at some point; just because there is an expectation that someone will likely die sooner does not change the nature of suicide being suicide: it is still a decision to end ones life. This is notwithstanding the fact that as any doctor will tell you, many beat the odds of a terminal prognosis: this is not medical assistance in dying, this is suicide in the face of a scary prediction. 

There doesn’t appear to be a clear reason if we adopt the position that people should have the right to choose, that the requirements to be granted a suicide pill shouldn’t be extended. Why not someone with a year or two years as a prognosis? Why should they not get the same choice? And why not those who find life very difficult to live and would prefer it ends, but find independent methods of suicide too difficult to carry out? Mentally ill people are excluded, but surely this can be seen as discriminatory; I am frequently suicidal, as someone who has had my life turned upside down by bouts of drastic episodes of mental ill health and struggles being autistic (which is much harder to manage after a severe episode). I frequently think it would be better if I didn’t exist; if I came to a real resolve to end my life outside of an episode, surely it would be discrimination to not allow me access to the suicide pill? You may say that these are just unfair “slippery slope” questions, but I implore you to see what happens in countries like Canada, The Netherlands and Belgium. I think it is completely unfair to say that these countries have gone ‘too far’ with Assisted Dying: no, they have executed and extended the law fairly and logically. When we set boundaries, they are essentially grabbed out of thin air and established by the current culture’s level of comfort. There is absolutely no rationale to stop the extension of the State's administration of suicide pills after we have granted our States permission to administer them.

There has been much talk about the need to respect choice in the issue. This is a fair point, humans are nothing without their choice. Although what has been displayed consistently throughout the history of philosophy and especially in the last 100 years of various psychological experiments is the human’s inability to make good choices. We are a creature fuelled with cognitive biases. Nonetheless, the nature of a liberal society is to allow for freedom to make choices, even though this may result in suffering. The State has a role in sustaining this freedom and this involves certain trade offs, you are not free to not pay your taxes as not doing so will limit the freedom of me to be able to walk on a pavement laden with dangerous potholes. The question of liberty and the balance of freedoms has to be very careful in order to limit harms and chaos. But in terms of freedom to end ones life, apart from occasions where an individual is thought to not be of sound mind and it has been judged that they need temporary constraint, suicide is something we are free to choose. It may not be pretty, and often it isn’t easy, but if I wanted to I can commit suicide. In fact, I have a specific plan which has at times taken all my energy not to follow through which I would be thoroughly unlikely to survive. In the UK the Mental Health Act protects people like me when the urge to follow through with suicide is at its highest. It allows measures for the medical profession to restrain individuals who display risk of committing suicide. If one is unknown or hides from the medical profession (likely psychiatric), the freedom to choose to ends ones life is still very much available, but in principle the UK has anti-suicide protective measures enshrined in law. The libertarian philosopher of psychiatry Thomas Szasz disapproves of this, as a staunch libertarian he argues even a psychotic individual should have their “choice” of suicide respected and shouldn’t be restrained. Szasz disagrees what he would see as an over-extension of the State’s control in the decision of suicide; one can assume that he would lean more towards the freedom of the private sector to sell means of a gentle exit from this world. The Assisted Dying Bill doesn’t grant freedom for suicide, it makes suicide accessible and easy, and what’s more it gives the suicide the State’s stamp of approval, this is counter to the values of the Mental Health Act which has always been protective against suicidal intent, and has undertones of Szasz’s libertarian dystopia (albeit still with too much State involvement). The most sinister move of the Bill is that it doesn’t give people an option to end their life, rather what it does is move suicide from being a difficult and uncomfortable option into a comfortable and palatable option. This sanitisation of suicide changes its very nature of what the essence of the decision is; to inflict death on the self. 

Freud conceived of the Ego which we can think of the individual consciousness which acts in the world. But the Ego is constantly battling with the Id, our animalistic drive and the Superego which can be thought of as the hyper moralistic father figure who supervises and disciplines us. This goes on in the background of our unconscious, and although far more complicated than the crude description that I am formulating here, Freuds idea is useful to articulate the danger of the State’s role. Looking to the State for permission and access the material for our suicide can appear to be an externalisation of the Superego. We say it is a dignified, autonomous decision, but this State involvement allows us to bypass our own reservations in a way which makes State-sanctioned suicide far less of an autonomous decision than we could see in independent suicide. In gaining the approval and blessing of an external agent, we forfeit our own independence in carrying through such a decision. The worry of coercion has been highlighted throughout this debate, and it is a somewhat nonsense issue, it’s impossible to police and proponents of the Bill have to shrug their shoulders and accept that there will be collateral damage due to some being directly coerced. But what I would like to draw attention to from this point is that in sanctioning State administration and approval of suicide, this to a degree can be conceived of as coercive in itself, albeit indirectly. In having the framework in which an authority figure relieves reservations of the suicide-decision, the individual who may have not have followed through with suicide, may make do so due to the sanitisation of the issue and the externalisation of their “superego” telling them it is an acceptable and viable decision.

Suicide in my view is always a tragedy, I hold a high view of humanity seeing us as bearers of the Image of God. Not everyone holds my theological perspective, but we all hold a theological perspective which underpins our positions, even if that is that we hold no more special status than any other creature. That doesn’t mean in the slightest that I morally judge someone who has died by suicide, it means I mourn every single one. The Samaritans are a helpline that has an entire purpose of avoiding death by suicide, and it is a number I have dialled in a couple of occasions. They still respect the decision of someone to perform the action; we will always have the choice. The only circumstance in which this debate can be over the choice of suicide is with the heavily physically disabled who cannot access any means to suicide without assistance. But these cases are not the topic of the Bill, and even if they were, legislating in helping in these suicides is still problematic. This is particularly due to the fact that any discussion of assisted suicide has an obvious risk of pressurising the disabled, as campaigners like Liz Carr have so brilliantly highlighted. There has been so much written about the risk to disabled people that I won’t go into it here, but will echo Carr’s concerns that the risk to disabled lives alone is enough to throw this Bill out of any consideration.

There are many things that may drive a person to suicide; pain, life difficulties, loneliness, disability but they all share in common a lack of hope. One may come to the resolve to end their lives, and they may do so with the multiple means available. I see the job of the community to always keep hope alive to avoid this happening, part of this is not allowing the State to provide resources and a space for a comfortable suicide. This is not restricting freedom, this is disallowing the State to administer the ultimate restrictor of freedom. There are heart wrenching stories of uncomfortable deaths, and there is a real need for the advancement and accessibility of palliative care. But death will always be undignified no matter how it happens. I understand the desire for suicide and frequently refrain from the temptation, but the State’s involvement in the administration of suicide is one to be rejected due to the range of possible dangers. There may be those that disagree and argue that suicide should be made accessible and available to allow for a comfortable death due to compassionate reasons. You may have a fair point, but I would implore you to refrain from sanitising the issue by use of more palatable terminology. As I have briefly summarised, there have been thinkers throughout history who have had different viewpoints in discussing suicide without hiding their views with abstract medicalised terminology. I clearly have concerns, but my major concern is that people are not totally aware of the weight of their opinions as they’ve been anchored by dishonest and sanitised language. Hold what you’re arguing for up and view it in the face: it’s suicide

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