The Other Kind of Suicide: Choosing How and When We Die
I recently detailed my personal struggles with depression and suicidal thoughts, but there are instances where thoughts of suicide aren’t necessarily linked to depression or mental illness, and one of those is when facing end-of-life decisions.
My partner and I, in the way many couples inevitably do when facing the sober realities of aging and all that it means, have discussed what kind of care we would want should either of us be diagnosed with a physical and/or mentally debilitating disease. While demurring to share my partner’s choices, I can say with sound mind that should I ever face the prospect of a slow and debilitating death due to some illness like a fatal cancer or a leeching of my memories and faculties like Alzheimer’s, I will choose to end my own life.
This kind of suicide is most definitely a choice, and I make it knowing that it’s not for everyone. There are many arguments against this path. People with debilitating diseases can live rich lives for many years, and I should be clear that I would not go from diagnosis to ending my own life in just a few breaths. I trust there will come a point during the slow creep of the disease when I will know the time has arrived, and that will be when I feel my dignity is threatened and my sense of “self” is slipping.
Then again, perhaps I will not decide to take my own life. It is very different thinking about something than actually living it. Perhaps I will decide to carry on, regardless of the hypothetical crippling disease, because certainly there may be much to live for and, in truth, most of the time I rather like existing. It’s about having that choice though, and the power that gives me to control my own fate. But what if this choice is something that I can’t carry out for myself? If I ask for help to end my own life, I could be putting my doctor or my partner in legal jeopardy.
What we’re talking about here is known as “assisted dying” or “assisted suicide,” and it holds that someone of sound mind but failing health who is no longer capable of fulfilling their own desire to die should be able to call on a doctor to help end their life. This is a very controversial subject and it is one that many nations are currently struggling with.
Where is Assisted Dying Legal?
Currently, assisted dying is legal in the states of Oregon, Washington, Montana, Vermont and New Mexico, though in Montana’s case assisted dying rests on the physician raising a defense after the patient’s death if they are charged with unlawful killing, which is, of course, a very precarious situation.
Canada doesn’t allow for assisted dying at the moment, though an ongoing court case may ultimately change that. As of June this year, Quebec does allow for assisted dying in certain circumstances.
There are a couple of South American nations that allow for assisted dying, though the legality is somewhat tenuous. Columbia, for instance, saw its Supreme Court rule that there is a right to assisted dying, but no legislation has ever been ratified. Even so, it’s widely understood that physicians can help terminally ill patients to die and not face a criminal investigation.
In terms of European countries, only Belgium, Luxembourg, Switzerland and the Netherlands provide for explicit safeguards for the right to die. Europe’s highest course has ruled that the right commit suicide is in fact a human right, but that there is no obligation for the state to help end someone’s life. There are ongoing legal battles in a number of European states to try to win or at least clarify the right to die.
My own country of birth, the UK, does not technically allow for assisted dying and the Supreme Court has urged MPs to clarify the law. In the handful of cases where (usually) a partner has helped their loved one to die, prosecution hasn’t been successful but people must still go through the criminal investigation, which can be extremely distressing. I should note that Scotland is currently considering legislation to allow for assisted suicide in some cases and it has received strong backing in a public consultation.
South Africa is currently considering the issue but it is reluctant to move forward until it has grappled with its shortage of physicians first. In general, North African countries do not allow for assisted suicide, though as in many nations there are gray areas as to what might qualify as “assisted” suicide.
China does not allow for assisted suicide and, because of a strong taboo surrounding the subject, that doesn’t look likely to change. Interestingly, Japan has voluntary euthanasia thanks to a decades old court ruling but it remains very rare that cases are heard of, largely down to a similar taboo around suicide.
The Right to Die with Dignity: It is Wanted but It Might Depend on How We Approach the Issue
In nations where the right to assisted suicide is legally enshrined, there aren’t masses of people making use of that law, and though the Religious Right might pretend differently, the actual rate of verified abuses is small.
At the same time, we’re aware of the phenomenon of so-called suicide tourism, most notably with people from Europe visiting Switzerland’s assisted dying clinics, and that has seen a moderate increase since 2010 when the figures were last looked at. About 50 more people have traveled from abroad to Switzerland for the purpose of using its assisted dying facilities, and usually it’s people from the UK or from Germany.
That said, we know that assisted dying with robust safeguards is supported by majorities in many nations, with a Gallup poll saying that about 70 percent of Americans believe that doctors should help patients to die by some painless means. There’s a “but,” though. That same poll found that when specifically asking the question of whether “assisted suicide” should be legal, support dropped to about 51 percent. This perhaps speaks to the taboo of suicide and even faintly religious feelings about the special and sacred aspect of life. It also explains why “assisted suicide” has been swapped for the more neutral sounding “assisted dying,” an uncomfortable re-branding that unfortunately might be necessary.
Returning to speaking personally, I do believe that life is remarkable, though as an atheist and a humanist I’m afraid I can’t subscribe to life being sacred. The best I can muster on this is to hope and indeed plan to die with some sense of dignity. For me that means, save for a quick accidental death, facing the end with as much of my mental faculties intact as possible, and to be as bodily whole as providence will allow.
Reducing suffering balanced against the prospects of future quality of life is what I think about when considering end-of-life choices — whether they are my own or for someone else — and this, I believe, is what we should focus on instead of allowing antiquated laws to dictate that someone should live on when, in sound mind and perhaps facing incredible pain, they would want peace.
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