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Suicide and Leprosy: The Ethics of Voluntary Isolation

with 10 comments

Imagine a person with leprosy, in the days before the invention of dapsone. This person has done nothing wrong to contract leprosy; nevertheless, there are certain precautions that this person could take to avoid transmitting the disease to others: namely, isolation. This person does not in any sense deserve either leprosy or isolation; nevertheless, the morally right thing to do is for this person to voluntarily isolate herself away from those who have not contracted the disease, including her own family and friends.

Similarly, although a potential suicide has done nothing wrong to be born, and although, I argue, the action of committing suicide is not morally wrong, the suicide can limit the harm his suicide will cause to those close to him by voluntarily isolating himself prior to committing suicide, just like the person with leprosy.

The suicide of one’s spouse or lover is much more devastating and personally affecting than the suicide of one’s former spouse or lover. While the latter may be painful and induce unpleasant feelings on the part of the surviving ex-lover or ex-spouse, it has much less chance of producing the shock and despair that are often the result of the suicide of one’s current spouse or lover. Given this clear differential of harm, I think a suicide owes a duty to his lover or spouse to end the relationship well prior to committing suicide.

This rationale also holds true for one’s friends. The suicide of a close friend is bound to be traumatic; however, the suicide of a former friend to whom one hasn’t spoken in years may barely affect one at all, beyond prodding some interesting reflection on life and mortality. Suicides should think carefully about ending close social relationships well ahead of the act in order to lessen the harm the act may cause.

Family relationships may not, as a practical matter, be ended. I am not sure what can be done to lessen the pain of one’s suicide to one’s relatives. My own informal study of news reports of various suicides seems to indicate, however, that family members are most accepting of the suicide of a close relative when they were aware of the suicidal person making a great effort to live during his life. The suicide of a person who “tried everything,” who struggled mightily during his life, and whose desire to die was obvious for a long time, seems to be less emotionally devastating to his family than a suicide that the family perceives as impulsive or random.

Finally, if a person decides conclusively to commit suicide, it is morally imperative to end any therapeutic relationship with a psychologist or psychiatrist, leaving as long an interval as possible between the end of the therapeutic relationship and the suicide. First, it is hard to imagine a therapist not feeling responsible for the death of his patient, whereas a former therapist may not hear of the suicide at all, and if he does, will likely feel less responsible for the death. Second, the suicide must recognize that his therapist may actually be sued by his survivors for failing to prevent his suicide. Someone who commits suicide months or years after formally ending the therapeutic relationship will not put his therapist in this troubling situation.

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Written by Sister Y

September 30, 2008 at 8:10 pm

10 Responses

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  1. Voluntary isolation and giving up therapy is not likely to be seen by family as “struggling to live”, so there seems to be a contradiction here.In general, the demands you propose strike me as very high, and I think they are likely to significantly further increase suffering for the suicide. First, you have to live all the time after you have broken up your relationships “well in advance”, in complete solitude. And second, once you have separated yourself, there is no way back to life in a different way than it is once you’ve jumped off a bridge, but still, it strikes me as a significant way. This can have a terrible effect in two ways: Either it makes you feel so desperate that it’s difficult to wait all the time and not kill oneself at once – that is, too early for the strategy to work -, or, if you are of the kind that cannot overcome their self-preservance urge, it makes the trap you’re in even more of a hell.Also, I feel one would need rather high acting skills for this… After all, one has to invent good reasons to break up the relation and possibly act against one’s emotional inclination.I think that interpersonal relationships are too complex and individual to posit such general duties. Too much depends on the individual preferences. In some cases, you may in fact end up being paternalistic if one follows your suggestions.A further remark in this area: There seems to be a lot of implicit agreement in relationships, only it’s unclear what counts as agreement to what.And then, with respect to the therapist, I suppose this person also has some kind of professional risk. You certainly don’t have a duty to spare him everything you can. At best everything you can <>easily<> spare him, but I’m not sure how much this would be in individual cases.I find your proposal somewhat too undifferentiated and radical, though of course there is some work to be done to decide where exactly the leprosy analogy fails. But that can only be done within a specific ethical theory, because it depends on this what you may make reference to in forming an argument.

    Anonymous

    October 1, 2008 at 4:04 pm

  2. What I am proposing is an extremely difficult long-term program of action for a committed suicide. I am also not certain that these things are ethically required. But this is the kind of conversation that is not happening at all, and I wanted to start it. Your comments are very helpful.First, you’re right that “struggling to live” and isolation are at odds. I think what I’m proposing is that any suicide should <>first<> make all apparent efforts to struggle to live, and only <>then<> engage in the isolation activities I’ve envisioned.Second, yes, these demands are very high. But the differential in suffering between, for example, a lover and an ex-lover when one commits suicide is also very high. Third – I like your explanation of the awful situation one might end up in if one attempts the program of isolation but changes one’s mind. It’s an excellent explanation of why this might really be too much to ask.I’d though about the program making suicide more likely, but I hadn’t though about people entering isolation and then no longer wanting to die, but being “stuck” nonetheless alone, having made their lives much worse.I’d like to turn society’s conversation away from “why it’s wrong to commit suicide” to “how can we minimize the harm of suicide?”Also, I’m interested in separating out “good” suicides from “bad” suicides.

    Sister Y

    October 1, 2008 at 5:05 pm

  3. So you have a utility calculus in mind? I guessed that much, so I was precisely trying to bring up some points that would affect this calculus. Besides, I’m afraid there aren’t many clues for conclusively solving it…<>I think what I’m proposing is that any suicide should first make all apparent efforts to struggle to live, and only then engage in the isolation activities I’ve envisioned.<>Then you have your family watch your life degenerating… Some extra negative utility again. So you will have to balance your family’s suffering against your friends’s. But how are you supposed to do this?<>But the differential in suffering between, for example, a lover and an ex-lover when one commits suicide is also very high. <>Only it’s by no means clear <>how<> high exactly. Also, this will vary significantly among individual cases.<>I hadn’t though about people entering isolation and then no longer wanting to die, but being “stuck” nonetheless alone, having made their lives much worse.<>This is definitely another important point. What I wanted to bring up is something slightly different, namely that the suicide may in fact still want to die, but for some reason be unable to kill himself, be it that his opportunity has vanished for external reasons, or that he just can’t overcome his instincts and bring himself to do it.<>I’d like to turn society’s conversation away from “why it’s wrong to commit suicide” to “how can we minimize the harm of suicide?”<>Ah, okay, that’s an entirely different question then! I thought you were concerned with what the suicide is <>obliged<> to do in order to minimize harm.

    Anonymous

    October 1, 2008 at 6:07 pm

  4. Maximizing utility is great, and it’s a starting point, but it’s not my only concern. (Is anybody arguing “pure” consequentialism any more?) There may be rights to do things that do not maximize utility.And I’m interested in moral <>obligations<> of suicides, too – not just what would be kind or good to do.

    Sister Y

    October 1, 2008 at 6:48 pm

  5. I guess that’s the problem in applied ethics in general – either you jump right into your issue and don’t spend any time on theory, or you spend all your time on theory and don’t actually deal with your issue. This is supposedly why so much applied ethics sucks.The ideal would be to treat the issue under multiple theories, I suppose.

    Sister Y

    October 1, 2008 at 6:56 pm

  6. As I see it, you can’t treat an issue if you don’t have a theory. How would you do that?And different theories sometimes lead to radically difficult conclusions. On utilitarian grounds, you will be able to impose many more duties on the suicide than on a deontological theory, especially with a libertarian outlook.So if you say that maximizing utility is great, <>but<>… – then it’s a problem to balance utility with what follows this “but”. Where do you consider utility, where something else?What do you mean by “pure” consequentialism?

    Anonymous

    October 1, 2008 at 10:26 pm

  7. I guess ultimately I’m using something like Rawls and pretending I don’t have a theory. I should be more explicit about it.What I mean by “pure consequentialism” is something like the moral system that requires actions that maximize utility (total, average, or some weird hybrid) and forbids other actions.

    Sister Y

    October 2, 2008 at 5:41 am

  8. I like Benatar’s approach, though – he defines his area, and shows how his solution is compatible with many different ethical theories.

    Sister Y

    October 2, 2008 at 5:44 am

  9. Hm, it seems to me that maximin and utilitarianism immediately give an example of differing results.On a utilitarian calculus, what you compare is the improvement for the others (possibly not even individually, but in sum) and the <>extra<> suffering that your suggested measure would cause for the suicide, and if the first outweigh the latter, then the suicide has an obligation to follow them.However, when following maximin, you compare the overall suffering of the suicide with the suffering of other people individually. And then it is likely to turn out that the suicide’s suffering is greater so that not imposing extra burdens slightly alleviates it and thus serves maximin.

    Anonymous

    October 2, 2008 at 3:09 pm

  10. Anonymous, your analysis (maximin/ utilitarianism) is clear and very helpful. This is the kind of thing it rarely occurs to me to do (along with anything resembling formal logic, also apparently one of your strong points), even though it clearly has a place in this kind of discussion.One point your previous response clarified for me is the degree to which the suicide prohibition makes it <>harder<> for suicides to act ethically. If it were comfortable and easy to commit suicide, there would be no worry that one would, say, end a relationship, be miserable, and then be unable to commit suicide. (The prohibition also makes it difficult for the suicide to have serious conversations about his intentions with his family and friends, because of the danger of forced hospitalization or other coercive prevention tactics.)This ties into my earlier article, about the terrible choice the suicide prohibition offers the suicide – between leaving one’s body to be discovered by an intimate, or dying in such a way that one’s intimates won’t know one is dead for who knows how long.

    Sister Y

    October 2, 2008 at 9:29 pm


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