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Archive for the ‘suicide rights’ Category

Patholysis, the Destroyer of Suffering

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Enjoy the dark hilarity of sweet, innocent, slightly stupid Dr. Sanjay Gupta getting more than he bargained for in interviewing the (presumably antinatalist) suicide choicer Jack Kevorkian:

Not surprisingly, [Kevorkian] strongly advocates assisted suicide, or euthanasia, or what he calls “patholysis.” Terms matter to Kevorkian, and this is the term he prefers when describing the “medical procedure” he performed on at least 130 people, by his own count.

“Path means disease or suffering,” he said to me.

“And lysis, [sic] means destruction,” I said.

“Exactly,” he answered. Patholysis, he repeated. The destruction of suffering.

Kevorkian at one point asks Gupta if he wants to know the worst moment of his (Kevorkian’s) life. “The single worst moment of my life… was the moment I was born,” he says.

See also: my argument for an“unwanted life” diagnosis.

Written by Sister Y

June 14, 2010 at 3:57 pm

Society for the Protection of Possible Future People

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Adam Ozimek at Modeled Behavior applies the successive-selves metaphysics suggested by neuroscience (examined in detail in, among others, Jennifer Radden’s 1996 book Divided Minds and Successive Selves: Ethical Issues in Disorders of Identity and Personality) to the issue of suicide. He argues:

If one seriously considers the future self as a separate self, it seems to me a serious challenge the Szaszian idea that mental illness is just extreme preferences and that suicide should be respected and allowed as a legitimate exercise of choice; if our future selves are separate selves, then suicide is murder. [Emphasis mine.]

TGGP disagrees on the ground that our present selves and future selves have such united interests that they should be thought of as a single entity. Practically speaking, “If suicide is murder, then spending in the present is theft from a future self, sex is rape and a boxing match is battery,” says TGGP.

This is certainly the reason that “successive selves” thinking will never catch on, true as it may be. Then we couldn’t lock people up for rapes and murders for long periods of time. (How do you punish a past self?) The entire justification for contract enforcement is destroyed.

But I think there’s a deeper reason that the suicide/murder analogy fails. I respond:

My future self is not anything other than a possibility. It’s a possible self. Even accepting the successive-selves view, suicide is no more murder than is abortion or contraception.

There’s a distinction between protecting the “right” of merely possible people to come into existence on the one hand, and protecting the interests of future people provided they come into existence on the other (as we do when we consider, e.g., environmental protection, budget deficits, etc.).

Written by Sister Y

April 1, 2010 at 3:41 am

Liberty and the "Real" Decision Maker

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One of the really interesting ethical questions about suicide (among other actions) is, what counts as the choice of the real person – especially if a person making a decision is shown to have conflicting desires and motivations?

Most of the time when we make decisions, we have conflicting motivations – such is the nature of a decision. Cognitive science research suggests that, most of the time, we don’t even know why we make a particular decision. We may feel that we are carefully weighing the pros and cons of action and inaction based on carefully considered criteria, but most of the time that is not how our brain apparatus actually works. (In fact, some suggest that decisions based on instinct are usually better than decisions made based on more rational criteria.)

Given this background of conflict, should we sometimes forcibly prevent a decision maker from acting until he is certain?

With many decisions and consequent actions – whether to eat a cheeseburger, whether to go to work, whether to get a divorce – people have many conflicting motivations, conscious and unconscious. There’s some value to waiting to make a decision until one is sure – which could include a friend forcibly preventing someone from making a decision until the decision maker is sure – especially since many decisions, like suicide, are irrevocable. But there’s also a cost to waiting to be certain (e.g. time spent being hungry until you eat the cheeseburger or being miserable until you get a divorce/commit suicide).

Taking an action is a decision between two options – acting and not acting. Both have consequences. Forcing someone to not act is making a decision for him and imposing the costs of that decision upon him without his consent.

I think a waiting period for serious decisions (like California’s 48-hour waiting period for marriage) – which amounts to forcing someone to take more time to think about a decision (and imposing the costs of that time on him) – is acceptable if the costs of the waiting period were found to be, on average, smaller than the costs of poor decisions without the waiting period. But this would have to be from a perspective of maximizing happiness, rather than promoting liberty. Waiting periods are paternalistic – I’m not a hardcore libertarian, so I think that can be okay at times where it’s not very intrusive. Ultimately, though, I think not only the decision of whether to act, but the decision of how long to wait before acting, should rest with the actor. And the costs (in terms of suffering) of being forced not to commit suicide are substantial – the longer the delay, the higher the potential costs.

The weirder question, which I’ve been struggling with, is what to do about people whose desire to commit suicide changes over time? If I sign something at age 18 that says I want to be forcibly prevented from committing suicide if I ever try it, should that be enforced when I’m 80 and want to die peacefully? If I want to die at 18, should it make a difference that I might change my mind later? I don’t have much of a framework from which to answer that one.

Chip’s suggestion – that we go with the “one that’s speaking, whenever” – is attractive in its simplicity, humanity, and apparent respect for liberty. But if our society followed it strictly, it would prevent us from ever increasing our happiness by binding ourselves. The whole idea of a contract (from sales to employment to marriage) is to increase our overall happiness by binding the actions of our future selves. Similarly, if I had a fairly happy life but very occasionally went into a despairing funk and wanted to die, I might think I’d be better off if I could prevent myself from committing suicide during that period. (Just as I, in my real incarnation, would feel myself better off if I could prevent my future addled self from docilely swallowing the activated charcoal if a future suicide attempt proved unsuccessful.) Are present and future benefits and costs allowed to weigh against each other?

Do I owe anything to my future self – since, in a sense, it is me? Can I take anything from my future self – again, since it is me – by either imposing suffering by not committing suicide, or removing its “chance at life” by committing suicide? Ethically, do I stand in relation to my future self as toward my present self, or as toward a totally different person?

In response to an email from reader Elizabeth, who also pointed me to the Wilson book – thanks!

Written by Sister Y

February 14, 2009 at 10:44 pm

No Death With Dignity for Potential Breeders

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From The Guardian:

The Italian government has been plunged into a constitutional crisis over the fate of a 38-year-old woman who has been in a coma for the past 17 years. Eluana Englaro was left in a vegetative state after a car crash in 1992. After a decade-long court battle, doctors reduced her nutrition on Friday in preparation for removing her feeding tubes, which her father claims would be in accordance with her wishes.

But in an extraordinary turn of events, the country’s prime minister, Silvio Berlusconi, after consultation with the Vatican, has issued an emergency decree stating that food and water cannot be suspended for any patient depending upon them, reversing the earlier court ruling. On issuing the emergency decree, Berlusconi declared: “This is murder. I would be failing to rescue her. I’m not a Pontius Pilate.”

Justifying his campaign to save Englaro’s life, the prime minister added that, physically at least, she was “in the condition to have babies”, a remark described by La Stampa newspaper as “shocking”. Giorgio Napolitano, Italy’s president, has refused to sign the decree, but if it is ratified by the Italian parliament doctors may be obliged to resume the feeding of Eluana early this week. [Emphasis mine.]

Christ. Really? (Thanks nil.)

Written by Sister Y

February 9, 2009 at 1:04 am

Is Moral Feeling the Same as Conscience?

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In my piece “Problems with Compassion,” I explained a way in which moral goodness and compassion – a desire to do what is best for others in accordance with one’s own values – could get in the way of allowing others to do what is best according to their values.

In the case of suicide, hardly anyone – not even myself – is willing to counsel a particular person that suicide would be a good thing for him to do. And yet, I genuinely believe that suicide can be a moral choice that a person may rationally decide is in his best interests, as do many others. Is this belief in conflict with such unwillingness to apply it in particular cases? Is this unwillingness to advise particular people to commit suicide evidence that suicide is wrong?

Visceral feeling is often in conflict with intellectual understanding of moral issues. When a coyote wanders into my neighborhood, I desperately want to (and, honestly, once did) give it a hot dog out of affection and generosity, even though intellectually I know giving it a hot dog is probably not in the coyote’s best interests in the long term. In a related case, we often can’t help feeding our pets human food, again out of affection, generosity, and perhaps empathy – even though intellectually we know it’s not good for them.

Emotional intuition is, I think, a starting point for moral reasoning. But it is not the end of it. And there are some emotional feelings that are so strong that, in terms of inducing action, not even clear intellectual arguments can overcome them. I think, as with coyotes and hot dogs, this is a sort of akrasia. But, in the case of not being willing to counsel in favor of suicide, I think that it is a relatively benign form of akrasia, so long as one does not go around force-feeding or forcibly hospitalizing or lobotomizing or performing involuntary ECT on people, or supporting these coercive practices.

For a person considering suicide, it can be extremely irritating to hear only an anti-suicide message, and to perceive that one’s doubts about life’s value are not being taken seriously by others. I have often found myself on both sides of this – being irritated, and being the cheery irritator – and I am moved toward greater tolerance toward people who have a hard time taking the right to suicide seriously in any specific case. Still, I have taken a great deal of comfort from #alt.suicide.bus.stop over the years, and I think it is extremely important that a place exists for seriously discussing the possibility of one’s suicide without the usual bias. And I think it has to be anonymous, because nonpartisanship is too much to ask of one’s friends in the matter of one’s suicide.

Written by Sister Y

January 11, 2009 at 7:49 am

The Drug Prohibition and the Right to Suicide

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Back in 1997, in The Atlantic, Ezekiel Emanuel wrote:

Rational people should be able to end their own lives; suicide should remain decriminalized. But to say that is a far cry from saying that people have a right to have others, namely physicians and pharmacists, help them to end their lives. The ability to commit suicide is what Isaiah Berlin called a “negative liberty” — a liberty to keep others from interfering with the individual. The right to euthanasia is a positive liberty — a liberty to have others help to realize an individual’s goal. The justifications for negative liberties are widely accepted, and the Bill of Rights is essentially a list of negative liberties; positive liberties are affirmed only when necessary to ensure robust participation in public affairs and to preserve essential opportunities. It is hard to see how granting a right to PAS and euthanasia is necessary to either of those goals.

In any case, the number of dying patients who have unremitting pain or who want to die and are physically incapable of killing themselves is very small — a few thousand of the 2.3 million Americans who die each year.

There is a right to suicide, claims Dr. Emanuel – a right not to be interfered with. Of course, in practical terms, Dr. Emanuel is terribly mistaken, even in his conception of the right to suicide as a negative right: the state regularly and predictably interferes with individuals attempting to commit suicide. Pro-forced-life U. S. Supreme Court Justice Antonin Scalia has stated, in his concurring opinion in Cruzan v. Director, Missouri Department of Health, that

It has always been lawful not only for the State, but even for private citizens, to interfere with bodily integrity to prevent a felony. That general rule has of course been applied to suicide. At common law, even a private person’s use of force to prevent suicide was privileged. It is not even reasonable, much less required by the Constitution, to maintain that, although the State has the right to prevent a person from slashing his wrists, it does not have the power to apply physical force to prevent him from doing so, nor the power, should he succeed, to apply, coercively if necessary, medical measures to stop the flow of blood. The state-run hospital, I am certain, is not liable under 42 U.S.C. 1983 for violation of constitutional rights, nor the private hospital liable under general tort law, if, in a State where suicide is unlawful, it pumps out the stomach of a person who has intentionally taken an overdose of barbiturates, despite that person’s wishes to the contrary. [Citations omitted.]

Justice Scalia unfortunately states the policy of our country: it is decidedly one of interfering, using as drastic and invasive means as possible, with an individual’s decision to commit suicide.

Even if we did live in the fairy land that Dr. Emanuel apparently hails from, in which there exists a “negative right” to suicide, there is still the problem of means. Dr. Emanuel says that there is no need for “assisted suicide,” because one can perfectly well off oneself, and one has no right to have another person assist one in the act. However, again Dr. Emanuel ignores the sad reality that all would-be suicides face: the only means to commit suicide that are reliable and comfortable enough so as to not be objectionably cruel are in the exclusive hands of doctors. With barbiturates under the strict control of doctors, the “right to suicide” doesn’t mean much.

As long as there is a drug prohibition, there will be a moral need for “assisted suicide.” Remove the drug prohibition – at least, the prohibition on barbiturates – and there will no longer be a moral need for “assisted suicide,” at least for able-bodied people.

Dr. Emanuel assures us that “the number of dying patients who have unremitting pain or who want to die and are physically incapable of killing themselves is very small.” I wonder what he means by “physically incapable” of killing oneself. Unable (or unwilling) to shoot oneself in the head with a shotgun? To slash one’s artery with a knife? To hang oneself? Is the “right” to do one of these things – and potentially be dragged back to life if one fails to die – really all the “right” that is morally called for?

Like many forced life advocates, Dr. Emanuel offers a comforting vision of an imaginary world, to distract us from having real compassion for suffering people in the real world.

Tragically, Dr. Emanuel is the Chair of the Department of Bioethics at the National Institutes of Health.

Edit: In summary, my problem is this: there is a general drug prohibition on sleeping pills that are lethal at high doses, and there are policy reasons for that, however misguided. In addition, there are good reasons why a person should not have the right to expect another person – here, a doctor – to assist him in committing suicide. But when you put these two sensible-sounding propositions together (drug prohibition and no right to assistance), they no longer make ethical sense. One of them has to give.

Written by Sister Y

December 16, 2008 at 5:07 am

A Response to Suicide.org on the Right to Suicide

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Kevin Caruso, in a piece titled “Don’t I Have the Right to Die by Suicide?” attempts to scare people into calling a suicide hotline on the grounds that there is, in fact, no moral right to commit suicide. (Note that Caruso is the one who says we should use the unnatural phrase “die by suicide” instead of the more natural construction “commit suicide” because the latter is hurtful to the friends and family of people who commit suicide.)

Many of Caruso’s questions are answered more formally in my essay, “The Harms of Suicide.” But I think it is worthwhile to have a single document answering a representative set of (implied) pro-forced-life arguments.

Caruso poses questions (typeset in bold), to which I propose answers (typeset in regular typeface):

Do you have the right to devastate your family?

We often “devastate” our families by exercising our rights. Some “devastate” their families by coming out of the closet, or by refusing to be doctors, or by moving across the country, or by refusing to have children. Where concerns of personal autonomy and suffering outweigh the interests of others in maintaining our company, then we do indeed have the right to “devastate” others.

Do you have the right to cause intense, almost unbearable pain for all of the loved ones that you leave behind?

Everyone dies. Nothing we can do will prevent our own death, nor the suffering our death will cause to those close to us. Suicide merely causes this pain to be experienced earlier.

In fact, the policy of suicide prohibition and prevention – not the act of suicide itself – must be seen as a major cause of the special pain and grief suffered by suicide survivors. (Also, not everyone is lucky enough to have “loved ones.” Are lonely people free to commit suicide, according to Caruso?)

Do you have the right to take away any possibility that you would get better?

Who has the right to decide whether a given treatment is in one’s best interests, or not? With physical illnesses like cancer, the decision rests with the patient as to whether a given treatment is worth the suffering it entails. We have the right to refuse treatment. With good reason – many treatments for suicidality, while possibly effective, are so damaging as to simply not be worth the cost. And, as with cancer, for some people, nothing works.

Do you have the right to take away all of the wonderful things in life that you have yet to experience?

Who but me has a right to decide whether the suffering the rest of my life will entail exceeds the value of the “wonderful things in life” I have yet to experience?

Do you have the right to take an action that is a permanent solution to a temporary problem?

One of the most common mushy-headed objections to suicide is that it is a “permanent solution to a temporary problem.” In reality, for many of us, suffering is an all-too-permanent problem.

Do you have the right to cause irreversible brain damage to yourself if your suicide is not completed?

Damage to oneself as a result of an unsuccessful suicide attempt is entirely an artifact of the suicide prohibition. Given a genuine right to comfortable, reliable suicide, this would simply not occur.

Do you have the right to cause yourself to become disfigured if your suicide is not completed?

See above. And, yes, one has the right to cause oneself to become “disfigured” by body modification. But an unchosen disfigurement caused by a suicide attempt is a sad consequence of the immoral suicide prohibition.

Do you have the right to cause yourself permanent paralysis if your suicide is not completed?

See above. Paralysis and akinetic mutism caused by suicide attempts are tragic consequences of the suicide prohibition, not of suicide.

Do you have the right to end your life instead of focusing on ending your pain? (It is the pain that you want to end, not your life.)

The pain may well be permanent. Caruso naively assumes that a given suicide has not done anything to try to alleviate his pain. But, yes, one has the right to decide when one has done enough to try to alleviate one’s pain, and when the pain appears permanent enough that a permanent solution is indicated. One’s life is one’s own.

Do you have the right to not receive treatment for the mental illness that you probably have — the treatment that will make you better?

Generally, we do have the right to refuse treatment – even potentially life-saving treatment – in the interest of bodily autonomy.

Again, “treatment” for mental illness is not a sure-fire way of relieving the suffering that leads to suicidality. Caruso assures us that treatment “will make you better,” but that is hardly the case for all suffering people. It is unfair and cruel to cheerfully assume that anyone can get better if he just tries the next experimental treatment.

I have written extensively on the mistaken idea that suicide is caused by mental illness. Even Thomas Joiner proposes that suicide is not caused by mental illness on its own, but rather by the alignment of the ability to commit suicide with the desire to commit suicide.

And mental illness causes severe suffering. Don’t the mentally ill, as much as the physically ill, have a right to end their pain?

Written by Sister Y

December 16, 2008 at 1:37 am