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The Harms of Suicide

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Citizens considering the issue of suicide generally fall into one of two camps: those who condemn suicide (and people who commit it) on moral grounds, and those who, while acknowledging suicide’s awfulness, excuse those who commit suicide on grounds of mental illness. Along with Thomas Szasz, I fall outside either camp: suicide is a choice for which the actor is responsible – he is not automatically mentally ill for having chosen suicide – but I doubt whether it is often a morally wrong choice. Suicide is both usually morally permissible, and a genuine choice for which the actor bears moral responsibility.

In the interest of clarifying the moral issue of suicide, I wish to catalog the harms attributed to suicide, and, to the degree that space permits, to examine each harm in terms of blameworthiness and in relation to similar types of harm inflicted in other ways.

1. Harm to Survivors – Friends, Relatives, and Others

Suicide opponents often call suicide a form of murder – self-murder. The suicide is viewed as improperly taking himself away from his friends and relatives earlier than they expected – frustrating their expectations.

However, comparing suicide and murder is problematic. People who die by suicide are not “victims” in the sense that people who die by murder are. Consent is a powerful element, transforming rape into consensual sex, slavery into work, kidnapping into a vacation. A suicide’s survivors are not victims, I will argue, because the type of harm that they suffer is a type of harm that the suicide himself, and not a murderer, has a right to inflict as a double effect of refusing to live.

And it cannot be that the harm to survivors is the only – or even the major – reason that murder is wrong. The murder of a lonely person with no relatives is surely no less horrible (or not much less horrible) than the murder of a person with many relatives. Daly & Wilson point out that “tribal people may explain a particular act of seemingly unprovoked homicide to an appalled missionary or anthropologist by pointing out that the victim had no relatives” – that is, there was no danger of retaliation – but to a modern mind, this is hardly a moral defense (Homicide, p. 228).

How much of the harm to survivors is due, not to the suicide itself, but to the suicide prohibition? An ASBS writer writing as “EverDawn” asserts that a great deal of the harm to survivors of suicide – in particular, the perception of suicide as “tragic” – is an artifact of the policy of suicide prevention and its attendant doctrines:

Perceiving an event as tragic makes it difficult to come to terms with, in contrast to an event which is just sad. If a sad event couldn’t have and shouldn’t have been prevented, then there is no blame to be placed, and nobody to be angry at. But a tragic event raises the questions: how could it be prevented, who should have prevented it. This leads to anger (when blaming others) and despair (when blaming self). The questions linger on, unanswered, making it far more difficult to come to terms with the event.

We have been led to believe that suicide should be prevented because suicide is tragic, when in fact, the reason why suicide is tragic is because society has chosen a policy of suicide prevention. Suicide is a sad event, however, the perception of suicide as tragic is a result of the choice society has made – a choice which society is responsible for. Ultimately, society is to blame for the negative consequences of this choice. [Emphasis mine.]

a. Loss of Company, Support, and Other Expected Goods

The most commonly cited harm inflicted by suicide is the harm to the surviving friends and relatives. What, exactly, does that harm consist of? Certainly, it is not merely the fact that the person has died. Everyone dies eventually; suicides are not unique in this. Family and friends must eventually come to terms with all of our deaths. The only special harm attributable to the suicide is that he has died early. The survivors are deprived of an expected period of the company and support of the person who has committed suicide – specifically, that period between the time of suicide and the time the person would have otherwise died. During that time, the lover or spouse no longer enjoys the affection of the suicide, the relative no longer enjoys his visits and presents and sidewalk-shoveling, the friend no longer enjoys his opinions and companionship, the parent may no longer hope for grandchildren.

The problem is that little of this “company and support” (and reproductive capacity) is morally obligatory. A person may, without committing a moral wrong, leave his spouse due to irreconcilable differences or move away from his friends and relatives to pursue a career or refuse to have children. Providing our company is a voluntary act, and we are under no moral obligation to do so. The company and support of a person is a privilege, not a right – with the important exception of a person’s voluntarily conceived children (there is a moral duty to care for one’s children that renders the suicide of a parent of dependent children, rebuttably, wrong).

The losses inherent in a suicide are real, but unlike the losses inherent in a murder, they may be inflicted in the exercise of a moral right. At the very least, we are generally permitted to inflict those losses in other contexts. If suicide is prohibited because of the harm to our mothers, should we also be legally forbidden to move away from our mothers?

(See also, “Is Suicide a Waste?“)

b. Knowledge of Permanent Loss

A loss of companionship and support is upsetting, but perhaps a suicide is worse than moving away, because it creates a knowledge in the survivors that the loss is permanent. It removes hope of an eventual return and reconciliation.

But do people have a right to this (often irrational) hope? Move-away losses and other estrangements are frequently permanent. While the knowledge of the permanence of the loss may be painful, it is also valuable to know the truth. The survivor of a suicide may be in this way better off than the person left behind in an estrangement he stupidly refuses to admit is permanent.

c. Discovering and Disposing of the Body

A very visceral harm must be suffered by someone in any suicide: the discovery and disposal of the body. Where the discoverer is a relative or close associate, the shock must be even greater.

While discovering the body of one’s spouse or friend or child must necessarily be awful, it is (a) an artifact of the suicide prohibition that this must happen, and (b) possibly preferable to a suicide’s being “missing” for days or weeks (or more) prior to discovery. Given the suicide prohibition, privacy and a controlled environment are essential to a suicide’s success; his own home is often the only place where these are possible. Legal, preplanned suicide, perhaps taking place in a hospital, would eliminate this harm. (See “In Defense of the Man Whose Wife Finds Him Hanged” for more on this.)

Frequently, as with suicides who jump in front of trains, another must suffer the great harm of being the unwilling agent of death for the suicide. This is unfortunate, and I see these suicides as particularly morally questionable. However, this harm (in fact, this type of suicide) is an artifact of the suicide prohibition and would disappear if reliable suicide that did not cause harm to bystanders were commonly available.

Everyone dies of something. And we can’t bury ourselves. Therefore, for every human being who has ever lived, someone must discover and dispose of the body (except, perhaps, for those who expect to be bodily lifted to Heaven by fairies upon expiring). It is mistaken to attribute this harm only to suicides. It is part of our humanity that we must inflict this harm on others – suicides and non-suicides alike.

2. Harm to the Suicide Himself

Those comfortable with paternalism often argue that suicide must be prevented – indeed, it displays a lack of compassion to allow it – because of the harm to the suicide himself.

a. Loss of Future Experiences

The harm inflicted by the suicide upon himself must be the deprivation of future experiences. Think of all the puppies and sunsets the successful suicide will miss out on!

However, by committing suicide, a person affirms that, in his evaluation, the expected future gains from living are not worth the expected costs. A number of people support this line of thinking when in comes to people dying of a terminal illness. But why would people dying of a terminal illness be the only people miserable enough to rationally want to die? Hope is not necessarily rational. Prohibiting suicide amounts to substituting one’s own (poorly informed) judgment for the suicide’s own (immeasurably better informed) judgment of the degree to which his life is worth living.

I have argued elsewhere that suicide is not, as many believe, the irrational product of mental illness. But what about suicide committed on impulse? Perhaps a person’s “self” evaluates the situation at time t and decides that suicide is preferable, but later, at time t plus 24 hours, he might decide he was mistaken, and dearly wish to keep living.

First, given the existing barriers to suicide, a suicide that appears “impulsive” may actually reflect the genuine rational desires of the suicide. The person who rationally prefers to die may be unfairly prevented from doing so by legal and practical barriers; he may need an “impulse” to push him over the edge and enact his rational desire. (I experienced this with my most serious suicide attempt, and I would definitely feel benefited from a renewed “impulse.”)

Second, there is evidence that suicidality is not impulsive and fleeting, but is in fact very permanent over the lifespan.

Third, even if we could be certain that a would-be suicide would be glad to be rescued (we can’t), this would not be a strong moral reason to prohibit suicide. The victim’s being “glad it happened” after the fact does not render interference morally justifiable.

b. Harm from an Unsuccessful Suicide Attempt

Harm inflicted by an unsuccessful suicide attempt is entirely an artifact of the suicide prohibition, not a harm inherent in suicide.

c. Failed Signaling

Many consider the proper response to a suicide attempt to be to universally interpret it as a cry for help. A successful suicide may be seen, then, as a failed signal for help. But this attitude benefits neither serious suicides, nor would-be signalers! Again, the idea of “failed signaling” is an artifact of the suicide prohibition.

In order for a person to send a reliable signal, the suicide attempt must appear lethal while not actually being lethal. If comfortable, reliable suicide were legally and practically available, there would be very little value in choosing any other method, and any other method would be less lethal than the medical option. This would interfere with the apparent lethality communicated by a suicide attempt, thereby decreasing the motivation to make a “signal” attempt in the first place.

What an insincere suicide attempter – a “signaler” – really wants is to be rescued. That is, he wants to be forcibly prevented from committing suicide, because he does not really want to commit suicide. Remove the possibility for rescue, and you remove this insincere suicide’s motivation to make the potentially harmful attempt in the first place. It is the suicide prohibition, and not suicide itself, that causes this harm to the would-be signaler.

Written by Sister Y

November 11, 2008 at 5:46 am

Thomas Szasz: "Suicide is not a medical matter"

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Thomas Szasz traces the parallels between suicide, contraception, and abortion – especially the “mental illness” (depression and threatened suicide) that, before the days of Roe v. Wade, was a pregnant woman’s only hope of getting a “therapeutic abortion”:

Regrettably, our memory of the history of medicalization is short and selective: We remember its glories and forget its infamies, especially as they relate to sexual behavior. When I was born, contraception was under complete medical control and abortion was illegal. When I was an intern in a Boston hospital, offering contraceptive advice, much less providing a contraceptive device, was a criminal offense. Only in 1965, in the celebrated case of Griswold v. Connecticut, did the Supreme Court strike down as unconstitutional the statute that made it a crime for a person to “artificially prevent contraception.” In that landmark case, the Court repealed the law that prohibited a conduct the law deemed illegal. It did not medicalize the alleged “condition” that motivates such conduct: The Court did not call the fear of pregnancy and the desire to avoid it a “disease,” nor did it call engaging in the formerly prohibited conduct “physician-assisted contraception” or classify it as a “treatment.” In short, the right to practice contraception was placed in the hands of the people, not in the hands of physicians.

Abortion underwent a similar metamorphosis, from sin to crime to right, with a brief stop-over as a treatment. When abortion was legalized, the mental illness whose treatment justified therapeutic abortion vanished. When suicide is legalized, the mental illness whose treatment justifies its therapeutic prevention will also vanish.

Although performing an abortion and developing effective methods of birth control entail the use of medical knowledge and skill, abortion and contraception are not medical matters. The same is true for suicide. Although killing oneself with a drug entails the use of medical knowledge and requires access to the necessary substance, suicide is not a medical matter. We ought to deal with death control the same way we have dealt with birth control: by removing it from the purview of Medicine and the State, by repealing all medical and legal interference with the act. [Bolded emphasis mine; italics in original; citations omitted.]

From Fatal Freedom: The Ethics and Politics of Suicide, by Thomas Szasz.

Written by Sister Y

November 10, 2008 at 6:34 am