in Philosophy, Thinking about psychiatry

Examination of the concept of ‘rational suicide’

It has been estimated that approximately 1 000 000 people die of suicide yearly worldwide  and whilst most studies indicate that people who commit suicide have a disturbance of mental functioning this does not exclude a relatively small number of people who, for whatever reason, might express the wish for an early death but yet lack any state that may impair their mental function.  For these people the paternalistic approach applied to many with a desire for suicide appears less appropriate and has lead to the notion of a ‘rational suicide’.  Many people feel strongly that this option for rational thinkers to end their lives should be available and argue that there is a historical precedent; it was in reference to manner of Socrates’ death that Compassion and Choices, an American euthanasia pressure group, was initially called the Hemlock Society.

The emergence of rational suicide as a concept has happened within a framework of contemporary era cultural, technological and philosophical shifts where individualistic attitudes lead people to treat their own goals and desires as paramount whilst advances in medical treatments have lead to increased lifespan.  Therefore at the end of life we are both encouraged, and afforded more opportunity, to contemplate the manner of our own passing.  Judgement of suicide has simultaneously moved away from assigning a successful suicide to be a moral or religious failure towards one where most suicides have come to be seen as the result of disturbance of mind.

Werth and others have suggested criteria under which a rational suicide should be allowed.  That these are notably circumscribed reflects the negative value that suicide generally holds and the concerns of others with this approach.  Proposed are that for a suicide to be considered rational the person in question must have an unremittingly hopeless condition, should make their decision as a free choice and have engaged in a sound decision making process, including assessment by a mental health professional.

Despite the face validity of this line, analysis of what is meant by ‘rational suicide’ and its implications reveal a more nuanced situation than the casual inquirer might anticipate.  From the definitions of the word ‘suicide’, taken from the latin sui meaning ‘of oneself’ and cidium meaning ‘to slay or kill’, and that of rational, an act that it is characterized by reason or is intelligible, sensible, or can be understood , one can surmise that ‘rational suicide’ is self slaying that is characterized by reason or ‘makes sense’ to others .  The arguments in favour of rational suicide generally come in two flavours.  The first emphasizes the need to respect an individual’s autonomy, the modern meaning of which was developed by the philosopher Kant.  In common usage it implies ‘being one’s own person or being able to act according to one’s beliefs or desires without interference’.  Kant expressed it as a respect for persons and wrote that to violate a person’s autonomy is to treat them as a means rather than as an end in themselves.  The ‘right to die’ is then an expression of the most extreme form of autonomy, that is the right to choose the time and manner of one’s passing.  The second argument in support of rational suicide involves the ability of an individual to make rational assessment of utility or ‘good’ that is gained by ending their life and here proponents argue that suicide can provide freedom from painful and hopeless disease.  In this argument the consideration that an individual has for their quality of life is of paramount importance.

However the concepts of autonomy, utility and rationality alone are inadequate arguments for the acceptance of rational suicide as none are ever identifiable in so pure a form as to be considered a philosophical trump card.  Werth’s guidelines are first and foremost pragmatic and with an irreversible decision at stake the standards of rationality must of necessity be high.  To come to a conclusion that an act or intention of suicide is reasonable is not a straightforward matter.

We must also recognize that in seeking a rational suicide, the components that inform this decision are culturally determined, thereby introducing considerable subjectivity and possible external disagreement.  Furthermore if the decision to end one’s life is informed by persistent suffering, then it is unlikely to be made on entirely non-emotional grounds and likely to be subject to cognitive distortions.  It is a curious position to seek to solve a problem in life, by ending the life itself and those intending a rational suicide would presumably actually prefer to be alive, just not under the current circumstances, indicating the presence of significant ambivalence regarding their decision.

There are few people who would argue that autonomy for a patient, at any stage of care, is not important.  However when we respect autonomy we are respecting a person’s right to exercise their right to make independent decisions about their life and these decisions will be made on the basis of considerations which are consistent with a person’s moral values or a personal code.  These values or code would ideally be independently derived; however this is not possible as people are heavily influenced by such things as their culture, parents and friends.  Thus the sense of autonomy as the exercise of independent thought is compromised.

Alternatively, if one wishes to frame rational suicide as the outcome of an audit of a life’s merits and demerits a pertinent question is what the continuation of this life is to be weighed up against.  If the decision is to be truly informed this should involve gaining all possible facts and imagining all consequences.  However since the experience of being dead is entirely unknown it is questionable whether it is possible to adequately foresee the outcome of one’s actions in this regard.

These concerns indicate that it may be difficult to satisfactorily reach a conclusion that rational suicide is possible.  The concept of a suicide being ‘understandable’ is probably more meaningful and suitable although may not carry the same weight.

Comment on this piece

Life is a disease so cut the bullshit please

Further reading:

Autonomy, rationality and the wish to die Clarke Journal of Medical Ethics 1999;25:457-462
A Primer on Rational Suicide and Other Forms of Hastened Death Werth and Holdwick The Counseling Psychologist, Vol. 28, No. 4, 511-539 (2000)
Rational suicide: uncertain moral ground Rich and Butts Journal of Advanced Nursing Volume 46 Issue 3 270 – 278

Encyclopedia of  death and dying – suicide types

Suicide – a rational choice?

The economics of suicide – Slate magazine

Thought for the day 9 June 2009

Addendum 23 June 2009 Neither euthanasia nor suicide but end of life choice,  Guardian 23 June 2009.  More about physician assisted suicide than rational suicide but the comments are interesting, as they touch on many of the issues raised above

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  1. I personally think all the ‘theory’ on this issue is nonsense. The bottom line is that if anyone is in a position to rationally want to commit suicide, then it’s a masive failure of the NHS. Nobody, I mean NOBODY should EVER have to fear dying in pain or humiliation. That is what hospice care is for. And because doctors are protected by the doctrine of double-effect, they can give somebody enough medication to make them comfortable even if they know that it would kill them. So the whole argument’s a moot point really.

    If anyone can give me one situation in which life is so bad that death is preferable, and nobody can do anything to restore the balance, then by all means please do so.

  2. Sorry, I didn’t mean to say it was necessarily always a failure on the part of the NHS. That’s just one example.

  3. FP

    “Furthermore if the decision to end one’s life is informed by persistent suffering, then it is unlikely to be made on entirely non-emotional grounds and likely to be subject to cognitive distortions.”

    I’m not sure the presence of emotion or suffering necessarily calls into question the rationality of a person’s decision. Let’s imagine a person who is suffering so much and in such a hopeless way they wish to die. However a miraculous medical discovery means a treatment becomes available that would remove their suffering yet carries a small but non-negligible risk of death. Surely the decision as whether or not to proceed with the treatment would also be subject to the same ‘cognitive distortions’ and emotion you draw attention to? However in this case we rarely think it appropriate to query the suffering person’s ability to reason. I guess my point is that the extent to which we agree with a person’s decision determines in part the extent to which we draw attention to reasoning biases and cognitive distortions.

    I also don’t know of any decisions that are made on entirely non-emotional grounds. In fact, making any decisions is almost impossible without emotion – it’s an essential part of the reasoning process.


    You may be interested in these online Yale lectures on the rationality of suicide.

    As the lecturer points out, there are many conceivable instances where death is preferable to a life of unremitting pain and torture.

  4. But that only applies if you assume that you know with absolute certainty that life is going to continue to be full of unremitting pain and torture. When is that ever certain?

  5. We can’t really be absolutely certain of anything. We continually have to make decisions on the basis of high probabilities. It is highly highly probable that we will all die, yet not ‘absolutely’ certain. Unfortunately we can conceive of lives where the probability of intense, unremitting suffering and pain without hope of recovery is about the same as the probability of death (i.e., near certain).

    For example, I would probably wish to die rather than endure a long, slow degenerative brain disease such as Alzheimar’s. For me, life would not be worth living. I do not wish to become incontinent and to lose my sense of self – it’s not pain exactly but the humilation and loss of identity means I see little point in enduring such a process. There is also currently no cure. I do not believe it is brave or cowardly to commit suicide in this context; courage has little to do with it. Such a decision is perfectly rational – indeed I’m sure someone could make a good case to say that wishing to continue to live during the end stages of certain illnesses is somewhat irrational.

  6. The problem with that is that, like I said, many people fear a humiliating and painful death from a terminal illness, merely because that is what society associates with that particular disease and they do not consider what a huge difference palliative care can make. My great aunt died of ovarian cancer, and because of the hospice care she received, she was not in any pain when she was dying, nor when she died. There was no drama, no alarms going off, she just went peacefully.

    My point is, people think that dying from a terminal illness is always bound to be extremely painful, but these days there is absolutely no need for anybody to die a painful death from a long-term terminal condition.

    However, I will grant you that there are some cases in which the decline of mental function associated with diseases like Alzheimers, Huntington’s, and other types of dementia would be unbearable. I think it may be possible for somebody to rationally want to commit suicide to avoid that.

    I don’t think you could argue that people who did want to continue to live would be irrational. People have their own reasons. If you want to respect the right of some people to want to die, you have to also respect that some people want to live as long as they possibly can. Some people are less bothered by things like incontinence than others are. Some people may decide they can live with that, in order to spend more time with their loved ones. That’s a personal choice.

  7. Thank you very much for your comments – this site has been somewhat wanting for them recently so I am pleased to get some feedback. Sorry for delay in replying.

    Sarah – Alas I think that it is inevitable that some people will die in pain, if not physical then certainly psychological or metaphysical. it remains, for me, at least conceivable that there are people out there who might find themselves in considerable discomfort before they die. There is a lot of talk about rational suicide being simply for terminal illness. If we were to truly allow rational suicide, then would be not have to allow it for anything at all?

    Paul – I’m writing this from the position that human is an organism that seeks life and whose modus operandi is to fight for it at every opportunity that this is necessary. Therefore to seek life saving treatment is not a choice vulnerable to distortions but rather what we do, the essence of our being. The argument for life is already made, just by an individual’s existence.

    You say that making a decision is almost impossible without emotion. But if a suicide is to be called ‘rational’, then it should it not be made with a minimal emotional component? And if important decisions are all emotional to a lesser or greater extent then again ‘rational suicide’ cannot meet the stringent criteria that its name implies.

    You also state that there are conceivable instances where death is preferable ‘to a life of unremitting pain and torture’, however this scenario cannot be anything but a caricature as the reality will be more complex than a life consisting purely of suffering. If a person wishes to commit suicide then to qualify for this to be ‘rational’ then they must have a minimal amount of ambivalence regarding the act. Again, to my view, ‘rational suicide’ cannot but fail to meet the criteria which its name implies as someone will have many conflicting emotions about their wishes.

  8. interesting

    “Werth and others have suggested criteria under which a rational suicide should be allowed”

    Not sure what you mean by “be allowed” as suicide is legal, so it’s the assistance of it that is at issue surely.

  9. That is a very good point – I think that I was mixing up, in my head at least rational suicide and physician assisted suicide. Perhaps this should be corrected to

    Werth and others have suggested criteria to guide the recognition of such a suicide.

    There is the situation were someone might wish to kill themselves and a physician not be asked to help where there is still an element of ‘allow’ to the act. If, say, we were standing next to someone who was going to attempt ‘non-rational’ suicide, we would feel a moral obligation to intervene – i.e. we would not allow it but if someone were commiting a suicide agreed ‘rational’ then would we feel the same compunction?

  10. I agree with Sarah. It is never rational to want to kill yourself as it doesn’t make things better or take away pain, it takes away everything. It’s not closure, it just means you die in a terribly unhappy and unwell state. I really believe that everyone who wants to kill themself can be made to feel better given the right treatment and care. I think that most people in this position view the fact that they once wanted to kill themselves but were stopped from doing so as being a genuine second chance.

  11. “Paul – I’m writing this from the position that human is an organism that seeks life and whose modus operandi is to fight for it at every opportunity that this is necessary. Therefore to seek life saving treatment is not a choice vulnerable to distortions but rather what we do, the essence of our being. The argument for life is already made, just by an individual’s existence.”

    Perhaps – but your point was that the level of emotion involved would surely lead to cognitive distortions (let’s say high emotion = impaired decision making capacity). My point is that the same amount of emotion is involved in any life or death decision. You might respond by saying it doesn’t matter when people are making the right decisions. I might agree with you, but I might also suggest “that’s a separate point!” That is, we should not confuse our judgements of the wisdom of the decisions people make with our judgements of their ability to make those decisions. That is, let’s not assume immediately that if someone decides to end their life they do not have the capacity to make the decision.

    “You say that making a decision is almost impossible without emotion. But if a suicide is to be called ‘rational’, then it should it not be made with a minimal emotional component? And if important decisions are all emotional to a lesser or greater extent then again ‘rational suicide’ cannot meet the stringent criteria that its name implies.”

    Clearly this depends on professionals assessing that a person’s ability to make a decision is not significantly lower than an accepted standard. Certainly, the gravity of the consequences of the decision should rightly influence the choice of standard. Equally though, we should not let our discomfort about suicide influence the stringency of the standard of rationality we require people to meet. I expect that the same standard we require for people deciding whether or not to have a life-threatening operation would be appropriate.

    “You also state that there are conceivable instances where death is preferable ‘to a life of unremitting pain and torture’, however this scenario cannot be anything but a caricature as the reality will be more complex than a life consisting purely of suffering.”

    Yes, I accept that life will of course be more complex in the majority of situations but that does not detract from the argument that the overall degree of pain and torture present in a life might be such that it is rational to want to end that life.

    “If a person wishes to commit suicide then to qualify for this to be ‘rational’ then they must have a minimal amount of ambivalence regarding the act. Again, to my view, ‘rational suicide’ cannot but fail to meet the criteria which its name implies as someone will have many conflicting emotions about their wishes.”

    I struggle to see how a rational decision requires a minimal amount of ambivalence. If a person decides to leave their job / country / wife despite having conflicting feelings over the issue, then we do not immediately assume they are being irrational. Rather we assume they have weighed up the information and decided the pro’s outweigh the con’s. If a person has to decide between a new experimental treatment (with, say, a 50% survival rate) or death within 2 years we do not assume ‘a priori’ that any decision they make can never be rational merely because they might have conflicting feelings about it.

    I would urge everyone to watch the freely available Yale philosophy lectures on suicide, available here (scroll down and click on either lecture 24, 25 and 26):

    Professor Shelley Kagan argues very convincingly that suicide can, in certain situations, be rational.

  12. Please forgive the brevity of my reply in light of your long and well thought out response. I am doing night shifts which are rather limiting.

    A key distinction, which I don’t consider to be just semantics, is that between ‘rational’ and ‘understandable’. To my mind a suicide in light of terminal illness may be understandable’, but cannot meet the criteria for ‘rational’.

    An argument not mentioned above for rational suicide is that it is a decision of ‘whether to die now or later’. This is quite a powerful approach in favour of suicide as an understandable act, but holds little weight for calling something rational.

    There may be something in your comparison between someone making a decision between an operation with a high mortality rate and someone wishing rational suicide. If you buy my assertion that humans are ‘life seeking’ then a distinction can be drawn between the two in terms of intentions. One seeks to postpone death – in line with instinct, the other to hasten it. They are thus not equivalent; an irreversible act such as suicide should demand the highest level of reasoning for it to be deemed acceptable. Whether or not we also equate an potentially hazardous operation to this level of accountability is a matter for debate, but not automatic.

    Ambivalence: Motto, referenced (#26) in Autonomy, rationality and the wish to die (link above – I can send you a copy of this if you cannot access it yourself) states that a rational decision has two characteristics: being realistic and having minimal ambivalence. “The first criterion addresses the importance of gaining full knowledge of the options and consequences, the second the potential problem of transient desires being inconsistent with a person’s more longstanding and fundamental values”. That’s why I included it. I think that the point that someone who wishes rational suicide doesn’t actually wish to die is informative.

    A note on the writing of the above post. It’s meant to be a review of the arguments either way and not to come down for one point of view. Problem is that the argument in support of rational suicide are quite straightforward and do not require a lot of explanation. To my mind they come close to an ideology. The arguments against are more subtle and require explanation, and therefore more column inches. Thus the above article comes across of quite bias I think when in reality it is not. However my personal view remains that although a suicide might be seen to be understandable, it cannot be rational.

    Thank you for the lectures I will listen to them when I can.

    BBC R4’s Unreliable evidence had an episode on The law and death which is worth a listen

  13. Thanks very much for the links and I’ll have a read of the Clarke paper.

    My initial thought is that the definition of rationality offered is interesting but probably superceded, rightly or wrongly, by the concept of decision-making capacity (DMC).

    BUT it seems to me the main problems with DMC are all to do with the ‘personal identity problem’. That is, a person may have intact DMC but how do we know the decision they want to make is ‘their’ decision? It may be that a person’s values change following an alteration to their psychological or biological make-up, without their ability to make decisions actually being affected (this argument has been raised by Tan et al in the context of anorexia). The extent to which society should or should not accord respect to this new set of values and their influence on a person’s decisions is of course very difficult to figure out (and we should note the personal identity question is often only asked when the decision the person is trying to make is one society regards as unwise).

    I mention all this because I’m struck by the similarity between the problem of ambivalence (“the potential problem of transient desires being inconsistent with a person’s more longstanding and fundamental values”) and the personal identity problem. My personal opinion is that while such concepts seem important to consider, I would bite the bullet and say DMC is all that ultimately matters.

    I certainly agree with you that the irreversibility of suicide requires an individual to demonstrate a high level of reason or DMC. However I would be wary of setting the bar too high as this could in effect become a way of prohibiting the act. Suicide is always a deeply tragic event and devastating for those left behind. I would, however, encourage people to also consider the moral problems associated with effectively compelling people to endure a level of pain, suffering or humilation that you would not wish on your worst enemies. Although such pain, suffering and humiliation may be rare we have to accept it exists.

    If we appraise all suicide as irrational then we run the risk of doing the person who has died one last final injustice; failing to bear proper witness to the extent of their suffering.

    This particular, heartbreaking question on the ‘Ask Philosophers’ site comes to mind:

  14. I’m a bit late to the party, but this touches on a couple of issues I’ve been thinking about recently. I think you provide a reasonable overview of the situation, but I take exception to two specific points.

    First, the assumption that to seek life is the essence of our being. Certainly I’ll grant you this appears to be the default position and there’s rather a lot of extraordinarily irrational behavior conducted in its support, but I don’t think that’s adequate to declare it a universal. It simply isn’t as important to me as some other things, such as autonomy. Unfortunately I’m not sure how to debate this point beyond my assertion that it is possible for individuals to vary from the norm, and I think this is an issue where it sometimes happens; it’s a fairly fundamental issue to disagree on, I suppose.

    Second (or the same continued, really), that “…those intending a rational suicide would presumably actually prefer to be alive, just not under the current circumstances, indicating the presence of significant ambivalence regarding their decision.” I would argue that you are presuming far too much, here; or you are being entirely unreasonable with your application of “the current circumstances”. There are a great many easily conceived situations in which the circumstances an individual identifies as intolerable are astronomically unlikely to change; anything from the old standard of terminal illness to an irreconcilable philosophical disagreement with the remainder of society to the very fact that, as you claim, the state of death is an unknown experience. If a friend told me he was entirely fed up with not being certain of death and wished no more delay in resolving the mystery for himself, then given due consideration of the other relevant factors I should see nothing in that to make me doubt his judgment.

    Ultimately I’m forced to concede that you may be right, and my position on this is bordering on or actually ideological. I’m not interested in bowing out in the immediate future (still have a few places to visit, and such); but to be told that I may die by any accident of fortune or any stranger’s hand but that I may never take ownership of myself and decide my own fate without being judged irrational comes across as indescribably presumptuous and irreconcilable with any philosophy that claims to care for individuality.

  15. Karl – I think it is very reasonable to point out that, for many people, the value of autonomy and freedom from pain outweigh the value of life. It is wrong to force the latter value on them merely because it is the predominant value.

    MF comments above that “suicide is legal.” This is true in a limited sense – suicide itself is not punished criminally. But, interestingly, suicide is the only non-criminal act that can be prevented by force. It is the only non-criminal act the assisting of which is a crime. And, most importantly, the only humane means of death – overdose of barbiturates – is illegal (unless prescribed). Legal methods (gunshot, hanging, opening an artery) are painful and likely to result in injury and horrors – they are considered too cruel for even convicted murderers or animals. These factors together function as a de facto suicide prohibition.

  16. One of the points of bias in these oft debates is the context in which they are applied.

    In some contexts murder is ‘understandable’ (rage) and can even be considered ‘rational’ (self defence) – yet it does not make it a desirable thing.

    I’m 40 and have no chronic illnesses. My suicide now would not be ‘understandable’. I have no intention of it either.
    However, I can at this moment in time say that I can foresee circumstances in which I would prefer to die than to go on living. The fine points aren’t there – but generally speaking; being a burden to others, chronic physical or emotional pain and a general sense of the ongoing torment of hope outweighing the likely suffering in the wait.

    If those circumstances are met and I will address the fine points as they need to be. If I then complete suicide – being of rational and uninfluenced mind at this time where I have already set out this process of determination – could such an action be considered rational?

    I also find it of great interest that Kohlberg, the grandfather of moral reasoning and presumably highly rational, should end his life by walking into the sea.

  17. Somewhere over the rainbow- way
    up high
    in the land
    that I heard of once
    Once in a lullaby

    Somewhere over the rainbow- skies
    are blue
    and the dreams
    that you dare to dream
    really do come true

    Someday I’ll wish upon a star
    and wake up
    where the clouds are far behind me
    Where troubles melt like lemon drops
    away above the chimney tops
    that’s where you’ll find me


    Someday I’ll wish upon a star
    and wake up
    where the clouds are far behind me
    Where troubles melt like lemon drops
    away above the chimney tops
    that’s where you’ll find me

    Somewhere over the rainbow
    skies are blue
    and the dreams…that you dare to dream
    really do come true
    If happy little bluebirds fly
    above the rainbow, why
    Oh, why can’t I?

  18. You ask under what conditions a suicide could be considered rational, I’d like to venture upon an even more fundamental issue and ask why a suicide should be rational in order to be morally acceptable or at the very least be allowed to take place. I base this argument upon the principle of legality: where there is no crime (as stipulated by the law) there should be no punishment. In a society under the rule of law no one should be detained against their will unless they’ve been charged with a crime, if that is the case they have the right to stand trial and have their case heard by an impartial judge or a jury. In order to be convicted and imprisoned the public prosecutor should prove beyond any reasonable doubt they’ve committed the crime they’ve been accused of (A it’s a crime and B they did it). Since suicide is not a crime the attempt at suicide is ipso facto not a crime either, what is not forbidden by law is by definition allowed and cannot be punished hence my question: even if an attempted suicide was clearly irrational still no crime has been committed and there is no cause for lawful imprisonment, where then does psychiatry get to be the exception to the rule and be awarded absolute authority and power over people’s lives? Surely they’ll sugarcoat it and call it ‘being committed’ or ‘protective custody’ and lofty ideals will be invoked (all throughout history people have been locked up, punished and brainwashed ‘for their own good’ and to make them see ‘the error of their ways’) but the basic fact remains: no crime has been committed and yet people are locked up against their will. This is both illegal and immoral and I don’t understand why a respected and humanitarian profession such as medicine would lower itself to such vile practices.

    “Would a rose by any other name not smell as sweet?” If imprisonment were to be called by any other name would it be less punitive and degrading? Psychiatrists are lucky a lot if not most of their patients are so messed up mentally they forego their rights and don’t press charges against them or many a career would be cut short. Surely no judge worth his or her salt will cast aside one of the most fundamental principles in the legal system and the constitution. So called mentally ill people, especially those wanting to commit suicide, are worse off than criminals since they have fewer rights (committed psychiatric patients have about the same legal status as minors) and are basically left at the mercy of their attending psychiatrist and the folly of society as a whole. While you can’t be arrested for thinking about committing a crime (murder, theft…), suicidal ideation is apparently enough to rob people of their liberty and lock them up against their will. In physical medicine treatment cannot be forced upon you, in psychiatry it doesn’t matter what you think or want as long as someone with a medical degree signs off on a paper declaring you unsound of mind. Surely I’m not the only one who has a serious problem with this?

    Why should there be an intervention if you intent to hurt yourself but not others? Lets compare suicide with alcoholism: the law does not forbid alcoholism in itself (you have the right to drink yourself stupid every night if you so wish) but the police will arrest you if you drive drunk, hit your wife or cause a ruckus in public while under the influence. Clearly if you pose a danger to others society has the right to neutralize that danger as long as it happens according to the relevant law, however the law explicitly recognizes individual autonomy (one of the most basic rights of all) and your liberty to do as you please as long as it does not harm others. You can’t have it both ways: either you grant people liberty and allow them freedom of choice even when they do something you absolutely abhor or you deny them their liberty and attempt to control every sort of behaviour that is deemed unacceptable. The liberty to do as you please as long as it’s within the norms and values of a certain system (far beyond merely respecting the rights of others) is not liberty but slavery: in that sense even citizens of the Third Reich were free, at least as long as they did what they were told and didn’t oppose the regime in any way. Clearly this is rather absurd. In Soviet Russia political protesters and critics of the regime were regularly committed to psychiatric hospitals and detained against their will, drugged or electrocuted until they were ‘cured’ (that is conformed to the political status quo and gave up their cause and ‘subversive ideas’). How does that differ from the current practice of locking up, drugging and applying ECT to would be suicides? In both cases behaviour and in so far as that’s possible convictions and opinions were modified through punitive measures, incarceration and the forced administration of mind-altering drugs or invasive physical therapies. This is hardly compatible with the notion of individual freedom and human dignity.

  19. A note on your notion of the need for suicide to be intelligible to others in order to be considered rational: why should this be the case? Who are these others you speak of? The family, friends, enemies, doctors, philosophers, politicians, debtors, one’s employer, your average joe? Each of these categories would probably have different criteria in terms of intelligibility and a lot depends on your definition of rationality, the meaning of life and its underlying values. If a slave escaped his owner’s custody in pursuit of liberty and freedom from oppression his action clearly would be rather unintelligible if not completely irrational to the slave-owner (he loses property and profit), yet from the standpoint of the slave his escape was entirely rational and completely in accord with his self-interest and values. Naturally the slave-owner will do anything he can to discredit the slave’s claim to rationality, morality and justice (going as far as to invoke the notion of a natural hierarchy of men, blatant racism, the god given right for his race and/or social class to rule over others and even the absurd argument he only acts in the best interest of poor black folk since they’re obviously incapable of self-regulation and would surely resort to barbarism if it wasn’t for his kind intervention). The situation of a would be suicide is not that much different: he too desires to escape oppression, pain and unbearable conditions, his efforts too are thwarted by any means available and his liberty denied on the grounds of weak sophisms and pseudo-scientific justification. If others can prevent you from dying when you want to you are completely at their mercy and you are their slave (de facto if not de jure) since self-ownership and freedom of choice is what constitutes individual freedom.

    Society has a stake in keeping suicidal people alive not because it has the best interests of the suicidal at heart (if they did they would allow euthanasia in case of unbearable and unmedicable suffering no matter the variety) but because the very topic of suicide is one of the last taboos in the modern world and it invokes blind & irrational fear in people’s hearts: both because it reminds them of the inevitability of death (the same reason why the elderly and the sick are segregated from so called normal and healthy people) and the very real possibility life can become so bad the natural instinct of self-preservation gets overwritten and death (while still feared in most cases) becomes desirable as a means to an end. The prospect of grave suffering, misfortune, the malice of others, the absence of objective values or objective meaning to life is indeed ghastly and people generally do not want to be reminded of how their lives are subject to change and chance (what you have today you may lose tomorrow, in the blink of an eye all one’s hopes, dreams and prospects may be shattered) and how they are building on quicksand, with death as an ever present and inescapable certainty.

    People commit suicide, not because they are mentally ill (even if they were this does not preclude rational thinking and sound decision making), but because they suffer unbearably (be it mentally or physically) and they have exhausted the means of alleviating that suffering and correcting unacceptable life-conditions. No one rushes into his death without good cause since thousands of years of evolution have instilled in us the will to live and nothing but the greatest misery, abject suffering and complete loss of hope will impel us to bravely overcome the greatest resistance and seek our own deliverance. Thinking about death and wishing one’s own demise is not a symptom of a mental illness but of very grave suffering and it’s perfectly normal in certain, suprisingly common, situations (make the circumstances in which one has to live sufficiently bad and nearly everyone will take their own life). With the amount of suffering in the world it’s a miracle no more than one million people commit suicide each year and as Camus stated ‘all healthy men have thought of their own suicide’, a variant of this would be Cesare Pavese’s ‘no one ever lacks a good reason for suicide’. I’m fairly certain almost everyone of us has had moments in which we contemplated death and said to ourselves we’d be better off dead (indeed a very strange strong case could be made here, even for all of mankind and not just individual cases), how then could the same action be called pathological and a sure sign of an illness (which can’t even be proven empirically and defined properly: when we ask what depression is we get the answer it’s the presence of a persistently low mood while one of the key symptoms is persistently low mood, when we ask what the sickness is that affects the brain causing this persistently low mood we get some vague, incoherent mumbling about serotonine). In short: suicide is a moral issue, not a medical one.

    We as a humane society shouldn’t be prolonging people’s suffering and keeping them here at all costs (even to our own humanity and morality) when its clear their limits have been reached and their will to live exhausted. If anything (given the notion that suffering is necessarily bad and the immorality of allowing suffering to exist when you can do something about it) we should help them achieve a good and soft death by ensuring they don’t have to be sneaky about it (by allowing them to say goodbye to their loved-ones, getting their affairs in order without being hassled and clearly explaining their motivation much of the suffering, guilt and doubt of the family would be removed), taking away the chance of failure and even more horrible consequences (permanent disability, disfigurement) and by soothing the pain and fear from which they’ve already had more than their fair share) that usually accompanies death. Herodotos informs of the custom of state-approved suicide on the island of Cos: when a person wanted to die he could inform the leaders of the state and if he could make a coherent case he would receive the cup of hemlock from the hands of the highest magistrate himself. If such a humane and perfectly rational modus operandi was possible in ancient Greece why wouldn’t it be possible here? This will not cause the disintegration of society, massive depopulation or steep decline in morals but what it will do is ensure for everyone a decent chance at happiness and protection against unnecessary and hopeless suffering which is an evil by all accounts.

  20. I totally agree with Zara.
    Sometimes one might want to go in a certain painless fashion.
    Yet to do this one has to keep living to acquire the means and the method so to guarantee success as much as possible so one will not end up severely crippled, a vegetable, or locked up somewhere because the mental health professionals do not want to open their minds to the perspective that for some people who may not be terminally ill or even depressed, death is a better option than continuing life.

    Hopefully one day a person can go somewhere and receive a guaranteed merciful death when they choose without having to have a terminal illness.

    The rest of us just have to make do with self inflicted methods and hope we succeed.

  21. There is no medical cure for old age. Moreover, old age accompanied by the lack of any social support system: No friends, no family, and no intimate relationships.

    You may want to review Maslow’s Hierachy of Needs.

    What does one have to look forward to: every day you look in the mirror and every day you are uglier. This is a world for the young; not the old. Even if you are vigorous and in good health at a certain age it is highly unlikely that you a going to find a companion. Who wants a relationship with another old person anyway. One ugly face looking into another ugly face.

    It is simple mathematics! The odds of more suffering greatly outweigh the chance of finding happiness; assuming that you believe happiness can be found in old age. And don’t give me any pious talk about a Higher Power and the Life Hereafter. If there is one, I am sure I will suffer there as I have all of my life. That must be the way “GOD” wants it. HE must enjoy watching people suffer.

  22. Edie you make an excellent point.
    That is one of the main reasons i am choosing a self inflicted death.
    Despite having family and friends the prospect of old age is nothing i want to deal with.
    Having had to partially care for my elderly grandmother and seeing what she goes through just reaffirms my choice.

    There also is a vanity issue involved as well. I enjoy looking youthful and healthy per a good diet and exercise regimen. However past a certain age no matter what one does the deterioration will still hit.

    And I would rather go out still youthful and kicking that to just hang around until I can barely do for myself anymore.

    As mentioned in the article suicide is one of the ultimate freedoms. To choose one’s own end. And if you look at some spiritual beliefs and even some societal mores people oppose it because they think you owe some deity or others something.

    As my grandfather, father, and uncles told me “The world owes me nothing.” So to me that means that I owe the world nothing either.

    Shame on those who prosecuted Dr. Kevorkian. Mouth breathing degenerate hairless apes.

  23. For those of us who suspect we live parallel lives, where one life is protected from the other, i.e., no memory of the other, the concept of rational suicide has minimal appeal. We are already moving on in the other existence. This life, may be little more than “dozing off.” The definition of death is where it gets personal. If you want the quote, unquote: “death experience”…then there’s no reason why your imagination should come into play. Settle for the minimum.

  24. @Sarah “But that only applies if you assume that you know with absolute certainty that life is going to continue to be full of unremitting pain and torture. When is that ever certain?”

    Its more a question of ‘probability’ than it is of ‘certainty’. I am not 100% certain that I won’t win the lottery but there is a high probability I will not. In life the idea that we should all live in expectation of some future comfort, safety or happiness is exactly that drives the high expectations of life, which after some time proving itself false, leads a person to unremitting despondency. We can argue that a teenager has less certainty of what may come from life than say a person of middle-age, so its fair to try and intervene but when it comes to the elderly or those who have lived life long enough to know what is probable then we should defer to their experience and sensibilities. After all only children think in absolutes and certainties. Adults think of what is probable.

  25. @Daisy “I agree with Sarah. It is never rational to want to kill yourself as it doesn’t make things better or take away pain, it takes away everything. It’s not closure, it just means you die in a terribly unhappy and unwell state. I really believe that everyone who wants to kill themself can be made to feel better given the right treatment and care. I think that most people in this position view the fact that they once wanted to kill themselves but were stopped from doing so as being a genuine second chance.”

    Once could easily argue that one rarely dies in a ‘happy and well state’ but nevertheless, you claim to believe that everyone who is suicidal “can be made to feel better given the right treatment and care”. Beliefs are beliefs precisely because they are based on faith and not any real knowledge. First you are assuming that there is something mentally wrong with the individual whereby pills or some talk therapy will remedy the matter. Second you assume that if there is something mentally wrong that pills and talk therapy are adequate responses and more than likely work, which statistically isn’t even accurate.

    A nonfatal suicide attempt is the strongest known clinical predictor of eventual suicide. Antidepressants can increase suicide thoughts and actions. Talk therapy only works for some types of problems and fails entirely with others. Some problems are related to life itself and cannot be drugged or talked away. Its the idea that life has easy answers that are magically fixed with ‘care and treatment’ without actually understanding what that means that often leads people further into frustration. Off the cuff remarks about the easiness of fixing life’s problems by those who have never even been remotely close to ending their life are never too helpful nor insightful. Its about perspective.

  26. I find it interesting that these discussions are always about ‘others’. Its considered a duty that a sane objective society needs to discuss and decide what should or should not be sanctioned for those ‘non-rational’, ill others’. Those poor pitiful things that are either too old, too sick or too neurotic to take their life into their own hands and take responsibility for the most basic right of man, to be or not to be.

    We ask man above a certain age to be responsible for every area of their life save whether they should live one or not. I find that to be absurd. There isn’t anything more intimate nor more subjective than the experience of ones own life and the feeling one has inside their body or that of ones own being, its so private that it cannot even be fully shared with family, friends or intimate lovers, its simply the nature of ones own consciousness the fulfillment of so many random acts in history. Like many here I find that to be an awesome thing, something to be respected. If we are to truly respect that experience, that journey then we cannot claim to know what is best for another. Even our own experience cannot fully be a guide for another, its just not possible. If depressions were easily fixed by “treatment and care” (how vague is that!) then it wouldn’t be a health crises. If managing pain were as simple as a call to hospice then there wouldn’t be so many patients on hospice calling for assisted suicide. If life never ended in unavoidable boredom, loneliness and isolation then you wouldn’t find some elderly and middle aged people choosing the time and manner of death even though they are without mental and physical illness.

    Because life is then suicide will be also. Now what we really should be asking is why that’s so difficult for us to accept? I think that’s the real question.

  27. A lot of this discussion focussed on assisted suicide, but it ignores the other kind, which is more what people think of when they think of suicide. When we focus on assisted suicide the debate soon moves into the safety of medical and legal pedantry, buf the other kind is left well alone, and rhe debate is incomplete.

    First, lets deal with definitions: “rational”, what does it really mean? Based on “reason”? On “logic”? You sometimes hear people say that logic doesn’t work in every context.
    Why don’t we try neurobiology? Sense of Agency and “DMC” seems to depend on that.

    Our brains work by making assessments of sensory input and beliefs assembled and consolidated in memory over time. Emotion is a key part of “tuning” the valency ans salience of memory. The purpose of emotion is arousal, for sex or death (the threat of ours or of our prey or enemy). Depression is often associated with low serotonin and lacknof emotion. Suicide is in many caes not quite an emotional event in thry way one might imagine; sometimes it takes the firm of numbness and “tiredness of life”, “asedia” perhaps.
    Where does rationality fit in here? Rationality is a neocortical thing, not a limbic thing, it’s not really a mechanism for how the brain makes decisions. The “modus operandi” to fight for life as a defining feature of a living organism seems borne out by the structure and function of the brain, except for one feature – self-awareness.
    We are aware of our own mortality, and able to contemplate it and make judgements about it. If those judgements are emotional, and not entirely rational, why is the notion of rationaloty used? Because the word “irrational” is used, as a kind of criticism.
    The brain works by the reward system being activated, and this is key to our emotions snd thus our decisions. The reward system is connected to tge parts of the brain that are associated with memory, emotion, and reason.
    The point at which a person condifers suicide as an option, is where the reward system is rarely or no longer activated. The brain ceases to see any point in life if there are no “rewards” for effort. At this mechanical, yet also philosophical, level, the brain is being logical and applying reason. Effort declines as reward declines. Life ceases to be worth the effort. To resolve the dissonance of lack of control over the inputs thatvare failing to deliver reward stimuli, the brain enters a “reward crisis” or dysphoria, and this vortex ultimately leads to a rational decision to destroy the system to end the dissonance.
    Whether “rational” equates to “good” is another (and perhaps subjective) question, but we seem to invest a lot in special words when really what we’re talking about is a lot simpler.
    Is suicide good or bad? Good for whom? Bad for whom? If “good” means “adaptive for inclusive fitness”, then msybe it is “good” if it benefits the group. If “good” means something more metaphysical or philosophical, then we risk delving into nebulous conjecture.
    Can suicide be rational? Probably. Does “rational” mean “good”? Maybe, sometimes.
    Good for who? Drugging people up with antidepressants does seem a little pointless; CBTing people into “resilience” and “acceptance” of having bad experiences doesn’t seem to address any problem, it’s just a surface dressing. Life is about sex and death, and if we are taking a stance that suicide should be prevented, what are we asking people to live for?!
    For us or for them? To plod along collecting experiences, achievements, and relationships?
    Everything, in the grand scheme of things is utterly pointless, and suicide can be a rational resonse to the realisation of the futile monotony of existence. Pushing food into your head, being aroused and indulging all your senses, acquisition of status and possessions? Watching people age and change? Experiencing events? Is that it? Why live for that? What good is it? What is it for? What does it do? It seems that is what rationality looks like, and the notion that wanting to live is rational, and not wanting to is irrational, seems banal.
    People value love and human relationships, because of the Dopaminergic activity in their Nucleus Accumbens and Caudate Nucleus in their Striatum, it’s all about reward, if there is little or no reward in life, then it seems entirely rational to want to opt out.


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