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
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
The economics of suicide – Slate magazine
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