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
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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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.
Sorry, I didn’t mean to say it was necessarily always a failure on the part of the NHS. That’s just one example.
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.
Sarah
You may be interested in these online Yale lectures on the rationality of suicide.
http://oyc.yale.edu/philosophy/death/content/sessions/lecture24.html
As the lecturer points out, there are many conceivable instances where death is preferable to a life of unremitting pain and torture.
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?
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.
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.
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.
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.
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?
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.
“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):
http://oyc.yale.edu/philosophy/death/content/class-sessions
Professor Shelley Kagan argues very convincingly that suicide can, in certain situations, be rational.
Some more grist for the mill:
http://plato.stanford.edu/entries/suicide/#AutRatRes
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
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:
http://www.askphilosophers.org/question/1763
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.
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.
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.
Sarah. Fear of painful death is not laothing of prolonged constrained life.
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
(Instrumental)
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?