Some thoughts on autonomy, freedom, reason, and suicide

I’ve caught up on the recent threads (both the ones about teachers, students, and young women’s agency — and the one about Pal Sarkozy and the question of whether an eleven year-old could ever sexually assault an adult). I’d been away from the computer for the holiday weekend, and when I’ve had some time to mull, expect to turn to both subjects again. For now, I want to answer a question posed to me by a reader named Natasha, who notes that I often write about the preciousness of autonomy.

She aks:

My question is about sovereignty and suicide.

Some background, firstly: I have recently been involved in a heavy and emotionally tiring (if mentally stimulating) debate with a very firm pro-life friend of mine (i.e. no abortion in any circumstance except if there is no way whatsoever for both mother and child to survive). I am firmly pro-choice, and this stance is centered on my belief that people have a right to bodily sovereignty and being able to make decisions that affect that sovereignty.

The difficulty I am having is that I come quickly to an impasse when I consider this philosophy beyond a woman’s reproductive rights. How do I reconcile – if it is at all reconcilable – bodily sovereignty with stopping a person’s decision to commit suicide (which is a right of bodily sovereignty if any, isn’t it?) (or, actually, any type of harm to oneself)? It’s not that I believe suicide is immoral or wrong – a relative of mine killed himself and I could never think of what he did as “something evil”. I think it’s a very sad, grief-filled action that people should avoid, but I can’t see it as immoral. However, this doesn’t change the fact that if I saw someone attempt to jump off a bridge, I would try my best to restrain him or her from doing so.

I could argue that the person may have been irrational, but how can I decide that if, afterwards, the person seems perfectly rational? If a person is in persistent unbearable pain that will never end, my gut reaction to a plea for euthanasia is that it’s understandable and rational, and I wouldn’t deny that person their right to live with dignity. But what if they’re not so? What if they’re healthy and really honestly believe that they’re not happy anymore with life or that life is too horrible? To that scenario, I just want to say, “You’re not thinking this through!” and I would call the police if I have to to keep them from committing suicide.

We place all sorts of reasonable limits on the right of individuals to do as they please, limits which don’t automatically contradict the principle that individual autonomy — sovereignty over one’s flesh — is particularly precious. California requires adults to wear seat belts in cars and helmets when they ride motorcycles. The state knows that the behavior of not wearing helmets or seatbelts has verifiable social and economic costs to our health care system, costs that others will bear. Society limits our ability to do as we please when our behaviors impinge upon others; my freedom to swing my fist, of course, stops at your nose.

A close friend of mine discovered his sister’s body after she had taken her life. She had electrocuted herself with a hair dryer in a bathtub; he found her body more than 48 hours after her death. He needed a great deal of therapy to cope with the experience, and nearly a decade later, still suffers from nightmares. Very few people commit suicide in a way that doesn’t leave a nasty mess for others to clean up. It doesn’t strike me as unreasonable for the state to say that this particular exercise of sovereignty — the exercising of the “right not to be” — needs to be limited because of its enormous impact on others.

I’m a strong supporter of the right of the terminally ill to die with dignity; I have long supported doctor-assisted suicide for those who are in great pain or who are unwilling to cope with the loss of autonomy that comes with a degenerative disease. I think it is right and good to offer folks with late-state cancer or ALS the option of dying on their own terms with medical assistance. Of course, ethicists and physicians need to work together to make sure that no undue pressure from insurance companies or estate-hungry relatives is being brought to bear on the person who is contemplating dying. Euthanasia needs to be an option, never an imperative; I don’t buy the assertion that allowing the former will invariably lead to the imposition of the latter.

I’m also someone who has been suicidal as an adult. On more than one occasion I attempted to take my own life, using drugs or (the last time) with gas. Obviously, I was always ambivalent about dying; I chose methods that while dangerous, were likely to be unsuccessful in ending my life swiftly. I’m hugely grateful to those who, on six different occasions between 1987 and 1998, intervened and had me locked up in hospitals. I’m grateful to those police officers and physicians who decided that I met the criteria of someone who was incapable of exercising sovereignty over his body and his life, and needed to be placed — involuntarily — on locked wards. Had there been no laws granting the state the right to commit someone to treatment against his or her will, I might very well not be alive today.

I support the right to abortion. I do think that abortions are rightly performed by medical profesionals rather than by amateurs, which is why I so strongly support the work of Medical Students for Choice. Even when we exercise our right to autonomy, we still need help. And just as those who seek to terminate a pregnancy ought to seek out a doctor or nurse practitioner, so too those who are making a decision about ending their lives ought to do so in consultation with professionals.

Of course, the standard of rationality applies: doctors ought not refuse a woman’s request for an abortion, but may have excellent reasons for intervening in order to stop someone who is suicidal from following through on their impulses. Suicide is a permanent solution to what is — at least in a great many cases of mental rather than physical illness — a temporary and solvable problem. It tends to be the preferred option of those whose capacity to reason has been gravely compromised. And while I do not rule out the possibility that someone with severe depression might rationally choose suicide as more preferable to living on in endless agony, I’m reluctant to extend to them that right, at least outside of a clinical setting.

Any philosophical or theological belief will have dilemmas it cannot easily solve. Very few thinking people hold a position to which they will not admit exceptions. My own view of the individual is woven together from many disparate strands; I’ve read my Aristotle and my Aquinas, but love better my John Stuart Mill and my Isaiah Berlin. I’m a believer who has always found the arguments of the non-believers to be more intellectually compelling, but those of the faithful to be of indispensable comfort. And so I believe we are created beings, beings who were given the capacity to reason and to reflect and to feel. We were designed for a paradox — given free will to choose, and forced to limit some choices in order to live together in community.

We are meant, in the words of the prophet Isaiah, to “reason together” — perhaps with God, certainly with each other. And when we are at our loneliest and most despairing and most likely to end our lives, it doesn’t seem unjust to ask that we reason our way through our terrible dilemma, together. And when we’re really desperate, the state may just need to intervene, and force us to that place where we can “reason through our reasons” for wanting to die.

14 thoughts on “Some thoughts on autonomy, freedom, reason, and suicide

  1. Professor, I am in just awestruck by your intellectual and spiritual thought. I wish I had the opportunity take more courses with you at PCC. I know I would always get on your nerves with being late. Ha-ha, I’m sure you remember summer of 09′.

    I don’t even know what to write, just that I wish you taught here at my university. I always tell everyone I know your famous quote, “Sleep is a sin. Wakefulness by any means possible is a virtue.” I share a similar schedule that wipes my body and coupled with a physical and mental burden that plaques my body, your words of wisdom woven into all the other attributes and characteristics that go into defining Hugo Schwyzer give me solace and a renewed desire to fight on as I try to make sense of a world that I physically and mentally have clashes that teeter both ways with the desire to live and sense to just give up.

  2. Thank you, Olivier, but do know that that particular maxim was delivered tongue very much in cheek!

    Giving up is a moral and philosophical question that deserves serious reflection. Having a purpose, as Viktor Frankl made clear, is vital.

  3. I phoned you about this but I will write it here in case this gets to you first. I wish I’d seen this post the same way Olivier did but I don’t. And as much as I love you it bothers me.
    You really give very little reasons for why one shouldn’t do it. The only one you really give is that it is devastating to others. Every one of the other things you outline is devastating to others on some level. And,as you well know, people can be plenty devastating to others by their actions when they are alive.
    I have to take a little exception to using the phrase’extend them that right’ when referring to someone with severe clinical depression. How is that a right that is expended by you. And how do you make the distinction between someone with severe clinical depresssion and someone who’s just plain ole’ suicidal?
    So I’ll pose a different version of the original question: why should someone who, as you put it, lives every day in agony stick around?

  4. … she had taken her life. She had electrocuted herself with a hair dryer in a bathtub

    This was how my mom attempted suicide three times and now I am crying, for this post hits me deeply. More thoughts to come…

  5. It doesn’t strike me as unreasonable for the state to say that this particular exercise of sovereignty — the exercising of the “right not to be” — needs to be limited because of its enormous impact on others.

    But where exactly is the line? Plenty of things I do have an enormous impact on others- moving across the country had an enormous impact on my family, choosing to wear clothes that diverged from t-shirts and jeans seemed to impact my fellow students a great deal in high school, and choosing to ask my professors questions and participate in class seemed to impact my college peers. If my blogging is at all successful (as unlikely as that is) it will have sweeping and wide-ranging effects on others peoples lives (hopefully for the better).

    A good deal of my decisions effect my community, and my narrow family and groups of friends a great deal. But, the decision not to be is considered sacrosanct- something substantively different from everything else I do. Why is that, and where is the line?

  6. As reluctant as we will be to admit it, some people cause great anguish to others by *living*. If the consequences for others, the years of therapy and the persistent nightmares are held as the main reasons to continue a life, how far are we from using the same reasons to end a life? I have heard about people who only breathe feely when their abusers die, even though these people have been long incapable of harming than anymore. Is this a justification to end their lives prematurely? And if we see a terrorist or a criminal, likely to be bemoaned by nobody watching him die, trying to kill himself – should we intervene? And if somebody with no close relatives and friends wants to die – will it be OK if he is just considerate enough to do it somewhere where his body will never be found? I am sorry, but this just feels so wrong.

    Then you question whether somebody committing suicide is rational enough to make this decision (and by extension, should we trust his judgment and let him die) and you say: “while I do not rule out the possibility that someone with severe depression might rationally choose suicide as more preferable to living on in endless agony, I’m reluctant to extend to them that right, at least outside of a clinical setting.”

    That sounds very much like agreeing with assisted suicide for mental illnesses – provided a professional agrees with the patient’s wish. Now, while I am sure you know about depression more than I do – and I deeply respect your experience with overcoming it – this sentence sounds very much like the mythical slippery slope. Some people will never overcome mental illness completely, but they might be rational enough to explain their desire for death in reasonable terms. Should they be granted their wish? HOW can we measure when pain of mind is too much – when we don’t even have the multitude of indicators available for physical illnesses? Victims of mental illness might very well be isolated, with few family members or friends to care much what happen to them. The professionals taking care of them might eventually despair of their ever getting well. They themselves might not have the slightest wish to live. Should we just allocate them a specific time to get better – even a decade or two – and then help them die in the nicest way possible?

    The issue is complex, I admit. Less so for me, as a religious person trained to believe that your life does NOT belong to you – you are the property of G-d and it’s up to Him to decide how long you live. But if you do believe in the autonomy of a person over their body and life…I can see where you have a difficulty to draw a line. But I would think the line must be drown very clearly, never mind your beliefs, and than it’s better to say you are moved by feelings you can’t explain then to come up with arguments which could easily be contradicted.

  7. It might be useful to pull apart the different contexts and relationships involved in making these sorts of decisions. Imagine someone — call her/him M — who’s depressed or newly physically disabled or has just lost her/his job of 25 years or, for whatever other reason, is upset and is considering suicide. M can talk with many different people about their worries and thoughts of suicide:
    * a good friend or family member;
    * a trained volunteer at a suicide hotline;
    * a therapist, physician, pastor, mentor, or other advisor;
    * a judge, police, or other representative of the state.

    Of course, these `different’ people might be one and the same — the family physician who’s a close family friend, for example. But think of these as distinct roles. How should the people in each role respond to M?

    I don’t have a complete answer to that question, but I suggest that the right responses are different for people who are related differently to M. The good friend can tell M that s/he is simply wrong, point out how much s/he’ll be missed, offer love and encouragement and solidarity in addressing these problems that, at the moment, seem overwhelming. But, as you move down that list, this sort of response becomes more inappropriate: a judge considering an assisted-suicide claim shouldn’t reach out, hug M tightly, and tell her/him that everything’s going to be okay, we can get through this together. The judge is probably in a very poor position to assess M’s reasons and values, and thus there’s reason for the judge to respect M’s stated desire to commit suicide if M seems otherwise sound of mind.

    In short, it’s appropriate for friends and family to intervene, and maybe (maybe!) in a few cases even temporarily forcibly restrain someone who’s mind is set on making a huge mistake. But not the state, or its representatives.

  8. Let me be clear that in my hour of darkness and time of need (to paraphrase Gram Parsons), on more than one occasion it was only the state’s representatives (in the form of police officers who 5150ed me — California code for involuntary psychiatric hold) who were there for me.

    The cops, by forcibly confining me, kept me alive long enough to have the talks with the physicians and family members and 12 step sponsors who would initiate the great transformation.

  9. The personhood question strikes me as very relavant here. We weigh non-person life against personal autonomy and rule in favor of autonomy all the time: not just abortion but meat-eating, spider-crushing, chopping down a tree to make room for that new deck, etc. When it comes to weighing autonomy against the life of a person, we usually rule in favor of human life, i.e. murder and suicide.

    The latter case is complicated, though. If my ailing grandmother expressed the desire to end her life, I would be extremely upset and conflicted. If my healthy teenage brother did the same, I would not be conflicted at all. I would call the cops.

  10. Funt, because the evidence is that psychic agony can be overcome. It’s not an obligation to overcome it, any more than it is an obligation to live — but it is a possibility, a real and tangible one, and that hope ought to give the despairing pause. I wish I could offer more than that, but anything more than personal experience is above my paygrade, as our president was wont to say.

  11. Yes, I knew that you didn’t really mean that. I understand that you do have a hectic life that requires you to be up and running all day and almost all night. I like it because I took it with a more personal context. I do like it though since we never know when we will depart this world, so taking advantage of every second we have it a good thing. (well at least for me).

    As for the the contemplation of suicide I agree with you that it does take and require serious thought. Life is a precious thing that we have control over to create or destroy that beauty that is within us all. Depending on how we feel at that moment and as we examine how we arrived there nothing should be done is haste. It is irreversible when one does commit suicide as well as the repercussions that will echo in the hearts of loved ones for a long time to come.

  12. I am not very comfortable with your language about psychic pain being “overcome.” I know people often speak about “beating” a disease, but such language seems imply that people with more severe or chronic illness have “lost” or “failed.” I think it is important to note that even if it is *not* possible to permanently “overcome” pain or “defeat” a painful or dehabilitating illness, it is possible to find a sense of peace, purpose and reconiliation with the fact of living in pain. Our society has such phobia of pain and disability, mental or physical, but it doen’t have to be that way.

    As far as terminal illness goes, I know I am biased on the topic due to my experience with a friend who died after a long terminal illness. She reached a point where she felt that she could no longer bear the physical and mental pain she was in and truly wanted to die. I believe that if it had been legal for her to obtain assistance in ending her life she would have done so. As it was not legal, her doctors worked to find a way to alleviate her pain and depression and eventually hit upon a treatment regimine that worked. The difference before and after was like night and day. Her illness eventually took her life, but we had several more happy, pain-free months with her before that happened.

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