Under the banners of compassion and autonomy, some are calling for legal recognition of a "right to suicide" and societal acceptance of "physician-assisted suicide." Suicide proponents evoke the image of someone facing unendurable suffering who calmly and rationally decides death is better than life in such a state. They argue that society should respect and defer to the freedom of choice that people exercise in asking to be killed. There are many moral, ethical, and theological reasons as to why active euthanasia is inherently wrong. I would like to structure my argument around the fact that Suicidal Intent is most often transient. To legally entitle a suicidal individual to be left alone without genuine help and without addressing the real issue is to negate true understanding of the underlying origins of suicidal tendency.
Studies show that few people if any will simply sit down and make the calm, rational decision to commit suicide as propagated by those advocates of acts such as Initiative 1000. In St. Louis a study done by Dr. Eli Robbins showed that 47% of those committing suicide suffered from either schizophrenic panic disorders, depression, or bipolar disorders, and additional 25% suffered from alcoholism, 15% more had some recognizable but undiagnosed psychiatric disorder, 4% had organic brain syndrome, 2% were schizophrenic and 1% were drug addicts. The total of those with diagnosable mental disorders was 94%. [1] In a separate study conducted in Britain, it was found that approximately 24 percent of terminally ill patients desire death. Of those desiring death, nearly 100 percent had clinical depression, which is a treatable condition. [2]
The fact that mental illness is so prevalent in those desiring suicide is very significant. Psychologists recognize that a suicidal person suffering from depression undergoes severe emotional and physical strain, impaired basic cognition, unwarranted self-blame, inappropriate guilt, and helplessness. Those with terminal illness often feel as though they are a burden to their families and to others. These individuals often think in a very rigid ‘all or nothing’ mindset. They are unable to see the range of genuine alternatives. They generally maximize their problems while minimizing their achievements and are unable to see the larger context of their situation. Indeed, treatable depression, rather than the terminal illness itself, usually accounts for such a patient's expression of a wish to die.[3]
Most mental illness including depression can be treated, alcoholism can be overcome. [4] And even the pain associated with most of the terminally ill patients who would qualify for the right to be euthanized according to Initiative 1000 can be overcome. According to the Washington Medical Association "adequate interventions exist to control pain in 90 to 99% of patients." [5] The problem is that uninformed medical personnel using inadequate methods often fail in practice to bring patients relief from pain. With today's advanced techniques freedom from this suffering is possible.
World renowned psychiatrist Elisabeth Kubler-Ross outlined the 5 stages of the dying process -- denial, anger, bargaining, depression, and acceptance. Since that time, Dr. Kubler-Ross has worked with thousands of dying patients and their families to help them deal with the dying process. In a recent interview she said: Lots of my dying patients say they grow in bounds and leaps, and finish all the unfinished business. [But assisting a suicide is] cheating them of these lessons, like taking a student out of school before final exams. That's not love, it's projecting your own unfinished business. [6]
Intervention and treatment, a search for alternatives is the correct and best method to help those who desire physician assisted suicide. It is a fact that a very small minority of those who are rescued from their fleeting suicidal desires and then helped and treated will go onto commit suicide later. In an American study less than 4% of 886 suicide attempters actually went on to commit suicide after their initial attempt. [7] Intervention to keep the individual alive is the course most likely to honor the individual’s true wishes and respect the person’s autonomy.
Years of studies and experience give professionals a near automatic presumption that one who desires or attempts suicide is in need of psychological help. If suicide and physician-assisted suicide become legal rights then those seeking suicide would be legally entitled to be left alone without genuine help and without addressing the real issue. [8] And all of this, much more often then not, will be based on a distorted assessment of their own circumstances.
1 - Barraclough, Bunch, Nelson, & Salisbury, A Hundred Cases of Suicide: Clinical Aspects, 125 BRIT. J. PSYCHIATRY 355, 356 (1976) and E. Robins, THE FINAL MONTHS 12 (1981).
2 - Breitbart, MD; Rosenfeld, PhD; Pessin, MA; Kaim, PhD; Funesti-Esch, RN; Galietta, MA; Nelson, MA; Brescia, MD., Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer, JAMA. 2000;284:2907-2911.
3 - Minkoff, Bergman, Beck & Beck, Hopelessness, Depression and Attempted Suicide, 130 AM. J. PSYCHIATRY 455
4 - Silverman, Silverman & Eardley, Do Maladaptive Attitudes Cause Depression? 41 ARCHIVES GEN. PSYCHIATRY 28, 29
5 - Albert Einstein, "Overview of Cancer Pain Management," in Judy Kornell, ed., Pain Management and Care of the Terminal Patient (Washington: Washington State Medical Association, 1992), p. 4.
6 - Leslie Miller, "Kubler-Ross, Loving Life, Easing Death,"USA Today, Monday, November 30, 1992, p.6D
7 - Rosen, The Serious Suicide Attempt: Five Year Follow Up Study of 886 Patients, 235 J.A.M.A. 2105, 2105
8 - A. Sullivan, Voluntary Active Euthanasia for the Terminally Ill and the Constitutional Right to Privacy, 69 CORNELL L. REV. 363
