In a published in the Journal of General Internal Medicine, out of thirty-five individual cases of people who were seriously considering physician-assisted suicide, twenty-three of the patients were motivated to pursue a hastened death because of a loss of bodily function. Twenty-two of these patients were motivated by a loss of sense of self, while twenty-one of them expressed fears about future quality of life and dying. To put this number in context, only fourteen of them were motivated to end their lives because of pain or the side effects of pain medications. Instead, each of the most highly cited reasons for pursuing physician-assisted suicide are related to issues of dependence and independence. Our society tells us that autonomy is what makes life worth living. Once these patients began to lose bodily function, they were told that they were also losing their identity and quality of life.
On Friday, March 30, the Star-Ledger in New Jersey published a column I wrote about blame in the aftermath of suicide as it relates to the Tyler Clementi-Dharun Ravi case. You can read the column here (it follows after the jump) or you can for a link to the Star-Ledger, where you’ll [...]
Unemployment can influence suicide by affecting suicide risk factors such as lowering household income, self esteem, work-centered social networks, and increasing depression levels. For example, in Austria the suicide rate for the unemployed was nearly 4 times that for the general population.
While generally acknowledging Hardwig’s suggestion that dutiesto others have been neglected in discussion of the ethics of suicide,critics of morally required suicide raise a number of objections tohis proposal. (See Hardwig et al. 2000, Humber & Almeder 2000.)Some doubt that the duty of beneficence to which Hardwig appealsjustifies anything stronger than a permission to take one’s ownlife when continuing to live is burdensome to others (Cholbi 2010b).Others worry that a moral requirement to engage in suicide raises thesinister and totalitarian prospect that individuals may be obliged toengage in suicide against their wishes (Moreland & Geisler 1990,94, Pabst Battin 1996, 94–95). This worry may reflect animplicit acceptance of a variation of the sanctity of life view (see ) or may reflect concerns about infringements upon individual’sautonomy (see ). Other critics suggest that even if there is a duty to die, this dutyshould not be understood as a duty that entails that others may compelthose with such a duty to take their lives (Menzel 2000, Narveson2000). Questions about social justice and equality (whether, forexample, especially vulnerable populations such as women or the poormight be more likely to act on such a duty) are also raised. Oneutilitarian response to these objections is to reject a duty to die onrule utilitarian grounds: Suicide would be morally forbidden becausegeneral adherence to a rule prohibiting suicide would produce betteroverall consequences than would general adherence to a rule permittingsuicide (Brandt 1975, Pabst Battin 1996, 96–98).
A more restricted version of the claim that we have a right tononinterference regarding suicide holds that suicide is permitted solong as—leaving aside questions of duties to others—it isrationally chosen. In a similar vein, Kantians might claim thatsuicidal choices must be respected if those choices areautonomous, that is, if an individual chooses to end her lifeon the basis of reasons that she acknowledges as relevant to hersituation. Such positions are narrower than the libertarian view, inthat they permit suicide only when it is performed on a rational basis(or a rational basis that the individual acknowledges as relevant toher situation) and permits others to interfere only when it is notperformed on that basis.
That Suicide may often be consistent with interest and with our duty to no one can question, who allows, that age, sickness, or misfortune may render life a burthen, and make it worse even than annihilation. I believe that no man ever threw away life, while it was worth keeping. For such is our natural horror of death, that small motives will never be able to reconcile us to it. And tho' perhaps the situation of a man's health or fortune did not seem to require this remedy, we may at least be assured, that any one, who, without apparent reason, has had recourse to it, was curst with such an incurable depravity or gloominess of temper, as must poison all enjoyment, and render him equally miserable as if he had been loaded with the most grievous misfortunes.
The simplest moral outlook on suicide holds that it is necessarilywrong because human life is sacred. Though this position is oftenassociated with religious thinkers, especially Catholics, RonaldDworkin (1993) points out that atheists may appeal to this claim aswell. According to this ‘sanctity of life’ view, humanlife is inherently valuable and precious, demanding respect fromothers and reverence for oneself. Hence, suicide is wrong because itviolates our moral duty to honor the inherent value of human life,regardless of the value of that life to others or to the person whoselife it is. The sanctity of life view is thus a deontological positionon suicide.
Obviously, answers to any one of these four questions will bear on howthe other three ought to be answered. For instance, it might beassumed that if suicide is morally permissible in some circumstances,then neither other individuals nor the state should interfere withsuicidal behavior (in those same circumstances). However, thisconclusion might not follow if those same suicidal individuals areirrational and interference is required in order to prevent them fromtaking their lives, an outcome they would regret were they more fullyrational. Furthermore, for those moral theories that emphasizerational autonomy, whether an individual has rationally chosen to takeher own life may settle all four questions. In any event, theinterrelationships among suicide’s moral permissibility, itsrationality, and the duties of others and of society as a whole iscomplex, and we should be wary of assuming that an answer to any oneof these four questions decisively settles the other three.
If Suicide be supposed a crime, 'tis only cowardice can impel us to it. If it be no crime, both prudence and courage should engage us to rid ourselves at once of existence, when it becomes a burthen. 'Tis the only way, that we can then be useful to society, by setting an example, which, if imitated, would preserve to every one his chance for happiness in life, and would effectually free him from all danger of misery.
The nineteenth and early twentieth centuries brought severaldevelopments that, while not explicitly philosophical, have shapedphilosophical thought about suicide. The first was the emergence, innovels by Rousseau, Goethe, and Flaubert, of a Romantic idealized‘script’ for suicide, according to which suicide was theinevitable response of a misunderstood and anguished soul jilted bylove or shunned by society (Lieberman 2003). The second was theemergence of psychiatry as an autonomous discipline, populated byexperts capable of diagnosing and treating melancholy, hysteria andother ailments responsible for suicide. Lastly, largely thanks to thework of sociologists such as Durkheim and Laplace, suicide wasincreasingly viewed as a social ill reflecting widespread alienation,anomie, and other attitudinal byproducts of modernity. In manyEuropean nations, the rise in suicide rates was thought to signal acultural decline. These latter two developments made suicideprevention a bureaucratic and medical preoccupation, leading to a waveof institutionalization for suicidal persons. All three conspired tosuggest that suicide is caused by impersonal social or psychologicalforces rather than by the agency of individuals.
Secondly, the sanctity of life view must hold that life itself, whollyindependent of the happiness of the individual whose life it is, isvaluable. Many philosophers reject the notion that life isintrinsically valuable, since it suggests, e.g., that there is valuein keeping alive an individual in a persistent vegetative state simplybecause she is biologically alive. It would also suggest that a lifecertain to be filled with limitless suffering and anguish is valuablejust by virtue of being a human life. Peter Singer (1994) and othershave argued against the sanctity of life position on the grounds thatthe value of a continuing life is not intrinsic but extrinsic, to bejudged on the basis of the individual’s likely future quality oflife. If the value of a person’s continued life is measured byits likely quality, then suicide may be permissible when that qualityis low (see ) (This is not to suggest that quality of life assessments arestraightforward or uncontroversial. See Hayry 1991 fordiscussion).