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290308 -
Stanford
Encyclopedia - First published Tue 18 May, 2004
Suicide is an enigmatic and
disconcerting phenomenon. Because of others' inability to
directly occupy the mental world of the suicidal, suicide
appears to elude easy explanation. This inexplicability is
stunningly captured by Jeffrey Eugenides in his novel The
Virgin Suicides. In the novel, the narrator describes the
reactions of several teenaged boys to the suicides of five
sisters. The boys keep a collection of the dead girls'
belongings, repeatedly sifting through them in a vain attempt to
understand their deaths.
In the end we had the pieces of the
puzzle, but no matter how we put them together, gaps remained, oddly
shaped emptinesses mapped by what surrounded them, like countries we
couldn't name. (Eugenides 1993, 246)
Undoubtedly, the challenge of simply
fathoming suicide accounts for the vast array of attitudes toward
suicide found in the history of Western civilization: bafflement,
dismissal, heroic glorification, sympathy, anger, moral or religious
condemnation. Suicide is now an object of multidisciplinary scientific
study, with sociology, anthropology, psychology, and psychiatry each
providing important insights into suicide. Particularly promising are
the significant advances being made in our scientific understanding of
the neurological basis of suicidal behavior (Stoff and Mann 1997) and
the mental conditions associated with it. Nonetheless, certain questions
about suicide seem to fall at least partially outside the domain of
science, and indeed, suicide has been a focus of philosophical
examination in the West since at least the time of Plato. For
philosophers, suicide raises a host of conceptual, theological, moral,
and psychological questions. Among these questions are: What makes a
person's behavior suicidal? What motivates such behavior? Is suicide
morally permissible, or even morally required in some extraordinary
circumstances? Is suicidal behavior rational? This article will examine
the main currents of historical and contemporary philosophical thought
surrounding these questions.
Surprisingly, philosophical difficulties
emerge when we even attempt to characterize suicide precisely, and
attempts to do so introduce intricate issues about how to describe and
explain human action. In particular, identifying a set of necessary and
sufficient conditions for suicide that fits well with our typical usage
of the term is especially challenging. A further challenge is that
because suicide is strongly colored by negative emotional or moral
connotations, efforts to distinguish suicidal behavior from other
behavior often clandestinely import moral judgments about the aims or
moral worth of such behavior. That is, views about the nature of suicide
often incorporate, sometimes unknowingly, views about the prudential or
moral justifiability of suicide and are therefore not value-neutral
descriptions of suicide. Definitions of suicide are "sometimes dependent
on prior judgments about its justifiability." (Lebacqz & Englehardt
1980, 701.) Theorists about suicide often fail to divorce questions
about whether an act was suicide from whether its motives were admirable
or odious. Hitler, most people contend, was clearly a suicide, but
Socrates and Jesus were not. (Though on Socrates, see Frey 1978) Suicide
still carries a strongly negative subtext, and on the whole, we exhibit
a greater willingness to categorize self-killings intended to avoid
one's just deserts as suicides than self-killings intended to benefit
others (Beauchamp & Childress 1983, 93-94.) Some go so far as to deny
the possibility that an act of self- killing motivated by altruism can
count as suicide (Margolis 1980.)
Such conceptual slipperiness befuddles
moral arguments about the justifiability of suicide by permitting us to
‘define away’ self-killings we believe are justified as something other
than suicide, whereas it would be desirable to identify first a
defensible non-normative conception of suicide and then proceed to
discuss the moral merits of various acts of suicide (Kupfer 1990.) Some
philosophers, on the other hand, have embraced the apparently value-laden
character of suicide, suggesting that word ‘suicide’ has as one its
functions the ascription of moral responsibility, and insofar as
disagreements about the extent to which agents themselves (as opposed to
social conditions, medical facts, etc.) are morally responsible for
their deaths persist, so too will apparently conceptual disagreements
about the nature of suicide persist (Stern-Gillett 1987.)
Supposing, however, that a purely
descriptive account of suicide is possible, where should it begin? While
it is tempting to say that suicide is any self-caused death, this
account is vulnerable to obvious counterexamples. An individual who
knows the health risks of smoking or of skydiving, but willfully engages
in these behaviors and dies as a result, could be said to be causally
responsible for her own death but not to have committed suicide.
Similarly, an individual who takes a swig of hydrochloric acid,
believing it to be lemonade, and subsequently dies causes her own death
but does not engage in suicidal behavior. Moreover, not only are there
self-caused deaths that are not suicides, but there are behaviors that
result in death and are arguably suicidal in which the agent is not the
cause of her own death or is so only at one remove. This can occur when
an individual arranges the circumstances for her death. A terminally ill
patient who requests that another person inject her with a lethal dose
of tranquilizers has, intuitively, committed suicide. Though she is not
immediately causally responsible for her death, she appears morally
responsible for her death, since she initiates a sequence of events
which she intended to culminate in her death, a sequence which cannot be
explained without reference to her beliefs and desires. (Such a case
might also be an example of voluntary euthanasia.) Likewise, those who
commit ‘suicide by cop,’ where an armed crime is committed in order to
provoke police into shooting its perpetrator, are responsible for their
own deaths despite not being the causes of their deaths. In these kinds
of cases, such agents would not die, or would not be at an elevated risk
for death, were it not for their initiating such causal sequences. (See
Brandt 1975, Tolhurst 1983, Frey 1981, but for a possible objection see
Kupfer 1990).
Furthermore, many philosophers (Fairbairn
1995, chapter 5) doubt whether an act's actually resulting in death is
essential to suicide at all. It is common to speak of ‘attempted’ or
‘failed’ suicides, instances where because of agents' false beliefs (about
the lethality of their behavior, for example), unforeseen factual
circumstances, others' interventions, etc., an act which might have
resulted in an agent's death does not.
Hence, suicidal behavior need not result
in death, nor must the condition that hastens death be self-caused. It
follows, therefore that, first, a correct account of suicide (contra
Durkheim 1897) must emphasize the non-accidental relationship
between suicidal behavior and death (i.e., death is in some respect the
aim of suicidal behavior). Second, what appears essential for a
behavior to count as suicide is that the person in question chooses
to die. Suicide is an attempt to inflict death upon oneself and
is "intentional rather than consequential in nature." (Fairbairn 1995,
58) These conclusions imply that suicide must rest upon an individual's
intentions (where an intention implicates an individual's
beliefs and desires about her action. (See Brandt 1975, Tolhurst 1983,
Frey 1978, O'Keefee 1981) One intention-based account of suicide
(similar to Graber 1981, 57) would say, roughly, that
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A person S's behavior B
is suicidal iff
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S
believed that B, or some causal consequence of B,
would make her death at least highly likely, and
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S
intended to die by engaging in B.
This account renders the notion of
suicide as self-inflicted attempted death more precise, but it is not
without its shortcomings.
Condition (a) is a doxastic
condition, and is meant to rule out as suicides deaths (or increased
risks for death) caused by an individual's behavior where the individual
causes these outcomes but does so out of ignorance of the relevant risks
of her behavior, as when an individual accidentally takes a lethal dose
of a prescription drug. At the same time, (a) accounts for cases such as
the aforementioned terminally ill patient whose death is caused only
indirectly by her request to die. Condition (a) does not require that
S know that B will put her at a significantly
greater risk for death, nor even that S's beliefs about B's
lethality be true or even justified. Suicidal individuals often have
false beliefs about the lethality of their chosen suicide methods,
greatly overestimating the lethality of over the counter painkillers
while underestimating the lethality of handguns, for instance. An
individual could believe falsely, or on the basis of inadequate evidence,
that placing one's head in an electric oven significantly increases
one's chances of dying, but that behavior is nonetheless suicidal. The
demand that S believe that B makes death highly likely
is admittedly inexact, but it permits us to navigate between two extreme
and mistaken views. On the one hand, it rules out as suicidal behavior
that which is in fact only marginally more likely to cause a person's
death (you are more likely to die in your car than in your living room)
and is rarely utilized as a suicide method anyway. On the other hand, to
demand that S believe that B certainly or almost certainly will
cause S's death is too strict, since it will rarely be the case
(given the possibility of intervening conditions, etc.) that B
will necessarily cause S's death, and in fact, many suicidal
individuals are ambivalent about their actions, an ambivalence which is
turn reflected in their selecting suicide methods that are far from
certain to cause death. It also allows us to distinguish genuinely
suicidal behavior from suicidal gestures, in which individuals
engage in behavior they believe is not likely to cause their
death but is nonetheless associated with suicide attempts, while in fact
having some other intention (e.g., gaining others' sympathy) in mind.
Condition (b), however, is far more
knotty. For what is it to intend by one's behavior that death result?
There are examples in which condition (a) is met, but whether (b) is met
is more problematic. For instance, does a soldier who leaps upon a live
grenade tossed into a foxhole in order to save his comrades engage in
suicidal behavior? Many, especially partisans of the doctrine of double
effect, would answer ‘no’: Despite the fact that the solider knew his
behavior would likely cause him to die, his intention was to absorb the
blast so as to save the other soldiers, whereas his death was only a
foreseen outcome of his action. Needless to say, whether a clear and
non-manipulable divide exists between foreseen and intended outcomes is
controversial (Glover 1990, ch. 6) (It is of course possible that
whether death is foreseen or intended has no bearing on whether an act
counts as suicide but still bears on whether that suicide is justified.)
Some would argue that given the near certainty of his dying by jumping
on the grenade, his death was at least weakly intended, in Alvin
Goldman's sense (Tolhurst 1983.) At the same time, cases that are
commonly viewed as suicide do not exhibit an full-fledged intention to
die. Current psychiatric theory holds that many examples of suicidal
behavior do not aim at death but are "cries for help." In such cases,
the person does not wish to die, but intends to gain others'
attention in such a fashion that holds out the possibility of death.
However, it seems correct to say that when a person who issues a cry for
help does die, despite not intending to die, their death is neither
foreseen, since the person actually intends not to die, nor
wholly accidental, since the person knowingly engaged in behavior that
she believed will make her death significantly more likely, making her
death in an obvious sense self-inflicted. (But see Graber 1981, 58) Such
a case might indicate the need for a third category besides intentional
suicide and accidental death, call it unintentional death or unintended
suicide.
The essential logical difficulty here
resides in the notion of intending to die, for acting so as to produce
one's death nearly always has some other aim or justification.
That is, death is generally not chosen for its own sake, or is not the
end of suicidal behavior. Suicidal behavior can have any number of
objectives: the relief of physical pain, the relief of psychological
anguish, martyrdom in the service of a moral cause, the fulfillment of
perceived societal duties (suttee and seppuku, e.g.),
the avoidance of judicial execution, revenge on others, protection of
others' interests or well-being. (See Fairbairn 1995, ch. 9, for a
taxonomy of the varieties of suicide.) Therefore, it is not the case
that suicidal individuals intend death per se, but rather that death is
perceived, rightly or wrongly, as a means for the fulfillment of another
of the agent's aims. (Graber 1981, 56) In short, there do not appear to
be any compelling examples of "noninstrumental" self-killings in which
"the overriding intention is simply to end one's life and there is no
further independent objective involved in the action." (O'Keefee 1981,
357) Nor does requiring that the individual wish to be dead (Fairbairn
1995, ch. 6) address this issue, since again, what one wishes is
presumably not death itself but some outcome of death. Both the grenade-jumping
soldier and the depressed individual issuing a ‘cry for help’ may wish
not to die insofar as they might prefer that their desires could be
satisfied without dying or without putting themselves at the risk
thereof. However, this is consistent with their willingly choosing to
die in order to satisfy their aims.
Some might wish to add a further
condition to (a) and (b) above:
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S was
not coerced into B-ing.
Yet again, both the concept of coercion
and its applicability to instances of risky or self-harming behavior is
unclear. Typically, coercion denotes interference by others. So,
according to condition (c), a spy threatened with torture lest he
relinquish crucial military secrets who then poisons himself did not
commit suicide, some would contend, since the spy's captors compelled
him to take his life. However, one can imagine a similar situation in
which the agent of "coercion" is not another person. An extremely ill
patient may opt to take his own life rather than face a future fraught
with physical pain. But why should we not say that this patient was
coerced by his situation and therefore did not commit suicide? Because
of their desires, loyalties, and values, both the spy and the ill
patient saw themselves as having no other alternative, given their ends,
but to cause their own deaths. In both instances, the economy of the
individuals' reasons for actions was modified by circumstances outside
their control so as to make death a rational option where it previously
was not. Thus, there does not appear to be grounds for restricting
coercion only to interference by other people, since factual
circumstances can be similarly coercive. Either any factor,
natural, human, or otherwise, that influences an individual's reasoning
so as to make death the most rational option counts as coercion, at
which point condition (c) hardly functions as a restriction at all, or
cases such as the spy facing torture are suicides too and (c) is
unnecessary. (See Tolhurst 1983, 113-115)
This brief attempt at conceptual analysis
of suicide illustrates the frustrations of such a project, as the
unclear notion of suicide is apparently replaced by equally unclear
notions such as intention and coercion. We may be attracted to
increasingly baroque or impractical analyses of suicide (Donnelly 1998,
20) or accept that suicide is an ‘open textured’ concept instances of
which are bound together only by weak Wittgensteinian family resemblance
and hence resistant to analysis in terms of strict logical conditions. (Windt
1981)
An alternative to providing necessary and
sufficient conditions for suicidal behavior is to view it along a
continuum. In the psychological sciences, most suicidologists view
suicide not as an either/or notion but as a gradient notion, admitting
of degrees based on individuals' beliefs, strength of intentions, and
attitudes. The Beck Scale for Suicidal Ideation is perhaps the best
example of this approach. (See Beck 1979)
Philosophical discourse about suicide
stretches back at least to the time of Plato. Still, prior to the Stoics
at least, suicide tended to get sporadic rather than systematic
attention from philosophers in the ancient Mediterranean world. As John
Cooper has noted (Cooper 1989, 10), neither ancient Greek nor Latin had
a single word that aptly translates our ‘suicide,’ even though most of
the ancient city-states criminalized self-killing.
Plato explicitly discussed suicide in two
works. First, in Phaedo, Socrates expresses guarded enthusiasm
for the thesis, associated with the Pythagoreans, that suicide is always
wrong because it represents our releasing ourselves (i.e., our souls)
from a "guard-post" (i.e., our bodies) the gods have placed us in as a
form of punishment (Phaedo 61b-62c.) Later, in the Laws,
Plato claimed that suicide is disgraceful and its perpetrators should be
buried in unmarked graves. However, Plato recognized four exceptions to
this principle: (1) when one's mind is morally corrupted and one's
character can therefore not be salvaged (Laws IX 854a3-5), (2)
when the self-killing is done by judicial order, as in the case of
Socrates, (3) when the self-killing is compelled by extreme and
unavoidable personal misfortune, and (4) when the self-killing results
from shame at having participated in grossly unjust actions. (Laws
IX 873c-d) Suicide under these circumstances can be excused, but,
according to Plato, it is otherwise an act of cowardice or laziness
undertaken by individuals too delicate to manage life's vicissitudes.
Aristotle's only discussion of suicide (Nicomachean Ethics
1138a5-14) is a difficult and confusing passage in which he attempts to
explain how suicide can be unjust and deserving of punishment if the
individual who could be treated unjustly is the suicidal individual
herself. He concludes that suicide is somehow a wrong to the state,
though he does not outline the nature of this wrong or the specific
vices that suicidal individuals exhibit.
What is perhaps most striking about
Plato's and Aristotle's texts on suicide is the relative absence of
concern for individual well-being or autonomy. Both limit the
justifications for suicide largely to considerations about an
individual's social roles and obligations. In contrast, the Stoics
largely believed that the moral permissibility of suicide did not hinge
on the moral character of the individual pondering it. Rather, the
Stoics held that whenever the means to living a naturally flourishing
life are not available to us, suicide may be justified, regardless of
the character or virtue of the individual in question. Our natures
require certain "natural advantages" (e.g., physical health) in order
for us to be happy, and a wise person who recognizes that such
advantages may be lacking in her life sees that ending her life neither
enhances nor diminishes her moral virtue.
When a man's circumstances contain a
preponderance of things in accordance with nature, it is appropriate
for him to remain alive; when he possesses or sees in prospect a
majority of the contrary things, it is appropriate for him to depart
from life…. Even for the foolish, who are also miserable, it is
appropriate for them to remain alive if they possess a predominance
of those things which we pronounce to be in accordance with nature.
(Cicero, III, 60-61)
Hence, not only may concerns related to
one's obligations to others justify suicide, but one's own private good
is relevant too. The Roman Stoic Seneca, who was himself compelled to
commit suicide, was even bolder, claiming that since "mere living is not
a good, but living well", a wise person "lives as long as he ought, not
as long as he can." For Seneca, it is the quality, not the quantity, of
one's life that matters.
The advent of institutional Christianity
was perhaps the most important event in the philosophical history of
suicide, for Christian doctrine has by and large held that suicide is
morally wrong, despite the fact that no passage in Scripture
unequivocally condemns suicide. Although the early church fathers
opposed suicide, St. Augustine is generally credited with offering the
first thoroughgoing justification of the Christian prohibition on
suicide (Amundsen 1989.) He saw the prohibition as a natural extension
of the fifth commandment:
The law, rightly interpreted, even
prohibits suicide, where it says ‘Thou shalt not kill.’ This is
proved especially by the omission of the word ‘thy neighbor’, which
are inserted when false witness is forbidden in the commandment
there is no limitation added nor exception made in favor of any one,
and least of all in favor of him on whom the command is laid! (Augustine,
book I, chapter 20)
Suicide, Augustine determined, was an
unrepentable sin. St. Thomas Aquinas later defended this prohibition on
three grounds. (1) Suicide is contrary to natural self-love, whose aim
is to preserve us. (2) Suicide injures the community of which an
individual is a part. (3) Suicide violates our duty to God because God
has given us life as a gift and in taking our lives we violate His right
to determine the duration of our earthly existence (Aquinas 1271, part
II, Q64, A5.) This conclusion was codified in the medieval doctrine that
suicide nullified human beings' relationship to God, for our control
over our body was limited to usus (possession, employment)
where God retained dominium (dominion, authority). Law and
popular practice in the Middle Ages sanctioned the desecration of the
suicidal corpse, along with confiscation of property and denial of
Christian burial.
The rediscovery of numerous texts of
classical antiquity was one of the spurs of the Renaissance, but for the
most part, Renaissance intellectuals generally affirmed the Church's
opposition to suicide and were not sympathetic to the more permissive
attitudes toward suicide found among the ancient pagans. Two intriguing
sixteenth century exceptions were Thomas More and Michel de Montaigne.
In his Utopia, More appears to recommend voluntary suicide for
those suffering from painful and incurable diseases, though the
satirical and fantastical tone of that work makes it doubtful that More
supported this proposal in reality. In his Essais, Montaigne
relates several anecdotes of individuals taking their own lives and
intersperses these anecdotes with quotations from Roman writers praising
suicide. While his general skepticism prevented Montaigne from staking
out a firm moral position on suicide, he gives only a nod to the
orthodox Christian position and conceptualizes the issue not in
traditional theological terms but as a matter of personal judgment or
conscience (Ferngren 1989, 160-161.)
The Protestant Reformers, including
Calvin, condemned suicide as roundly as did the established Church, but
held out the possibility of God treating suicide mercifully and
permitting repentance. Interest in moral questions concerning suicide
was particularly strong in this period among England's Protestants,
notably the Puritans. Nonetheless, the traditional Christian view
prevailed well into the late seventeenth century, where even an
otherwise liberal thinker such as John Locke echoed earlier Thomistic
arguments, claiming that though God bestowed upon us our natural
personal liberty, that liberty does not include the liberty to destroy
oneself (Locke 1690, ch. 2, para. 6.)
In all likelihood, the first
comprehensive modern defense of suicide was John Donne's Biathanatos
(c. 1607.) Not intended for publication, Biathanatos drew upon
an array of classical and modern legal and theological sources to argue
that Christian doctrine should not hold that suicide is necessarily
sinful. His critique is in effect internal, drawing upon the logic of
Christian thought itself to suggest that suicide is not contrary to the
laws of nature, of reason, or of God. Were it contrary to the law of
nature mandating self-preservation, all acts of self-denial or privation
would be similarly unlawful. Moreover, there may be circumstances in
which reason might recommend suicide. Finally, Donne observes, not only
does Biblical Scripture lack a clear condemnation of suicide, Christian
doctrine has permitted other forms of killing such as martyrdom, capital
punishment and killing in wartime (Minois 1999, 20-21.)
Donne's casuistical treatise was an early
example of the liberalized Enlightenment attitudes of the 1700's. The
Thomistic natural-law stance on suicide came under increasing attack as
suicide was examined through the lens of science and psychology. Where
Christian theology has understood suicide as "an affair between the
devil and the individual sinner" (Minois 1999, 300), Enlightenment
philosophers tended to conceive of suicide in secular terms, as
resulting from facts about individuals, their natural psychologies, and
their particular social settings. David Hume gave voice to this new
approach with a direct assault on the Thomistic position in his
unpublished essay "On suicide" (1783.) Hume saw traditional attitudes
toward suicide as muddled and superstitious. According to the Thomistic
argument, suicide violates the order God established for the world and
usurps God's prerogative in determining when we shall die. Hume's
argument against this thesis is intricate, as he tends to juxtapose
distinguishable but closely related considerations, but in essence Hume
attacks the seemingly arbitrary and contradictory notions of natural law
used to condemn suicide. Hume's argument is more or less as follows:
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If by the ‘divine order’ is meant the
causal laws created by God, then it would always be wrong to
contravene these laws for the sake of our own happiness. But clearly
it is not wrong, since God frequently permits us to contravene these
laws, for he does not expect us not to respond to disease or other
calamities. Therefore, there is not apparent justification, as Hume
put it, for God's permitting us to disturb nature in some
circumstances but not in others. Just as God permits us to divert
rivers for irrigation, so too ought he permit us to divert blood
from our veins.
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If by ‘divine order’ is meant the
natural laws God has willed for us, which are (a) discerned by
reason, (b) such that adherence to them will produce our happiness,
then why should not suicide conform to such laws when it appears
rational to us that the balance of our happiness is best served by
suicide?
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Finally if by ‘divine order’ is meant
simply that which occurs according to God's consent, then God
appears to consent to all our actions (since an omnipotent
God can presumably intervene in our acts at any point) and no
distinction exists between those of our actions to which God
consents and those to which He does not. If God has placed us upon
the Earth like a "sentinel," then our choosing to leave this post
and take our lives occurs as much with his cooperation as with any
other act we perform.
Furthermore, suicide does not necessarily
violate any duties toward other people, according to Hume. Reciprocity
may require that we benefit society in exchange for the benefits it
provides, but surely such reciprocity reaches its limit when by living
we provide only a "frivolous advantage" to society at the expense of
significant harm or suffering for ourselves. In more extreme situations,
we are actually burdens to others, in which case our deaths are not only
"innocent, but laudable."
Finally, Hume rejects the thesis that
suicide violates our duties to self. Sickness, old age, and other
misfortunes can make life sufficiently miserable that continued
existence is worse than death. As to worries that people are likely to
attempt to take their lives capriciously, Hume replies that our natural
fear of death ensures that only after careful deliberation and
assessment of our future prospects will we have the courage and clarity
of mind to kill ourselves.
In the end, Hume concludes that suicide
"may be free of imputation of guilt and blame." His position is largely
utilitarian, allied with a strong presumption of personal liberty. The
Enlightenment was of course not univocal in its comparatively permissive
attitudes toward suicide. The most vociferous opponent of suicide in
this period was Immanuel Kant. Kant's arguments, though they reflect
earlier natural law arguments, draw upon his view of moral worth as
emanating from the autonomous rational wills of individuals. (Cholbi
2000) For Kant, our rational wills are the source of our moral duty, and
it is therefore a kind of practical contradiction to suppose that the
same will can permissibly destroy itself. Given the distinctive worth of
an autonomous rational will, suicide is an attack on the very source of
moral authority.
To annihilate the subject of morality
in one's person is to root out the existence of morality itself from
the world as far as one can, even though morality is an end in
itself. Consequently, disposing of oneself as a mere means to some
discretionary end is debasing humanity in one's person… (Kant 423)
The nineteenth and early twentieth
centuries brought several developments that, while not explicitly
philosophical, have shaped philosophical thought about suicide. The
first was the emergence, in novels by Rousseau, Goethe, and Flaubert, of
a Romantic idealized ‘script’ for suicide, according to which suicide
was the inevitable response of a misunderstood and anguished soul jilted
by love or shunned by society (Lieberman 2003.) The second was the
recognition of psychiatry as an autonomous discipline, populated by
experts capable of diagnosing and treating melancholy, hysteria and
other ailments responsible for suicide. Lastly, largely thanks to the
work of sociologists such as Durkheim and Laplace, suicide was
increasingly viewed as a social ill reflecting widespread alienation,
anomie, and other attitudinal byproducts of modernity. In many European
nations, the rise in suicide rates was thought to signal a cultural
decline. These latter two developments made suicide prevention a
bureaucratic and medical preoccupation, leading to a wave of
institutionalization for suicidal persons. All three conspired to
suggest that suicide is caused by impersonal social or psychological
forces rather than by the agency of individuals.
Suicide was of central concern for the
twentieth century existentialists, who saw the choice to take one's life
as impressed upon us by our experience of the absurdity or
meaninglessness of the world and of human endeavor. Albert Camus
illustrated this absurdity in his philosophical essay The Myth of
Sisyphus. For Camus, Sisyphus heroically does not try to escape his
absurd task, but instead perseveres and in so doing resists the lure of
suicide. Suicide, Camus contends, tempts us with the promise of an
illusory freedom from the absurdity of our existence, but is in the end
an abdication of our responsibility to confront or embrace that
absurdity head on. (Campbell and Collinson 1988, 61-70). Jean-Paul
Sartre was likewise struck by the possibility of suicide as an assertion
of authentic human will in the face of absurdity. Suicide is, according
to Sartre, an opportunity to stake out our understanding of our essence
as individuals in a godless world For the existentialists, suicide was
not a choice shaped mainly by moral considerations but by concerns about
the individual as the sole source of meaning in a meaningless universe.
The principal moral issue surrounding
suicide has been
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Are there conditions under which
suicide is morally justified, and if so, which conditions?
Several important historical answers to
(1) have already been mentioned.
Note that this question should be
distinguished from three others:
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Should other individuals attempt to
prevent suicide?
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Should the state criminalize suicide
or attempt to prevent it?
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Is suicide ever rational or prudent?
Obviously, answers to any one of these
four questions will bear on how the other three ought to be answered.
For instance, it might be assumed that if suicide is morally permissible
in some circumstances, then neither other individuals nor the state
should interfere with suicidal behavior (in those same circumstances).
However, this conclusion might not follow if those same suicidal
individuals are irrational and interference is required in order to
prevent them from taking their lives, an outcome their more rational
selves might regret. Furthermore, for those moral theories that
emphasize rational autonomy, whether an individual has rationally chosen
to take her own life may settle all four questions. In any event, the
interrelationships among suicide's moral permissibility, its rationality,
and the duties of others and of society as a whole is complex, and we
should be wary of assuming that an answer to any one of these four
questions decisively settles the other three.
The simplest moral outlook on suicide
holds that it is necessarily wrong because human life is sacred. Though
this position is often associated with religious thinkers, especially
Catholics, we find similar positions in Kant and in Ronald Dworkin (Dworkin
1993.) According to this ‘sanctity of life’ view, human life is
inherently valuable and precious, demanding respect from others and
reverence for oneself. Hence, suicide is wrong because it violates our
moral duty to honor the inherent value of human life, regardless of the
value of that life to others or to the person whose life it is. The
sanctity of life view is thus a deontological position on suicide.
The great merit of the sanctity of life
position is that it reflects a common moral sentiment, namely, that
killing is wrong in itself. The chief difficulties for the sanctity of
life position are these:
First, its proponents must be willing
to apply the position consistently, which would also morally forbid
controversial forms of killing such as capital punishment or killing
in wartime. But it would also forbid forms of killing that seem
intuitively reasonable, such as killing in self-defense. To accept
the sanctity of life argument seems to require endorsing a
thoroughgoing pacifism.
Secondly, the sanctity of life view
must hold that life itself, wholly independent of the happiness
whose life it is, is valuable. Many philosophers reject the notion
that life is intrinsically valuable, since it suggests, e.g., that
there is value in keeping alive an individual in a persistent
vegetative state simply because she is biologically alive. It would
also suggest that a life certain to be filled with limitless
suffering and anguish is valuable just by virtue of being a human
life. Peter Singer (Singer 1994) and others have argued against the
sanctity of life position on the grounds that the value of a
continuing life is not intrinsic but extrinsic, to be judged on the
basis of the individual's likely future quality of life. If the
value of a person's continued life is measured by its likely quality,
then suicide may be permissible when that quality is low (see
section 3.5) (This is not to suggest that quality
of life assessments are straightforward or uncontroversial. See
Hayry 1991 for discussion).
Finally, it is not obvious that
adequate respect for the sanctity of human life prohibits ending a
life, whether by suicide or other means. Those who engage in
suicidal behavior when their future promises to be extraordinarily
bleak do not necessarily exhibit insufficient regard for the
sanctity of life. (Dworkin 1993, 238) To end one's life before its
natural end is not necessarily an insult to the value of life.
Indeed, it may be argued that suicide may be life-affirming in those
circumstances where medical or psychological conditions reduce
individuals to shadows of their former fully capable selves. (Cholbi
2002)
Two general categories of arguments for
the moral impermissibility of suicide have emerged from the Christian
religious tradition. The first of these is the aforementioned Thomistic
natural law tradition, critiqued by Hume (see section 2.3)
According to this tradition, suicide violates the natural law God has
created to govern the natural world and human existence. This natural
law can be conceived of in terms of (a) natural causal laws, such that
suicide violates this causal order, (b) teleological laws, according to
which all natural beings seek to preserve themselves, or (c) the laws
governing human nature, from which it follows that suicide is
‘unnatural’ (Pabst Battin 1996, 41-48.) These natural law arguments are
no longer the main focus of philosophical discussion, as they have been
subjected to strenuous criticism by Hume and others. These criticisms
include that the natural law arguments cannot be disentangled from a
highly speculative theistic metaphysics; that these claims are not
confirmed by observations of human nature (e.g., the existence of self-destructive
human behaviors casts doubt on the claim that we "naturally" preserve
ourselves); and that other acts (e.g., religious martyrdom) which God is
assumed not to condemn, also violate these natural laws, making the
prohibition on suicide appear arbitrary.
The second general category of religious
arguments rest on analogies concerning the relationship between God and
humanity. For the most part, these arguments aim to establish that God,
and not human individuals, have the proper moral authority to determine
the circumstances of their deaths. One historically prominent analogy (suggested
by Aquinas and Locke) states that we are God's property and so suicide
is a wrong to God akin to theft or destruction of property. This analogy
seems weak on several fronts. First, if we are God's property, we are an
odd sort of property, in that God apparently bestowed upon us free will
that permits to act in ways that are inconsistent with God's wishes or
intentions. It is difficult to see how an autonomous entity with free
will can be subject to the kind of control or dominion to which other
sorts of property are subject. Second, the argument appears to rest on
the assumption that God does not wish his property destroyed. Yet given
the traditional theistic conception of God as not lacking in any way,
how could the destruction of something God owns (a human life) be a harm
to God or to his interests? (Holley 1989, 105.) Third, it is difficult
to reconcile this argument with the claim that God is all-loving. If a
person's life is sufficiently bad, an all-loving God might permit his
property to be destroyed through suicide. Finally, some have questioned
the extent of the duties imposed by God's property right in us by
arguing that the destruction of property might be morally justified in
order to prevent significant harm to oneself. If the only available
means to saving myself from a ticking bomb is to stash it in the trunk
of the nearest car to dampen the blast, and the nearest car belongs to
my neighbor, then destroying his property appears justified in order to
avoid serious harm to myself. Likewise, if only by killing myself can I
avoid a serious future harm to myself, I appear justified in destroying
God's property (my life).
Another common analogy asserts that God
bestows life upon us a gift, and it would be a mark of ingratitude or
neglect to reject that gift by taking our lives. The obvious weakness
with this "gift analogy" is that a gift, genuinely given, does not come
with conditions such as that suggested by the analogy, i.e., once given,
a gift becomes the property of its recipient and its giver no longer has
any claim on what the recipient does with this gift. It may perhaps be
imprudent to waste an especially valuable gift, but it does not appear
to be unjust to a gift giver to do so. As Kluge put it, "a gift we
cannot reject is not a gift" (Kluge 1975, 124.) A variation of
this line of argument holds that we owe God a debt of gratitude for our
lives, and so to kill ourselves would be disrespectful or even insulting
to God, (Ramsey 1978, 146) or would amount to an irresponsible use of
this gift. Yet this variation does not really evade the criticism
directed at the first version: Even if we owe God a debt of gratitude,
disposing of our lives does not seem inconsistent with our expressing
gratitude for having lived at all (Beauchamp 1992.) Furthermore, if a
person's life is rife with misery and unhappiness, it is far from clear
that she owes God much in the way of gratitude for this apparently ill-chosen
"gift" of life. Defenders of the gift analogy must therefore offer a
theodicy to defend the claim that life, because it is given to us by a
loving God, is an expression of God's benevolent nature and is therefore
necessarily a benefit to us (Holley 1989, 113-114.)
In addition, there is a less recognized
undercurrent of religious thought that favors suicide. For
example, suicide permits us to reunite with deceased loved ones, allows
us those who have been absolved of sin to assure their entrance to
heaven, and releases the soul from the bondage of the body. In both
Christian and Asian religious traditions, suicide holds the promise of a
vision of, or union with, the divine (Pabst Battin 1996, 53-64.)
For libertarians, suicide is morally
permissible because individuals enjoy a right to suicide. (It
does not of course follow that suicide is necessarily rational or
prudent.) Libertarianism, which has historical precedent in the Stoics
and in Schopenhauer, is strongly associated with the ‘anti-psychiatry’
movement of the last half century. According to that movement's critics,
attempts by the state or by the medical profession to interfere with
suicidal behavior are essentially coercive attempts to pathologize
morally permissible exercises of individual freedom (Szasz 2002.)
Libertarianism typically asserts that the
right to suicide is a right of noninterference, to wit, that
others are morally barred from interfering with suicidal behavior. Some
assert the stronger claim that the right to suicide is a liberty
right, such that individuals have no duty not to commit suicide
(i.e., that suicide violates no moral duties), or a claim right,
according to which other individuals are morally obliged not only not to
interfere with a person's suicidal behavior but are in fact morally
required to assist in that suicidal behavior. Our having a claim right
to suicide implies that we also have rights of noninterference and of
liberty and is a central worry about physician-assisted suicide (Pabst
Battin 1996, 163-164.) Since whether we have a liberty right to suicide
concerns whether it violates other moral obligations, including
obligations to other people, I shall leave discussion of that issue to
section 3.5 and focus here on whether there is a
right of noninterference.
A popular basis for the claim that we
enjoy a right to suicide is the claim that we own our bodies and hence
are morally permitted to dispose of them as we wish. (In
section 3.3, we observed that some religious arguments for the
impermissibility of suicide depend on God's ownership of our bodies.) On
this view, our relationship to our bodies is like that of our
relationship to other items over which we enjoy property rights: Just as
our having a right to a wristwatch permits us to use, improve, and
dispose of it as we wish, so too does our having a right to our bodies
permit us to dispose of it as we see fit. Consequently, since property
rights are exclusive (i.e., our having property rights to a thing
prohibits others from interfering with it), others may not interfere
with our efforts to end our lives. The notion of self-ownership invoked
in this argument is quite murky, since what enables us to own ordinary
material items is their metaphysical distinctness from us. We can own a
wristwatch only because it is distinct from us, and even under
the most dualistic views of human nature, our selves are not
sufficiently distinct from our bodies to make ownership of the body by
the self a plausible notion. Indeed, the fact that certain ways of
treating ordinary property are not available to us as ways of treating
our bodies (we cannot give away or sell our bodies in any literal sense)
suggests that self-ownership may be only a metaphor meant to capture a
deeper moral relationship (Kluge 1975, 119.) In addition, uses of one's
property, including its destruction, can be harmful to others. Thus, in
cases where suicide may harm others, we may be morally required to
refrain from suicide. (See section 3.5 for arguments
concerning duties to others)
Another rationale for a right of
noninterference is the claim that we have a general right to decide
those matters that are most intimately connected to our well-being,
including the duration of our lives and the circumstances of our deaths.
On this view, the right to suicide follows from a deeper right to self-determination,
a right to shape the circumstances of our lives so long as we do not
harm or imperil others. As presented in the "death with dignity"
movement, the right to suicide is presented as the natural corollary of
the right to life. That is, because individuals have the right not to be
killed by others, the only person with the moral right to determine the
circumstances of a person's death is that person herself and others are
therefore barred from trying to prevent a person's efforts at self-inflicted
death.
This position is open to at least two
objections. First, it does not seem to follow from having a right to
life that a person has a right to death, i.e., a right to take her own
life. Because others are morally prohibited from killing me, it does not
follow that anyone else, including myself, is permitted to kill me. This
conclusion is made stronger if the right to life is inalienable, since
in order for me to kill myself, I must first renounce my inalienable
right to life, which I cannot do (Feinberg 1978.) It is at least
possible that no one has the right to determine the
circumstances of a person's death! Furthermore, as with the property-based
argument, the right to self-determination is presumably circumscribed by
the possibility of harm to others.
A fourth approach to the question of
suicide's permissibility asks not whether others may interfere with
suicidal behavior but whether we have a liberty right to suicide,
whether, that is, suicide violates any moral duties to others. Those who
argue that suicide can violate our duties to others generally claim that
suicide can harm either specific others (family, friends, etc.) or is a
harm to the community as a whole.
No doubt the suicide of a family member
or loved one produces a number of harmful psychological and economic
effects. In addition to the usual grief, suicide "survivors" confront a
complex array of feelings. Various forms of guilt are quite common, such
as that arising from (a) the belief that one contributed to the suicidal
person's anguish, or (b) the failure to recognize that anguish, or (c)
the inability to prevent the suicidal act itself. Suicide also leads to
rage, loneliness, and awareness of vulnerability in those left behind.
Indeed, the sense that suicide is an essentially selfish act dominates
many popular perceptions of suicide (Fedden 1938, 209.) Still, some of
these reactions may be due to the strong stigma and shame associated
with suicide, in which case these reactions cannot, without logical
circularity, be invoked in arguments that suicide is wrong because it
produces these psychological reactions (Pabst Battin 1996, 68-69.)
Suicide can also cause clear economic or material harm, as when the
suicidal person leaves behind dependents unable to support themselves
financially. Suicide can therefore be understood as a violation of the
distinctive "role obligations" applicable to spouses, parents, and other
caretakers. However, even if suicide is harmful to family members or
loved ones, this does not support an absolute prohibition on suicide,
since some suicides will leave behind few or no survivors, and among
those that do, the extent of these harms is likely to differ such that
the stronger these relationships are, the more harmful suicide is and
the more likely it is to be morally wrong. Besides, from a utilitarian
perspective, these harms would have to be weighed against the harms done
to the would-be suicide by continuing to live a difficult or painful
life. At most, the argument that suicide is a harm to family and to
loved ones establishes that it is sometimes wrong.
A second brand of social argument echoes
Aristotle in asserting that suicide is harm to the community or the
state. One general form such arguments take is that because a community
depends on the economic and social productivity of its members, its
members have an obligation to contribute to their society, an obligation
clearly violated by suicide (Pabst Battin 1996, 70-78.) For example,
suicide denies a society the labor provided by its members, or in the
case of those with irreplaceable talents such as medicine, art, or
political leadership, the crucial goods their talents enable them to
provide. Another version states that suicide deprives society of
whatever individuals might contribute to society morally (by way of
charity, beneficence, moral example, etc.) Still, it is difficult to
show that a society has a moral claim on its members' labor, talents, or
virtue that compels its members to contribute to societal well-being
no matter what. After all, individuals often fail to contribute as much
as they might in terms of their labor or special talents without
incurring moral blame. It does not therefore seem to be the case that
individuals are morally required to benefit society in whatever way they
are capable, regardless of the harms to themselves. Again, this line of
argument appears to show only that suicide is sometimes wrong, namely,
when the benefit (in terms of future harm not suffered) the individual
avoids by dying is less than the benefits she would deny to society by
dying.
A modification of this argument claims
that suicide violates a person's duty of reciprocity to society. On this
view, an individual and the society in which she lives stand in a
reciprocal relationship such that in exchange for the goods the society
has provided to the individual, the individual must continue to live in
order to provide her society with the goods that relationship demands.
Yet in envisioning the relationship between society and the individual
as quasi-contractual in nature, the reciprocity argument reveals its
principal flaw: The conditions of this "contract" may not be met, and
once met, impose no further obligations upon the parties. If a society
fails to fulfill its obligations under the contract, namely to provide
individuals with the goods needed for a decent quality of life, then the
individual is not morally required to live in order to reciprocate an
arrangement that society has already reneged on. As Baron d'Holbach
wrote:
If the covenant which unites man to
society be considered, it will be obvious that every contract is
conditional, must be reciprocal; that is to say, supposes mutual
advantages between the contracting parties. The citizen cannot be
bound to his country, to his associates, but by the bonds of
happiness. Are these bonds cut asunder? He is restored to liberty.
Society, or those who represent it, do they use him with harshness,
do they treat him with injustice, do they render his existence
painful?… Chagrin, remorse, melancholy, despair, have they
disfigured to him the spectacle of the universe? In short, for
whatever cause it may be, if he is not able to support his evils,
let him quit a world which from thenceforth is for him only a
frightful desert. (d'Holbach 1970, 136-137)
Moreover, once an individual has
discharged her obligations under this societal contract, she no longer
is under an obligation to continue her life. Hence, the aged or others
who have already made substantial contributions to societal welfare
would be morally permitted to commit suicide under this argument.
To this point, we have addressed
arguments that concern whether a moral permission to engage in
suicidal behavior exists. Yet the social arguments against suicide are
fundamentally consequentialist, and some act-utilitarians have discussed
the correlative possibility that the good consequences of suicide might
so outweigh its bad consequences as to render suicide admirable or even
morally obligatory (Cosculluela 1995, 76-81.) In fact, in some
cases, suicide may be honorable. Suicides that are clearly other-regarding,
aiming at protecting the lives or well-being of others, or at political
protest, may fall into this category (Kupfer 1990,73-74.) Examples of
this might include the grenade-jumping solider mentioned earlier, or the
spy who takes his life in order not to be subjected to torture that will
lead to his revealing vital military secrets. Utilitarians have given
particular attention to the question of end-of-life euthanasia,
suggesting that at the very least, those with painful terminal illnesses
have a right to voluntary euthanasia (Glover 1990, chs. 14-15, Singer
1993, ch. 7.) Yet utilitarian views hold that we have a moral duty to
maximize happiness, from which it follows that when an act of suicide
will produce more happiness than will remaining alive, then that suicide
is not only morally permitted, but morally required. Critics worry that
a moral requirement to commit suicide raises the sinister and
totalitarian prospect that individuals may be obliged to commit suicide
against their wishes. (Moreland & Geisler 1990, 94, Pabst Battin 1996,
94-95) This worry may reflect an implicit acceptance of a variation of
the sanctity of life view (see section 3.2) or may
reflect concerns about infringements upon individual's autonomy (see
section 3.6). One alternative for utilitarians is to
adopt a rule-utilitarian standpoint according to which suicide would be
morally forbidden because general adherence to a rule prohibiting
suicide would produce better overall consequences than would general
adherence to a rule permitting suicide (Brandt 1975, Pabst Battin 1996,
96-98.)
A more restricted version of the claim
that we have a right to noninterference regarding suicide holds that
suicide is permitted so long as — leaving aside questions of duties to
others — it is rationally chosen, or to put it in a Kantian vernacular,
if it is undertaken autonomously. This position is narrower than the
libertarian view, in that it permits suicide only when performed on a
rational basis and permits others to interfere when it is not performed
on that basis.
This approach has given rise to a rich
philosophical literature concerning the conditions for rational suicide.
For the most part, this literature divides the conditions for rational
suicide into cognitive conditions, conditions ensuring that
individuals' appraisals of their situation are rational and well-informed,
and interest conditions, conditions ensuring that suicide in
fact accords with individuals' considered interests. Richard Brandt
captures the spirit of this approach:
The person who is contemplating
suicide is obviously making a choice between future world-courses:
the world-course that includes his demise, say, an hour from now,
and several possible ones that contain his demise at a later point…
The basic question a person must answer in order to determine which
world-course is best or rational for him to choose, is which he
would choose under conditions of optimal use of information,
when all of his desires are taken into account. It is not
just a question of what we prefer now, with some
clarification of all the possibilities being considered. Our
preferences change, and the preferences of tomorrow are just as
legitimately taken into account in deciding what to do now as the
preferences of today (Brandt 1975.)
Other examples of this approach include
Glenn Graber, who states that a suicide is rationally justified "if a
reasonable appraisal of the situation reveals that one is better off
dead." (Graber 1981, 65.) An appraisal is reasonable, according to
Graber, if one judges rationally about the likelihood of her present and
probable future values and preferences being satisfied. On Graber's view,
a suicide is rational if it results from a clearheaded assessment of how
suicide would further or impede one's overall interests. Margaret Battin
identifies three cognitive conditions for rational suicide (a facility
for causal and inferential reasoning, possession of a realistic world
view, and adequacy of information relevant to one's decision), along
with two interest conditions (that dying enables one to avoid future
harms, and that dying accords with one's most fundamental interests and
commitments) (Pabst Battin 1996, 115.)
For the most part, suicidal individuals
do not manifest signs of systemic irrationality, much the less
the signs of legally definable insanity, (Radden 1982) and with the
exception of severe psychopaths, engage in suicidal conduct voluntarily.
However, these facts are consistent with the choice to engage in
suicidal behavior being irrational, and serious questions can be raised
about just how often the conditions for rational suicide are met in
actual cases of self-inflicted death. Indeed, the possibility of
rational suicide requires that certain assumptions about suicidal
individuals' rational autonomy be true which may not be in many cases. A
person's choice to undertake suicidal behavior may not be a reflection
of her true self and her self-inflicted death could be an act that she
would, in calmer and clearer moments, recoil at. In other words, even if
there is a right to self-determination which in turn implies a right to
suicide, it seems to imply a right to commit suicide only when one's
true self is making that determination, and there are numerous factors
that may compromise a person's rational autonomy and hence make the
decision to engage in suicidal behavior not a reflection of one's
considered values or aims. Some of these factors cognitively distort
agents' deliberation about whether to commit suicide. The act of suicide
is often impulsive and poorly thought out, reflecting the intense
psychological vulnerability of suicidal persons and their proclivity
toward volatility and agitation (Cholbi 2002.) Suicidal persons can also
have difficulty fully acknowledging the finality of their death,
believing that (assuming there is no afterlife) they will continue to be
subjects of conscious experience after they die. In what are known as
dyadic suicides, the suicidal individual actually looks forward to the
moment when she will (posthumously) enjoy having insulted or having
exacted revenge upon another person.
Particularly worrisome is the evident
link between suicidal thoughts and mental illnesses such as depression.
While disagreement continues about the strength of this link (Pabst
Battin 1996, 5) little doubt exists that the presence of depression or
other mood disorders greatly increases the likelihood of suicidal
behavior. Some studies of suicide indicate that over 90% of suicidal
persons displayed symptoms of depression before death, while others
estimate that suicide is at least 20 times more common among those with
clinical depression than in the general population. In cases of suicide
linked with depression, individuals' attitudes toward their own death
are colored by strongly negative and occasionally distorted beliefs
about their life situations (career prospects, relationships, etc.). As
Brandt (Brandt 1975) observed, depression can "primitivize one's
intellectual processes," leading to poor estimation of probabilities and
an irrational focus on present suffering rather than on possible good
future states of affairs. The suicidally depressed also exhibit
romanticized and grandiose beliefs about the likely effects of their
deaths (delusions of martyrdom, revenge, etc.) Furthermore, suicidal
persons are often hesitant about their own actions, hoping that others
will intervene and signaling to others the hope that they will intervene
(Shneidman 1985.) Finally, although repeated suicide attempts by the
same individual are common, the impulse to suicidal behavior is often
transient and dissipates of its own accord (Blauner 2003.) Taken
together, these considerations indicate that, even if there is a right
of self-determination, the scope of suicidal conduct that genuinely
manifests fully informed and rational self-evaluation may be rare and so
only occasionally will suicide be rational or morally permissible, even
when excusable because irrational. (Philip Devine has even argued that
suicide is necessarily irrational: Because no one has
experience of death, a suicidal individual lacks the knowledge needed to
judge continued life with its alternative (Devine 1978).) Moreover, if
suicide is frequently not an expression of individuals' rational self-determination
about their well-being, that suggests that others may have a prima
facie reason to interfere with suicidal behavior and so is there is
no general right to noninterference. (See section 3.7)
With the exception of the libertarian
position that each person has a right against others that they not
interfere with her suicidal intentions, each of the moral positions on
suicide we have addressed so far would appear to justify others
intervening in suicidal plans, at least on some occasions. Little
justification is necessary for actions that aim to prevent another's
suicide but are non-coercive. Pleading with a suicidal individual,
trying to convince her of the value of continued life, recommending
counseling, etc. are morally unproblematic, since they do not interfere
with the individual's conduct or plans except by engaging her rational
capacities (Cosculluela 1994, 35, Cholbi 2002, 252.) The more
challenging moral question is whether more coercive measures such as
physical restraint, medication, deception, or institutionalization are
ever justified to prevent suicide and when. In short, the question of
suicide intervention is a question of how to justify paternalistic
interference.
As mentioned in section
3.6, the impulse toward suicide is often short-lived, ambivalent,
and influenced by mental illnesses such as depression. While these facts
together do not appear to justify intervening in others' suicidal
intentions, they are indicators that the suicide may be undertaken with
less than full rationality. Yet given the added fact that death is
irreversible, when these factors are present, they justify intervention
in others' suicidal plans on the grounds that suicide is not in the
individual's interests as they would rationally conceive those interests.
We might call this the ‘no regrets' or ‘err on the side of life’
approach to suicide intervention (Martin 1980, Pabst Battin 1996, 141,
Cholbi 2002.) Since most situations in which another person intends to
kill herself will be ones where we are unsure of whether she is
rationally choosing to die, it is better to temporarily prevent "an
informed person who is in control of himself from committing suicide"
than to do "nothing while, say, a confused person kills himself,
especially since, in all likelihood, the would-be suicide could make
another attempt if this one were prevented and since the suicidal option
is irreversible if successful." (Cosculluela 1994, 40.) Further
psychiatric or medical examinations may settle the matter regarding the
rationality of the suicidal individual's decision. The coerciveness of
the measures used should be proportional to the apparent seriousness of
the suicidal person's intention to die.
A neglected aspect of our duties toward
the suicidal is the possibility that we may have a moral duty to aid
others to commit suicide. (This possibility is directly related to
physician-assisted suicide and the larger question of whether the right
to suicide is a claim right.) If there are circumstances that justify
our intervening to prevent suicide undertaken irrationally or contrary
to a person's self-interest, then the same paternalistic rationale would
justify our helping to promote or enable those suicides that are
rational and in accordance with a person's self-interest. The widespread
moral acceptance of aiding others to commit suicide may portend
substantial moral perils, as it opens up the possibility that assisted
suicide could be vulnerable to various forms of abuse, manipulation, or
undue pressure that make an otherwise irrational suicide rational (Pabst
Battin 1996, 145-157.) For example, the family members and health care
providers of a terminally ill patient might grow weary of the financial
or personal burdens of caring for such a patient and decide to provide
substandard palliatve care in order to make suicide more attractive to
that patient. Hence, by giving license for others to assist in suicides,
we may unwittingly permit them to encourage suicides not because those
suicides are in fact in the best interests of the individual in question,
but because those suicides advance the interests of other people or of
institutions. Indeed, a good deal of the apprehension surrrounding
physician-assisted suicide arise from worries about whether laws and
institutional practices can be formulated that both permit others to aid
in rational suicide while also preventing abuses and manipulation.
As the foregoing discussion indicates,
suicide has been and continues to be a rich field of philosophical
investigation. Recent advances in medical technology are responsible for
the extensive philosophical attention paid to one kind of suicide,
euthanasia or physician-assisted suicide (PAS), while more "run-of-the-mill"
suicide motivated by psychological anguish is somewhat overlooked. This
is somewhat unfortunate: Euthanasia and physician-assisted suicide raise
issues beyond those associated with other suicides, including the
allocation of health care resources and the patient-physician
relationship. However, many of the same issues and concerns that
surround PAS and euthanasia also surround run-of-the mill suicide, and
many writers who address the former often disregard the vast literature
on the latter.
Not only is suicide worthy of
philosophical investigation in its own right, it is source of insight
for various philosophical subdisciplines: moral psychology, ethical
theory, social and political philosophy, the metaphysics of personhood,
free will and action theory. Suicide is also an area where philosophical
interests intersect with those of the empirical sciences. The collective
efforts of philosophers and others continue to illuminate what has
struck many people as the most incomprehensible and most troubling of
human behaviors.
-
St. Thomas Aquinas, 1273, Summa
Theologica.
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Aristotle, Nicomachean Ethics.
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St. Augustine. City of God.
Marcus Dods, trans.
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Cicero, c. 2nd century BCE, De
Finibus, trans. H. Rackham.
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Donne, J., c. 1607, Biathanatos,
A Declaration of that Paradoxe, or Thesis, that Selfe-homicide is
not so naturally Sinne, that it may never be Otherwise.
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Durkheim, E., 1897, Le Suicide.
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d'Holbach, Baron, 1970, The
System of Nature, or Laws of the Moral and Physical World, v.
1, Robinson, trans. New York: Burt Franklin.
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Hume, D., 1783, "On Suicide." [Available
online].
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Kant, I., 1785, Metaphysics of
Morals, M. Gregor trans., Cambridge: Cambridge University Press.
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autonomy: in moral and political philosophy
|
autonomy: personal |
death |
euthanasia: voluntary |
libertarianism |
mental
illness |
paternalism |
well-being
|
