Bioethics Discussion Blog: Rational Suicide Considered: "Fire in the Belly" and Whose Quality of Life?

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Sunday, July 31, 2005

Rational Suicide Considered: "Fire in the Belly" and Whose Quality of Life?

I watched last night the PBS “Point of View” presentation of the film produced by the daughter of Bob Stern. As you may recall from my July 25th posting, Mr. Stern videotaped his explanation to his family of his intended suicide. His son and wife were present to listen and argue. The suicide was completed by the next morning. The film was very interesting and enlightening since most people who commit suicide never openly discuss their rationale, in detail, to their family in advance of their act. The film provided a extensive look into the life a man who tried to be in control of his life throughout the years and insisted to be in control up to the end when he found he was losing control because of the medical problems of an earlier stroke and then cancer of the prostate and finally scheduled surgery for an abdominal aortic aneurism.

The question is whether his death represented a “rational suicide”, one based on a thought out decision considering the gains and losses, as he had always done in his business life, but without an underlying mental depression to sway that decision. After reviewing the film, I find it difficult to define Bob Stern’s act as fully thought out and free of depression. First, I truly doubt some clinical depression was not present despite his fairly upbeat appearance that he had made a clear thinking analytical decision. He talked about losing the “fire in [his] belly” which had provided the drive for many of his previous business and personal accomplishments. Couldn’t this comment suggest underlying depression?

Further, and this is a consideration I would like my visitors to discuss, should a “rational” decision for suicide be made only with regard to the individuals own “best interest” as he described it and not include the best interest of the caring family? It seems Mr. Stern had developed through his presence, attention, interaction and love over the years a concerned, loving and in a sense dependent family. Yet, their need for him seems to have been disregarded in his analytical balancing of his life account as he worked out his decision. Should his considerations of quality of life, as he called it, have been limited only to his own or should he have considered the quality of life of his family with him gone? It is because of these points that if there is such an act as rational suicide, I don’t believe that Bob Stern’s death qualifies. What do you think? ..Maurice.

9 Comments:

At Sunday, July 31, 2005 11:36:00 AM, Anonymous Frank said...

Not having seen the program I am at a disadvantage in assessing the "rationality" of his decision. Two thoughts--I am not sure the presence of depression rules out a rational calculation--depression and rationality are not logically incompatible--in fact--the presence of depression may be part of the rational calculation--I am assuming it was not a psychotic depression or the product of bipolar illness which might well have accompanying thought disturbances. Also, from the illnesses you mention it is reasonable to assume the depression might persist--while there might be some elevation of mood with medication and supportive counselling it is not going to cure a stroke or Ca of the prostate. ALso, I am not sure how much one can take family and loved ones into a rational calculation--it could well be presumptuous to assume you know, and can act, on their values. their loss/grief might be counterbalanced by relief, etc. Also, I am not sure how you can ask a loved one to enter into that calculation of your own suicide other than to be supportive and accepting of the final calculation. After all, who is going to say, all things considered I think you should kill your self.. One may think it, even privately hope for it (yes we do have those kind of thoughts) but saying it is another level of responsibility. We can not help what we think and feel but we can mange what we say

 
At Sunday, July 31, 2005 1:17:00 PM, Blogger Maurice Bernstein, M.D. said...

Frank, all good points.

What got me, if I can recall the video correctly, is the way he used the "best interest" expression. What I remember is that when he first used the term "best interest",in balancing the details leading up to his decision, he then caught himself and said "my best interest" stressing the "my".

Even though part of his family was present at the time of the video recording, they may have not fully informed him about their true personal values regarding the decision. But shouldn't he have included their "best interest" and their resulting quality of life as the result of his act? After all, he will be gone (no interest, no life) but his family will continue living. I got the feeling he was only looking toward himself in the decision.
That would be acceptable for a "street person" with no family or close friends but not a long time husband and father.

Frank, I hope you will have a chance to see the film somewhere and I would be interested in your futher comments. ..Maurice.

 
At Monday, August 01, 2005 4:35:00 AM, Anonymous Anonymous said...

Maurice, I just don't think you can include your loved ones/families "best interest" in the calculation--it is difficult enough to honestly assess one's own interests without speculation regarding the best interest of others--also--I am not sure their interests can be seen outside the prism of one's own interests--finally--assessing the interests of others in making a decision to end ones's life could lead to a decision that suicide is right and proper given the pain, disappointment and anguish you are causing others--let alone financial calculations that may well indicate that they are better off with you dead--mounting medical bills, costs of care life insurance etc.--thanks for raising the question--I never really thought about it and I run a mental health center with a large memergency psychiatric service--Take Care Frank

 
At Monday, August 01, 2005 8:01:00 AM, Blogger Maurice Bernstein, M.D. said...

Frank, you are correct that usually it would require speculation about the best interest of others, however Bob's case was unique in that there was documented "consultation" with the family members present and he could have covered this issue. His case is further unique in that ,as brought out in the film, his family was financially rich.

What strikes me in the story about Bob and his suicide is that his main fear was not about the consequences one way or the other with regard to his family. In fact, as I recall, he spoke out to the effect that his absence would be of no lasting effect on his family. However, his fear was his inability to accept having another person, the physician, controlling his illnesses and his life. This went against his long need for personal control of his life. This need then led to him doing nothing about his steadily growing prostate cancer as documented by the progressively increasing high PSA values. And, when it came to the life threatening abodominal aortic aneurism which was on the verge of being surgically corrected, the loss of control of his body during surgery and later with the possibility of surgical complications or post-op deterioration, I think, was the primary reason for his decision for a self-controlled death and had nothing to do with the values or effects on the family. I know this is a harsh evaluation of the man, but if the film did not leave out other factors to consider, this is my conclusion. What Bob needed and what he did not get was some professional psychologic counseling. ..Maurice.

 
At Tuesday, August 02, 2005 11:50:00 AM, Anonymous Frank said...

I will watch the video--thanks for the discussion--I am sure control can be a significant issue--it certainly is in my life--Since this post I have given some thought as to how/or if I would include my family and/or closest friends in a decision regarding my own suicide--not that I have any plans--but I must admit, if I was facing Bob's medical challenges I might be giving it active consideration--Take Care Frank

 
At Friday, May 19, 2006 10:01:00 PM, Blogger kilo2tango said...

What drival

each person makes a decision taking whatever he wants and then acts

do not over think it

life is complicated
death is simple

 
At Thursday, February 15, 2007 8:18:00 PM, Anonymous Coranth Gryphon said...

Two comments on your analysis. First, it appears that you are presuming that anyone who contemplates suicide cannot, somehow by definition, be free of depression.

As a threshold matter, I doubt there is any rational adult who is completely free from depression. There are always bad days, unhappy events, periods of fatigue or stress... all of these are aspects of depression. So, while you may be right that Mr. Stern had at least some tangential depression, the same can be said of almost everyone.

Also, isn't depression itself rational if the cause is direct, objective and measurable? Someone with a terminal disease or recently divorced or unemployed (assume despite best efforts) for years -- wouldn't those be rational grounds to be depressed, at least to some degree?

So, your counter argument seems to be that every adverse situation which would possibly lead someone to rationally consider suicide by definition makes the person unsuited to consider suicide. That argument is circular, because you assume the conclusion to support the premise.

Second comment -- any decision about a person's life will have an collateral impact on the other people in that person's life. That's a given. But at what point should we allow the secondary impact on others' lives to dominate?

If a person's "best interests" must always place others at an equal or higher priority than their own issues and choices, then the concept of "best interest" becomes meaningless.

Either everyone has the option of making decisions about what is best for their own lives, even if those decisions are not in the best interests of others, or they don't. And if they don't, then you also seem to discount divorce (rarely in the bests interest of children), working late (ditto), vacations (often not in the best interests of those you work with), and so on.

The bottom line is that any rational choice is going to include emotional factors, especially factors so common as to be part of everyday experience. And any rational choice about one's own "best interests" is likely to have some adverse effect on others.

But we can't live our lives primarily for others, or they cease to be "our" lives. And if we grant that everyone has the right to choose how to live their life, we also have to grant that people can make rational choices about how to end their lives.

Granted, very few people do make rational decisions about such life or death matters. But we can't assume the decision is irrational just because it isn't made in a complete vaccuum.

 
At Thursday, February 15, 2007 9:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Since I first posted this thread, I find all of my visitors comments quite understandable and rational including Kilo2tango's "life is complicated, death is simple". I am willing to accept that rational decisons can be made despite depression not associated with pathologic thought disturbances. I also accept the difficulty in understanding why the individual's best interest should always trump that of the surviving family.

I just think there was something missing from the way the story played out. Somehow I feel there was a role for professional help for Bob Stern in perhaps the sorting out or clarification of how he could find mental peace short of death. ..Maurice.

 
At Monday, July 16, 2007 8:19:00 AM, Anonymous Ceejay said...

Quality vs. quantity?

If he remains alive to fultill the needs of his family the extension of life is there for sure, but what quality, for all concerned?
In fact, I would posit that his family would come to rue the day they became the primary focus of his decision to 'stay or leave'.

I was told many years ago that 'rational suicide' was acceptable in my case. (Severe disabling trigeminal neuralgia and many failed surgeries, treatments, etc.)

I had no family so that was not an issue but the idea of depression is one that always comes into play.

I can only speak to chronic pain but I found that the definition of depression - hopelessness and helplessness - was also appropriate for chronic, untreatable, unrelenting chronic pain.

I would not be surprised to find this also a factor when one is faced with a physical crisis where the fear of pain is also highly present.

I have to agree with the writer who said counseling should have been given. I wonder if the fear overrode the reality of possible quality of continued life if he went ahead with the surgery for the aneurysm.

The one thing about suicide - absent coma or quadriplegia (or other problems making physical use of the arms and mouth impractical or absent) it is a choice that remains available; at least until nature makes it's own decision for you.

Carol Jay Levy
author A PAINED LIFE, a chronic pain journey
member, cofounder with Linda Misek-Falkoff, PWPI, Persons With Pain International
member U.N. NGO group, Persons With Disabilities

 

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