Bioethics Discussion Blog: “Rational Suicide” or Is It Depression?

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Monday, July 25, 2005

“Rational Suicide” or Is It Depression?

“Bob Stern always was a fiercely logical thinker, and he made the decision to die with the same unflinching reason that had governed his life.
He explained the process to a video camera he set on a tripod in his living room.”

The comments above is from the story of Bob Stern and his family and his self-inflicted death in
“One man's defense of his own suicide
Documentary looks at his 'rational' act” by
Reyhan Harmanci, staff writer of the San Francisco Chronicle in today’s edition

I present this resource now as a followup to the July 16, 2005 posting here on assisted suicide in which commentator Bob Koep discusses the concept of “rational suicide”.

This issue is also discussed in the Chronicle article with comments by Hemlock Society founder Derek Humphrey who is quoted "Elderly suicidal people recognize that life has run its course and if that's what the person wants…" Whereas Wesley Smith, an opponent of assisted suicide, is quoted "If you end up with a public policy around rational suicide, you might as well throw suicide prevention in the trash…If a mental health professional gets in the business of stamping suicide, it's abandonment."

My question: Does the fact that a person requests “assisted suicide” makes the diagnosis of depression since the person is “asking for help” and if the person such as Bob Stern shoots himself in his head, this act makes a diagnosis of “rational suicide”? Or should we just forget about the term “rational suicide” since all suicide represent mental irrationality of one sort or another?. ...Maurice.

p.s.- Thanks to Alyssa Uphoff for referring me to this article.

15 Comments:

At Monday, July 25, 2005 4:01:00 PM, Anonymous Anonymous said...

This is an interesting question and it reminds me of my grandmother. She's 92 years old, and almost completely blind from macular degeneration, but her mental capacity is still tip-top. She gets lots of support and interaction from children, grandchildren, and now great-grand children because she's a delightful person and we all adore her. My grandfather, after 60 years of marriage, died 2 years ago, and now she shares a house with my aunt. She's also on the edge of kidney failure and has already stated there will be no dialysis; and she recently tripped over some tools left by a handy man and broke her jaw. She isn't suicidal (or doesn't seem to be), but I'm not sure it would seem irrational to me if she were to become so. Her hobbies were cooking, reading, sewing, crossword puzzles and gardening, but now she's stuck with nothing but books on tape and listening to a tv she can't see; she can't even take pain meds or have the foods she likes best because of the kidney problems. Short of some sort of chemically induced mania, how can one not be depressed by these circumstances? What does she really have to hope for except that the rest of her life isn't too bad and that she doesn't cause her family too much trouble? She never complains, but we're all keenly aware that good things are not in store.

 
At Monday, July 25, 2005 8:28:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous, I most appreciate your description of your grandmother's current quality of life. But I want to take your commentary to make an important point that many of us including healthcare professionals forget. And that is-- your grandmother's quality of life is something that she should be describing. For you or anyone else looking at her current situation, any description of quality of life is really as you or the other person looks at your grandmother but through your own eyes and values and goals and not necessarily hers.

In your commentary you really don't mention what she has said about her quality of life and that would be the most important description to consider.
Also remember that considerations of quality of life may change considerably as the individual ages and what might have been totally unsatisfactory in the past may be quite acceptable in later times.

You say "she never complains but we're all keenly aware that good things are not in store." Perhaps she gets the most pleasure from interacting with a supportive family and their children. Maybe if she lost that, she would complain. Also maybe she is more accepting of the bad things in store than you or the family.

As I said before, families are not the only ones misreading quality of life. When healthcare professionals do that, the resulting professional therapeutic conclusions and advice may be really quite inappropriate for what the patient would have really wanted. ..Maurice.

 
At Monday, July 25, 2005 9:32:00 PM, Blogger the_applicant said...

I just read this article, it is very interesting. Had Stern sought help and had the surgery, what would his quality of life have been like? I've often wondered whether we have the right to choose when, where, and how we die? I personally would like to say yes, we do have that choice (and honestly, some people could care less what anyone else do with their lives) or else, if I could, I would like that choice. It seems so much more in control then trying to fight death which has own its mysterious timeline. But as a future mental health professional, I think it is a responsibility for us to keep people alive. And not only alive, but alive and well. For the majority who want to die, I believe most are trying to end their pain, regain control, freeze the moment or whatever else they might want, but if they can choose between dying and living well, they would choose to live. But the choice is not that, but between dying and living in despare. And one can only live in despare for so long. I'll see if I could tune in to see the show tomorrow night.

 
At Tuesday, July 26, 2005 11:13:00 AM, Blogger Stephen Drake said...

Two additional items in terms of coverage/commentary:

Press Release re: "Self-Made Man"
http://www.notdeadyet.org/docs/selfmademanPR0705.html

Article in today's edition of USA Today:
http://www.usatoday.com/news/nation/2005-07-25-right-to-die-documentary_x.htm

I'm quoted in the USA Today article, but I have to admit my favorite quote is from somebody else:

"If someone between the ages of 15 and 22 dies by suicide, our compassion just flows out of us," says Patrick Arbore, director of the Center for Elderly Suicide Prevention in San Francisco. "But with older people, as an ageist society, we say, 'Well, they were old anyway.' We all say, 'Gee, this is great, we're going to live longer. But nobody wants to be old.' "

BTW, I find it interesting that James Werth, "rational suicide" advocate, who is quoted in both articles is never credited for his role as a member of the advisory board of a national organization that actively lobbies to spread legalization of assisted suicide. He's been in that role a long time and it's not the first organization he's been officially involved in that way. Odd, anyway.

 
At Tuesday, July 26, 2005 2:26:00 PM, Anonymous anonymous said...

As the SF Chronicle writer says near the end of the article:
"In the push-and-pull of who decides when it's OK to die, there are acres of gray space."

Those who think they know what answers the rest of us should reach are living in imaginary black-and-white worlds.

 
At Tuesday, July 26, 2005 4:48:00 PM, Blogger Maurice Bernstein, M.D. said...

Think about this: When we "healthy" (emotionally and/or physically) folks hear about a suicide we feel that we or some others in society have failed that suicide victim in some way. For example, how often when you have heard about a suicide did you say to yourself or others "good decision!" Probably rarely. Most of the time you might say "Shouldn't there have been something done to help?" I think this guilt we experience affects how we explain or define suicide and also affects how we look towards legislation for or against suicide and keeping us within the "imaginary black-and-white worlds." If you think I am way off on this theory, please let me know. ..Maurice.

 
At Tuesday, July 26, 2005 6:34:00 PM, Anonymous Anonymous said...

This seems like a very intriguing discussion. Let me pose some questions: Is the reason that we don't want someone to die is out of selfish (for lack of a better word) reasons - ie. we don't want to miss the person, we don't want to feel bad or guilty etc. or what exactly are you thinking of or would be thinking of when you tell someone that you don't want them to die? I'm not sure I can convince myself that I know exactly why we do what we do. What is the motive behind what we say? That we know that things will get better for this person? What if it won't? Who are we to judge? It seems that committing suicide is maladaptive or counter-intuitive because humans are naturally programmed to want to survive. But is that the reason - is that all there is?

 
At Wednesday, July 27, 2005 2:26:00 PM, Anonymous anonymous said...

Maurice is probably right that feelings of guilt could influence how we approach suicide -- perhaps keeping us within overly simple black-and-white worlds. But guilt, along with a lot of other emotions, won't always affect us in similar ways. Some people change their views in response to guilt. Others rationalize their guilt away rather than change their views.

 
At Wednesday, July 27, 2005 2:33:00 PM, Blogger Stephen Drake said...

Maurice said:
For example, how often when you have heard about a suicide did you say to yourself or others "good decision!" Probably rarely.

My guess is you don't read coverage of assisted suicides, let alone hang out on email lists populated by pro-euthananasia activists.

Frankly, Patrick Arbore nailed it when he talked about the difference in the reaction people have to the suicides of people according to the age. For example, the press coverage of the double suicide of Admiral Nimitz and his wife was very positive overall, with headlines mostly a variation of "An Admiral in Control Til the End." (Maybe in control of his wife, as well, eh?)

Arbore's probably not aware that the same thing happens when it's the suicides of younger disabled people. Media and societal reactions range from shrugs of apathy to outright applause.

 
At Wednesday, July 27, 2005 3:19:00 PM, Blogger Maurice Bernstein, M.D. said...

As a physician, I most likely would not participate in an assisted suicide if asked. For the appropriate terminally ill patient I would prescribe hospice management. For the patient who is obviously clinically depressed, I would get prompt psychiatric help. For the patient who simply "wants to be in control" and who doesn't apparently represent one of the other two categories, I would spend time listening to the patient describe the personal needs and how he or she has attempted to meet them in the past. I would try to find ways to mitigate concerns and attempt to facilitate actions which could still represent control but be short of suicide. If that doesn't work.. well, if the patient is a Bob Stern or an Admiral Nimitz, I would rationalize my guilt of failure with "I can't be everybody's keeper" and return to caring for those who want to continue to live. ..Maurice.

 
At Sunday, October 28, 2007 4:30:00 PM, Anonymous Anonymous said...

I am in pain and have nerve conditions in four limbs that can progress to disability. I wish the people who are against suicide were in my shoes instead of me, truly. Don't tell me what I can't do with my own body.

 
At Thursday, July 14, 2011 1:19:00 PM, Anonymous Anonymous said...

I believe in freedom. If a person wants to commit suicide, they have the right to do so. They don't need to justify it to anybody. DW

 
At Sunday, November 13, 2011 11:59:00 PM, Blogger Christoph said...

Life is a mixture of good things (orgasm, orange juice, children playing, sunshine, or other things depending on what a person likes) and shitty things (being unwanted by those one wants, sickness, poverty, physical discomfort and pain, deterioration, torture, or other things a person dislikes).

It is not true that the good always outweighs the bad, or that it is always likely to in the future.

Therefore, from a subjective point of view of enjoying one's life the MOST (pleasure - pain), it makes PERFECTLY logical sense to kill oneself in some situations, and those situations are not necessarily few and far between. Before you say we can't know the future, of course we can't, but we can assess probability and make decisions, just like we do with every other important decision.

Further, there is no objective reason to believe in any God, an afterlife, or any meaning at all to our lives! There is no REASON one should automatically start from the position that life = good, suicide = bad. It really doesn't matter because we're going to die anyway.

But if a person wants to cut out a few years to a few decades of meaningless or misery in a universe that is already 14.7 billion years old?

It's their business! And it can be perfectly rational. Those who go around insisting -- often through force and violence! (calling the police to show up with guns and hand cuffs, forcibly taking away someone's freedom and putting them in a locked hospital, damaging their brains with drugs and electric shock) are perpetuating misery, and you ought to be ashamed of yourself. Even when you do manage to bring about some joy (and the future is always a mixture of joy and misery), you had no right to make the decision for another person.

You should, as far as I'm concerned, be charged with crimes against humanity and imprisoned yourselves.

 
At Monday, November 14, 2011 12:01:00 AM, Blogger Christoph said...

"Maurice Bernstein, M.D. said...

"As a physician, I most likely would not participate in an assisted suicide if asked. For the appropriate terminally ill patient I would prescribe hospice management. For the patient who is obviously clinically depressed, I would get prompt psychiatric help. For the patient who simply "wants to be in control" and who doesn't apparently represent one of the other two categories, I would spend time listening to the patient describe the personal needs and how he or she has attempted to meet them in the past. I would try to find ways to mitigate concerns and attempt to facilitate actions which could still represent control but be short of suicide. If that doesn't work.. well, if the patient is a Bob Stern or an Admiral Nimitz, I would rationalize my guilt of failure with "I can't be everybody's keeper" and return to caring for those who want to continue to live. ..Maurice."

That is a compassionate, caring, and reasonable doctor.

Now I hope my other comment is posted here as well.

 
At Monday, November 14, 2011 7:26:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks Christopher for your comments. I have always wondered why over the years, suicide has been considered a crime and the act performed by the individual to be banned. It seems that society has a compulsion to have control of the living (as it has in many areas of life) but also control of the dying. Why? ..Maurice.

 

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