Bioethics Discussion Blog: “I think I will not hang myself to-day”

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com

IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice

FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD

Thursday, November 03, 2005

“I think I will not hang myself to-day”

From Poetry Online comes the classic poem on suicide by G.K. Chesterton.

A Ballade of Suicide
G.K. Chesterton

The gallows in my garden, people say,
Is new and neat and adequately tall;
I tie the noose on in a knowing way
As one that knots his necktie for a ball;
But just as all the neighbours on the wall
Are drawing a long breath to shout "Hurray!"
The strangest whim has seized me. . . After all
I think I will not hang myself to-day.

To-morrow is the time I get my pay
My uncle's sword is hanging in the hall
I see a little cloud all pink and grey
Perhaps the rector's mother will NOT call
I fancy that I heard from Mr. Gall
That mushrooms could be cooked another way
I never read the works of Juvenal
I think I will not hang myself to-day.

The world will have another washing-day;
The decadents decay; the pedants pall;
And H.G. Wells has found that children play,
And Bernard Shaw discovered that they squall;
Rationalists are growing rational
And through thick woods one finds a stream astray,
So secret that the very sky seems small
I think I will not hang myself to-day.


ENVOI

Prince, I can hear the trumpet of Germinal,
The tumbrils toiling up the terrible way;
Even to-day your royal head may fall
I think I will not hang myself to-day.


Actually, Chesterton’s poem is quite upbeat in that suicide is being set aside day after day because life and world are not as bad as initially thought as the day begins.

It is interesting to read about society’s view of suicide down through the ages. Lance Stell, an ethicist, writing recently on a bioethics listserv noted:

Suicide isn't a crime anymore. But at common law it was, involving as
Blackstone colorfully put it, a double offense - against the King, who
has an interest in the preservation of all his subjects and against God,
for rushing into the presence of the Almighty, uncalled for. [Although
Locke said something similar by way of explaining why the jurisdiction
we have over our lives isn't a property right, Blackstone's theological
imagery is interesting to reflect on for a few minutes].

On the thought that suicide is a very serious matter and should be
criminal, the problem arises - how to punish offenders.
Lawyers proved up to the task - the suicide's estate would be taken by
the Crown, burial in sacred ground was prevented, the body would be
desecrated. Powerful deterrents to such willful wrongdoing!

The African Ashanti proved more inventive still. If a suicide were
buried prior to a legal investigation, the corpse was ordered dug up and
put on trial for murder (I assume w/o the privilege of cross-examining
witnesses).


From Wikipedia:

“Ironically, the punishment for attempted suicide in some jurisdictions has been death. In addition, suicide can have other legal consequences. For example, in the United Kingdom prior to 1961 their estate was forfeited.
The United Kingdom decriminalized suicide and attempted suicide in the Suicide Act 1961. By the early 1990s only two US states still listed suicide as a crime, and these have since removed that classification. Increasingly, the term commit suicide is being consciously avoided, as it implies that suicide is a crime by equating it with other acts that are committed, such as murder or burglary.”

Discussing the past philosophical thought regarding suicide, an article in Wikipedia presents these further views:

… Thomas Szasz would argue that suicide is the most basic right of all. If freedom is self-ownership, ownership over one's own life and body, then the right to end that life is the most basic of all. If others can force you to live, you do not own yourself, and belong to them.

It is important to note that the liberal view above is not associated with classical liberalism; John Stuart Mill, for instance, argued in his influential essay On Liberty that since the sine qua non of liberty is the power of the individual to make choices, any choice that one might make that would deprive him or her of the ability to make further choices should be prevented. Thus, for Mill, selling oneself into slavery or killing oneself should be prevented, in order to avoid precluding the ability to make further choices. Concerning these matters, Mill writes in On Liberty:

“Not only persons are not held to engagements which violate the rights of third parties, but it is sometimes considered a sufficient reason for releasing them from an engagement, that it is injurious to themselves. In this and most other civilized countries, for example, an engagement by which a person should sell himself, or allow himself to be sold, as a slave, would be null and void; neither enforced by law nor by opinion. The ground for thus limiting his power of voluntarily disposing of his own lot in life, is apparent, and is very clearly seen in this extreme case. The reason for not interfering, unless for the sake of others, with a person's voluntary acts, is consideration for his liberty. His voluntary choice is evidence that what he so chooses is desirable, or at the least endurable, to him, and his good is on the whole best provided for by allowing him to take his own means of pursuing it. But by selling himself for a slave, he abdicates his liberty; he foregoes any future use of it, beyond that single act. He therefore defeats, in his own case, the very purpose which is the justification of allowing him to dispose of himself. He is no longer free; but is thenceforth in a position which has no longer the presumption in its favor, that would be afforded by his voluntarily remaining in it. The principle of freedom cannot require that he should be free not to be free. It is not freedom, to be allowed to alienate his freedom.”

Philosophical thinking in the 19th and 20th century has led, in some cases, beyond thinking in terms of pro-choice, to the point that suicide is no longer a last resort, or even something that one must justify, but something that one must justify not doing. Existentialist thinking essentially begins with the premise that life is objectively meaningless, and then poses the question "why not just kill oneself?". It then proceeds to answer this by suggesting the individual has the power to give personal meaning. Nihilist thinkers reject this emphasis on the power of the individual to create meaning, and acknowledge that all things are equally meaningless, including suicide.

On the other hand, some thinkers have had positive or at least neutral views on suicide. Some of the pessimist philosophers (Nietzsche, Goethe, Schopenhauer) see suicide - or knowing that at any time, one can escape the suffering of life - as the greatest comfort in life. Herodotus wrote "When life is so burdensome death has become for man a sought after refuge". Schopenahuer affirmed "They tell us that suicide is the greatest piece of cowardice... that suicide is wrong; when it is quite obvious that there is nothing in the world to which every man has a more unassailable title than to his own life and person". In Thus Spoke Zarathustra Nietzsche discusses the importance of "dying at the right time", claiming that one must not outlive his work (or "purpose") of life.


Unlike Chesterton, ruminating about suicide but finding an excuse against attempting, people, of course, do think about suicide and act it out.

One may find an ethical issue involving physicians who care for attempted suicide victims. If we, as physicians, save their lives are we violating their autonomous right to decide about their own life? Can we always excuse our resuscitation on the basis that the patient is depressed and their attempt is not purely voluntary? Is there, as I have mentioned in previous postings, such an act as a rational suicide attempt? How about if we decide not to interfere, especially if a patient says by voice or note not to interfere, are we thus aiding and abetting the suicide? Is this in a sense an "assisted suicide"? And then comes the issue of true intentional medically assisted suicide but that demands a different posting on another day. ..Maurice.

10 Comments:

At Friday, November 04, 2005 7:59:00 AM, Blogger Maurice Bernstein, M.D. said...

Note: I have transferred the following comment to this posting from one the visitor may entered in error. ..Maurice.



At Thursday, November 03, 2005 6:34:42 PM, marin gillis said...

Nietzsche also wrote:"The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night." (BGE)

 
At Sunday, November 06, 2005 12:50:00 AM, Anonymous Epicurus said...

As physicians it is our duty to assist those with suicidal ideation of course...if there is a treatable medical cause contributing to this then it is, IMHO, grossly negligent to not do so.

The difficulty lies more in the restrictions of freedom, even temporarily, to enable a risk to lessen whilst treatment begins, and the conflict between 'medical containment' in the best interest of someone temporarily irrational and insightless...and between civil liberties.

 
At Sunday, November 06, 2005 12:52:00 AM, Anonymous Epicurus said...

One more thing, in addendum.

You've probably heard this before..

Primum Non Nocere

 
At Sunday, March 23, 2008 9:20:00 PM, Anonymous Anonymous said...

Wow, interesting blog.
I would call Nietzsche though a positive pessimist. He directly refutes Schopenhaur when he says one should have an affirmation of life!
& When it comes to assisted suicides, my thoughts are thus: The term 'suicide' means to kill oneself, does it not? So if you are not doing it...it isnt suicide, it is murder. Whether the person okayed it or not, that is what it is.
-Thought Provoking Blog though. You brought up many interesting points.

 
At Sunday, March 23, 2008 10:30:00 PM, Blogger Maurice Bernstein, M.D. said...

One can achieve relief of the pain and burdens of chronic illness through the institution of palliative care. Palliative care can be the affirmation of life and not the patient's choosing of death. Unfortunately, until recently palliative care was a hit or miss process. Presently, it is becoming a evidence-based specialty with value in the practice of medicine. ..Maurice.

 
At Friday, June 13, 2008 3:22:00 PM, Blogger Curator said...

Anonymous: interestingly, the East German fascist government in the 1980s re-termed "suicide" as "self-murder" (and stopped keeping suicide statistics) because the high rate of suicide showcased the suffering that people, including many artists and writers, endured under fascist rule. I think re-terming suicide "self-murder" is a particularly fascist response. More generally, coercive suicide prevention, without addressing the suffering that causes people to wish to commit suicide, merely functions to mask the level of suffering endured by a population.

I think that the fantasy of "rescue" from a suicide attempt is dangerous, and contributes to many suicidal gestures that may not have been intended to be lethal, but are. Removing the basis for this harmful fantasy - instituting a clear policy of non-rescue in cases of clear intent - might actually serve to reduce suicide, and would certainly encourage people to make choices more authentically in keeping with their values.

Rescuing an attempter with a rescue fantasy is the correct action, given the expectations he has been given by current policy. "Rescuing" a person who genuinely wishes to die is imposing a value on him that he does not share. It is not proper to perform medical procedures on adults without their consent (we may not, for instance, intubate adults without their consent, even if failing to do so means death); clearly, a serious suicide is refusing consent. It's a bit of a leap to assume that he lacked capacity for consent prior to the attempt.

 
At Friday, June 13, 2008 9:07:00 PM, Blogger Curator said...

That's interesting - it does seem that the very fact that a suicide attempter was discovered alive is some evidence that he or she might have wanted to be discovered. (Though that assumes that the suicide had the means to attempt suicide in a manner so as not to be discovered. This might be especially unlikely for people who are not wealthy enough to afford a private residence.)

ER docs are in a difficult situation. In most cases, I think you must be right that clear information about intent and competence is simply not available. But this seems to lead to a rule of "intervention in all cases," even in those few cases where competence and intent are readily established.

I am especially concerned about situations like that reported in Annals of Neurology last year, where a 48-year-old female patient with akinetic mutism (after a suicide attempt by hanging) has been kept alive for over two years (as of March 2007). The paper is on the surprising effects of the drug Ambien, which caused the woman to "wake up" and walk around briefly. Basically, this poor woman has been kept alive, apparently against her will, and essentially had medical experiments performed on her without her consent. Is it really proper to assume, as a default condition, that she would prefer such a life to death? I know this isn't the case for most "rescued" suicide attempters, but this situation seems like an expression of a problem with the medical system.

Oh, and your link sent me back to this page - I assume you wanted to point out another post? Thanks!

 
At Friday, June 13, 2008 9:51:00 PM, Blogger Maurice Bernstein, M.D. said...

HERE IS MY COMMENT TO WHICH Curator WAS REFERRING. THE LINK I ATTACHED WAS ERRONEOUS. HOPEFULLY, THE LINK BELOW IS APPROPRIATE.


Sometimes it is difficult for a physician, especially in the emergency room environment, to establish intent. One must make a decision on the method used, whether suicide was attempted in isolation or in the vicinity of people who might discover the victim before death and the psychiatric history of the patient and history of prior attempts.

You may be interested in another thread on an attempted suicide and the patient refusing treatment. ..Maurice.

 
At Monday, March 15, 2010 10:16:00 PM, Anonymous Andrew said...

I am glad to see this poem quoted, but although I think it is reasonable to use it as a springboard for talking about suicide, I think you have misunderstood the intent of the poem. Chesterton is criticising the materialist spirit of the age, which if followed to its logical conclusion would lead us all to suicide. His observation is that despite this, materialists still manage to decide to live and that this reflects a deeper purpose in life that we all live by even if we do not acknowledge it. I thoroughly recommend reading his book "Orthodoxy" although it can be a bit hard to get through as his style is now a little dated.

 
At Monday, January 03, 2011 1:09:00 PM, Anonymous Anonymous said...

As long as it cannot be shown that so called 'mental illnesses' are diseases of the brain it's not reasonable to assume free will is compromised otherwise any type of action or opinion that is not in accord with the general opinion or the will of those in power can be attributed to 'mental illness' and the person locked up and drugged to elicit conformity. To my knowledge no legitimate medical test (bloodtest, brainscan...) exists today that can show the presence or absence of mental illness, hence it's not a disease and hence not a medical matter. To prevent someone from doing what he or she wants (within the limits of the law which is the welfare of others) is coercion and if you must stay alive while you don't want to anymore you are nothing more than property of society or a slave doing the masters bidding. It's interesting to note that in Roman society suicide was entirely legal and even commendable or obligatory (as a form of capital punishment for noblemen): the only exceptions were slaves since they were considered property of their owners and soldiers since they were considered property of the state, indispensable to the safety of all. Yet they were free in that they chose to enlisten in the army, unlike the slaves who never gave consent. This is very comparable to the state humankind is in: no one chose to be born, we were never asked and in a lot of cases we are harmed by our parents decision to bring us into this world (Benetar would argue we are always harmed by being brought into this world), hence we should at least be allowed to leave it if and when we please. In most cases suicide or the desire to die can be attributed to extreme and incurable suffering: who are we to stop those people from escaping a condition that is objectively bad? Even when there's no apparant reason for it: who are we to decide when it's enough when we cannot possibly experience directly another's suffering? Suicide should not only be legal (it's not now since you are prosecuted for attempting or even thinking about it), people should be allowed to freely discuss this topic (without fear of 'intervention') and if it's clear the person is compos mentis (he or she isn't talking gibberish, isn't drunk or high, isn't hearing voices) he should be given free access to painless and certain means. This would avoid the mess doctors are left to deal with in the ER: if the person didn't apply for the safe exit he or she should be considered incapable of making a rational decision and should be treated. This would both remove the abomination of the thought-police with forced treatment (basicially the way Stalin used psychiatry) and expose phonies and people wanting attention since it would become hard to make a convincing suicidal gesture when you can actually acquire the means to do it right. I think this system would benefit those who had enough of life and the doctors who should see a significant decrease in attempted suicides being rushed to the hospital. The way I see it this would be a humane alternative to the policy of 'keep alive at all costs' and 'lock up the loonies who have the guts to think life isn't worth living'.

I conclude with the words of the great David Hume:

"If suicide be supposed a crime, 'tis only cowardice can impel us to it. If it be no crime, both prudence and courage should engage us to rid ourselves at once of existence, when it becomes a burthen. 'Tis the only way that we can then be useful to society, by setting an example, which if imitated, would preserve to every one his chance for happiness in life, and would effectually free him from all danger of misery."

Zara

 

Post a Comment

<< Home