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Suicide Documentary on the BBC

3 Apr, 09 | by Iain Brassington

In case you missed it, there’s a little under a week left to listen again to last night’s Radio 4 documentary on the Swiss assisted suicide movement: follow this link.  For what it’s worth, I couldn’t help thinking that it was a little scare-mongering and tabloid.  (So the mentally ill or non-terminal might be able to access AS; maybe even the not-ill-at-all.  Woo-hoo.  I don’t really see why that should have to be a problem.  At the very least, it seems to display a shoddy blanketing of all those with mental illness as being, like, CRAZY ALL THE TIME.  Not so.  It seems perfectly reasonable to imagine, say, a schizophrenic or bipolar person deciding calmly that they no longer want to live this kind of life – and the mere fact that, strictly speaking, they have a mental illness is neither here nor there for most of the time.  Granted, you might want to assist with suicide during a psychotic episode – but there’s more to it than that.)

The programme gets a reasonable write-up in The Times - with, unsurprisingly, extra comments from people like Care not Killing and Dignity in Dying.  Sarah Wootton, of the latter organisation, is quoted as saying that

We believe the law should change in the UK to allow terminally ill, mentally competent, adults to have the choice of an assisted death but we are also very clear that should be within a strict framework of legal safeguards.  I am very concerned about Dignitas. Mental competence is an essential precursor to an assisted death and we are absolutely immovable on that. We need to give a clear signal that to assist non-terminally ill adults to die is wrong.

Well, yes: legal safeguards are probably in order.  But I find myself siding with Dignitas’ Ludwig Manelli here – why the terminal illness criterion?  (Apologies for the blatant spamming, but this is a question I’ve raised elsewhere.)  If a person wants to cash in their chips and they’re competent, and if there’s someone who’s willing to help, then why not let them?

Posted in In the News, Life and Death, Navel-gazing.
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  • John Coggon

    The answer, of course, is because the issue is not one that is debated within a singular moral universe.

    I can’t and don’t speak for dignity in dying, but it strikes me that if you are campaigning for a radical change in the law, tactically it would make sense to make (in principle not terribly defensible) concessions, under the belief that some good is better than no good (or some access to ‘assisted-dying’ for those whom it would benefit is better than no access for anyone at all).

    Advancing rationally defensible stipulations to support a wider change in policy is only effective if it falls on ears open to rational argument.

    As seems to be the case for Iain, I have not seen any argument that is even remotely convincing to recommend in principle that ‘assisted-dying’ should be for the terminally ill only. Nevertheless, I’ve seen a whole bag of bad but effective arguments spilling over in public debate, and these can’t be ignored.

    Dignity in dying (etc.) are taking part in the public debate. It is perfectly rational to push for less than the ideal, in order to reach some of the good.

    Consider if abortion were unlawful – provided you support abortion’s legality, you will accept that the status quo in England is better than outright prohibition. Those who push for greater change (eg, to allow a right to abortion; ‘demedicalisation’ of the issue; no time limit to be imposed on abortion for ‘social grounds’, etc.) will tell you how bad, arbitrary, misplaced, wrongly grounded, etc. the current law is. But if it’s the best that can be achieved following public debate (a big ‘if’, I know), then maybe we should somewhat content ourselves with it, notwithstanding a. its imperfections, and b. that we can simultaneously push for further reforms.

    Equally, in ‘end-of-life’ debate – we can somewhat content ourselves with a less than full extension of freedoms to enjoy ‘assisted-dying’ measures, whilst also knowing the boundaries ought to be pushed further.

    And we can recognise the rationality of advocating what seems irrational (or not completely rational).

    Tactics in public debate do not recommend the same terms of engagement as reasoned argument in philosophical discourse.

    Selling ‘assisted-dying’ for the terminally ill in public debate will (one suspects) be a lot easier than selling ‘assisted dying’ for all takers.

    That is the reason.

    It’s not a principled reason, but it might allow for a better state of affairs than asking for something that won’t be given.

  • Iain Brassington

    Oh – absolutely. Your pragmatic argument is quite correct. However, I think that it’s also not only conservative: it’s also corrosive, because it means that the advantage always passes to the most stubborn…

  • John Coggon

    Possibly – but the advantage, if that’s how we cast is it, is already with the conservative; ie ‘assisted-dying’ is prohibited. What I suggest thus removes some advantage, rather than passes it over, doesn’t it?

    If the liberal (?) wants the advantage (ie a complete removal of unprincipled prohibition), that will most quickly be achieved by revolution (which may carry more disadvantage than advantage overall) or incremental steps (which is slower and tedious, but probably is the better means).

    What’s more corrosive (or what matters more that is being corroded) – actual change from a conservative start point, albeit slow; or no change at all, but supported by principled comment on why wholesale change is the only thing that can be defended morally?

  • Keith Tayler

    I have had numerous conversations with people with mental health problems who have made unsuccessful suicide attempts, or have threatened suicide, or have expressed a wish to die. In a very small number of cases I have accepted that the individual’s life is so tormented that suicide could be a rational option for them. For me, however, it can never be a totally rational option; I know that the majority of people that are prevented from taking their own lives will be thankful – given time – that they did not, as you say, cash in their chips. I accept that this rationalisation of the problem (external perspective) cannot trump the rationalisation (internal perspective) of the individual who wishes to end his or her life. It would nonetheless be irrational for me or anyone to help in an assisted suicide knowing that in most cases the person you are assisting would – given time – have gone on to live a contented life.

    Again, I accept that suicide might be ‘rational’ for some individuals, but it would be a “shoddy blanketing of all those with mental illness” if I or anyone else presumed to ‘know’ all their minds, and were in a position to ‘know’ who to assist and who not to assist. What you are asking is impossible. For sure there are those that claim to have such knowledge, but they are for the most part dangerous.

  • Iain Brassington

    Keith -
    Thanks for that, and, of course, you’re right to point out that those who claim to know others’ minds are frequently a bit morally suspect. However, we don’t normally require that kind of insight when it comes to decisions about whether or not to offer a medical procedure, so isn’t the onus rather on the person who wants to show that his patient/ client is not capable of making that sort of decision, rather than on anyone else to show that he is? That is to say: isn’t there a moral reason to assume that people are competent/ capable/ whatever unless and until we can demonstrate that they aren’t?

    I’m also not sure about the work you want to be done from reason: again, I agree that a desire to end one’s life may not be rational – but I don’t really see why anyone would think that it is in any case. It could simply be a brute preference – I don’t think my not killing myself, or not wanting to be dead, is either rational or irrational: reason doesn’t get a look in. Reason of an instrumental sort might get a look in when it comes to deciding what to do once you’ve decided that the present situation is intolerable – but that seems to me to be about the size of it.

    And, of course – in other situations, people might make non-rational decisions. This isn’t just to do with refusal, either: we might imagine that someone wants cosmetic surgery, and that they’re driven by some “non-rational” consideration like vanity or envy or something like that. I don’t think that that militates against providing the treatment. So why should this be any different? That a preference is non-rational seems not to add much to the story. (You can argue for this sort of position along Millian lines, of course, if that’s how the fancy takes you: allow people to make whatever daft choices they want – as long as noone else is hurt, it’s their problem.*)

    I also think that the otherwise contented life line is a bit of a red herring. Again, it’s true that many would-be suicides are, a little later, glad their attempts failed. But, brutally, that’s only because they’re still alive to be glad of anything. Had their attempt failed, they wouldn’t regret it. That’s why, in a sense, making a “poor” decision to end your life is possibly worse than making a “poor” decision about other things – at least you won’t live to regret it. I think that sounds glib, but there’s something important there.

    *Oh, god. I’m citing Mill approvingly. Gah.

  • Keith Tayler

    Iain

    I have had numerous conversations with people with mental health problems who have made unsuccessful suicide attempts, or have threatened suicide, or have expressed a wish to die. In a very small number of cases I have accepted that the individual’s life is so tormented that suicide could be a rational option for them. For me, however, it can never be a totally rational option; I know that the majority of people that are prevented from taking their own lives will be thankful – given time – that they did not, as you say, cash in their chips. I accept that this rationalisation of the problem (external perspective) cannot trump the rationalisation (internal perspective) of the individual who wishes to end his or her life. It would nonetheless be irrational for me or anyone to help in an assisted suicide knowing that in most cases the person you are assisting would – given time – have gone on to live a contented life.

    Again, I accept that suicide might be ‘rational’ for some individuals, but it would be a “shoddy blanketing of all those with mental illness” if I or anyone else presumed to ‘know’ all their minds, and were in a position to ‘know’ who to assist and who not to assist. What you are asking is impossible. For sure there are those that claim to have such knowledge, but they are for the most part dangerous.

    It is not possible to explain what a mean by ‘rational’, or indeed why I would make a distinction between it and ‘reason’. As a pluralist I do not always look for rational explanations nor indeed do I believe in the transparency of rationality. We appear to disagree about what might count as being rational. Vanity and envy were for Adam Smith two of the major drivers of the human mind. It all gets a bit grey, but we are able to reason about vanity and envy.

    Returning to the suicide issue, if I accept a duty of care for someone with mental health problems, I have to rationalise their state of mine, my state of mind, future outcomes, etc.. I do not think this will enable me to ‘fully’ understand the individual’s mind and life, but it does help me to communicate with others who are engaged in their care or have some special interest in their wellbeing. You might think this to be a minor consideration but a can assure you that communication is extremely important within mental health care.

    I have never encountered an individual who wanted to kill them selves because of a “brute preference”, or at least a brute reference that lasts more than a few hours. Everyone, even from within the deepest depression, will give ‘some’ reasons for not living. The problem is, as Heidegger observed in the context of ‘theory’, reason and rationality are not without ‘mood’. It is the latter that causes the difficulties.

    You say “isn’t there a moral reason to assume that people are competent/ capable/ whatever unless and until we can demonstrate that they aren’t?” Obviously I accept that, but it does not resolve the problem. As I explained earlier, I do accept that in some cases there are reasons to assume that an individual is competent to end their life (not a ‘moral’ reason, I would rather keep morality out of the problem as far as possible). But that brings me back to what you call a red herring.

    You are right it does sound glib and it is of course something I have discussed with people who are in a suicidal mood (it is after all a joke ‘rationalisation’ that can sometimes help raise the mood). This type of rationalisation can never be more that a joke because it is nothing but a rationalisation. ‘You will not live to regret committing suicide’ is self-evidently true. It is simple, rational and sane, but it is still a joke. But suicide is about individuals (including those that are left after a suicide)and cannot be resolved – one way or the other – with transparent rationalisations (even Habermas draws a live when confronted with these problems). I hope you seriously do not want too much work to be done by your ‘reason’.

  • Keith Tayler

    Iain

    Sorry I copied in my first reply with my second. It is late and I should be in bed.

  • Iain Brassington

    You’re right that reason is a slippery word here. And I do think that there might be such a thing as a rational suicide. But there’s also scope to imagine it being – if you like – more of an “aesthetic” decision: that is, someone just deciding that they don’t like their current life and realising that there’s no alternative. That’s something like what I meant by the phrase “brute preference”, too – the idea that there might come a point when it’s just that a person has had enough, and there’s no real chain of reasoning behind it.

    I accept fully that communication within mental health care is important – but I don’t really see how that alters the point that there might come a time when a person decides that they no longer want to fight their illness – be it mental or somatic, and chooses AS as a means not to have to. And I don’t see any reason in principle why a mental illness should make such a decision less powerful.

    None of this means that we have to take people at their first-expressed word, of course… I can well imagine a “cooling-off” period so that we can be as sure as possible that we’re not dealing with a passing crisis. Within that, the mood might well remain, though – and it’s not a problem if it does. If Heidegger is correct to say that there’s a mood to rationality, then it seems that we have to accept that moodedness as inevitable, and the mere fact that there’s a mood there won’t make any difference. The question then would concern why we get more jumpy about some moods than about others. Why should being “down” get treated with suspicion? Indeed: isn’t “down” to describe a mood potentially rather question-begging?

    I hope you seriously do not want too much work to be done by your ‘reason’.
    Ha! Never!

    :)

  • Keith Tayler

    I still do not recognise your “brute preference”. The elderly can just give-up, but to offer them AS is complicated by them often having relatives that are making them feel that way, or worries about nursing home costs, etc.. In most cases – not all – the situation could be resolved, there usually being a reason for their brute preference. If you are going to gear everything for the very small number of individuals that ‘just’ have a brute reference (end of story), you are going to give AS to a larger number of people who would recover from their brute reference. I am not a utilitarian, but they do exist and they do get excited about saving lives worth living and all that stuff.

    The point about communication is about ‘external’ rationalisations. For sure an individual can decide to end their life but that decision has to be communicated to others (usually to prevent it from happening). It may sound like a small point but it is the way the individual is ‘framed’. Not a good frame but it does enable a large number of people to communicate.

    Anyone with a mental illness is quite likely to have impaired judgement and decision making. That is in part a definition of mental illness. Thus decision making for the mentally ill is problematic. I am usually of the mind that the mental ill should make their own decisions and should not be protected from the consequences of those decisions because they are ill – it makes the world real, something is learnt, etc.. But there are of course limits, and, given the consequences of suicide, suicide is the limit.

    I do not think we are going to agree on this matter. May be we can approach it from anther direction within a different context in another blog – in principle of course.

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