The right to die

This is a re-posting of a comment I left a little while ago over at Mental Nurse.  The post I was commenting on was discussing the sad case of Kerrie Wooltorton, a woman who had made use of a so-called ‘living will’ to ask doctors not to save her life following a suicide attempt.

We all know that mental illness usually comes and goes.

Usually.  But what about those people for whom it doesn’t?

We also know that in PD patients, although the disorder is always present, suicidal feelings come and go.

But what if the person diagnosed with a PD decides that the non-suicidal times aren’t good enough to make it worthwhile enduring through the suicidal times?

I don’t have a PD, at least not as far as I know, but this is the knife-edge I walk.  My depression varies over time, and I have good patches and bad patches.  But the ‘good’ patches are only ‘good’ relative to the truly horrendous bad patches.  I am never happy, not in the way that a non-depressed person would understand that term, so maybe it would be more accurate to say that I have bad patches and worse patches.  I have not been told my depression is untreatable – who would be cruel enough to take away that last glimmer of hope? – but I have been told it is ‘treatment resistant’ and I have, demonstrably, reached the end of what MH services in my area can do for me.  All that was available to me was low-key monitoring, from which I have chosen to disengage.

So, what about me?  What about someone like me, who can’t be helped, and won’t ever be happy, and will – inevitably, unavoidably – experience endless recurrences of a level of mental pain that it is beyond my ability to describe?  Isn’t it my right – as the only person who knows the extent of the pain I’m in – to decide whether that pain is worth enduring?  What gives another individual – whatever job title they have, whatever powers an act of parliament has conferred upon them – the right to tell me that I must suffer endlessly, and without hope of respite, just because it makes ‘society’ uncomfortable if I die by my own hand?

This is why I always lie when I am asked about suicide.  It’s why I will never be completely honest with a MH professional.  It’s why, if I do ever decide that the time has come for me to die, I will choose a place and a time and a method which will guarantee success.  The right to choose death is mine, and I will not surrender it to anyone.

Kerrie Wooltorton’s life was her own.  It belonged to her, not to the doctors treating her, or to her family, or to people discussing it on blogs, or newspaper pundits, or happy-clappy jesus freaks.  It was her life, which means it was her life to end.  It’s kind of people to feel sad about her death, but it’s irrelevant.  She had a clear, unambiguous, persistent wish to die.  It was her right to die.  All the rest is irrelevant.

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6 Responses to The right to die

  1. Kapitano says:

    The right to die, in a time and manner of one’s own choosing, has always been a no-brainer for me. It’s a basic right and I’ve never heard a anti-euthanasia campaigner put forward a coherent argument otherwise.

    Suicide is a major decision. And if a person makes the decision wrongly – based on faulty reasoning or inaccurate information – there’s obviously no way to correct the mistake if the suicide is successful.

    But life is full of major decisions. Should I live in that country?, should I marry that person?, should I accept that job? Even, should I have another drink before driving home?, should I buy this feelgood pill from this stranger?, or should I believe this person who’s promising me a get-rich-quick scheme? If you get any of these wrong, you may never recover.

    But the kind of people who want to forbid suicide are the kind of people who advocate self determination in all these other major decisions. It’s simple hypocrisy.

    They seem to view it as a catch-22. If someone is in their right mind, then their decision to kill themselves is to be respected. But anyone who wants to kill themselves can’t be in their right mind, therefore no suicide decision is right.

    They don’t have any concerns about people buying houses, making investments or for that matter turning to alcohol when not “in their right mind”, but they’re suddenly obsessed with it when it comes to ending one’s own life.

  2. Lucy McGough says:

    Aethelread – I agree.

  3. erik simons says:

    i’m not sure about this. how can we be sure she wouldn’t have changed her mind?

    there’s an interesting discussion at the bmj about the limitations of capacity testing:

    http://blogs.bmj.com/ebmh-talk/2009/10/02/respecting-the-right-to-die%E2%80%A6revisited/

  4. aethelreadtheunread says:

    Thanks for the comments.

    Kapitano – well, quite. To be fair, someone diagnosed with a serious mental illness would probably find people crawling over all their decisions, including ones like where to live and what to do with their money. But, so far as we can tell from the media reports of what the doctors who examined her said, the whole point about Kerrie Wooltorton’s case is that she wasn’t mentally ill. She just really, really wanted to die.

    Lucy McGough – It’s always nice to get a vote of confidence!

    erik simons – How can we be 100% sure of anything in advance of it being done? It’s a philosophical and logical impossibility, isn’t it?

    Forgive me for being slightly facetious, but you seem to be saying that you would be prepared to accept that someone in Ms Wooltorton’s position has a right to die, but only if they can prove, while still alive, that their desire for death will persist unabated up to their very final instant of life. In other words, you’re asking these people to perfect both time travel and techniques that allow communication with the dead, but once they’ve performed these two impossible tasks, you’ll be very happy to honour their fundamental human rights. I would suggest that this is unreasonable, both in the sense of being unfair, and in the sense of being an unreasoned argument.

    As a general rule, when trying to make predictions about the future, we allow our experience of the past to guide us. Kerrie Wooltorton had attempted suicide by the same method 9 times previously. It seems to me, therefore, overwhelmingly likely that she would continue to attempt suicide until she was successful. The most likely consequence of a 10th refusal to allow her to die would have been that she would not have called an ambulance the next time, and so would have died alone, frightened, and in pain. I would suggest that this would not have represented a better outcome for anyone other than the medics, who would not have had to experience the transitory moral discomfort of watching a young woman die of something they could have treated.

    Thanks for the link you provide, which i’ve checked out. I have to say, though, it doesn’t seem like much of a discussion to me. There’s only one comment, which expresses agreement with the post’s author, and goes on to suggest a legal technicality on which the medics could have refused to honour Ms Wooltorton’s clearly-expressed and entirely unambiguous wishes.

    As for your suggestion that it contains material relating to the limitations of capacity testing – well, this is not what i see when i read the post. What i see is an author profoundly uncomfortable with the idea of allowing healthy people to die by their own hand, claiming that, because of this discomfort, there are grounds for deciding that someone who can be demonstrated to have capacity nonetheless lacks capacity in some more profound but entirely unspecified way, and utterly failing to provide any evidence to support the argument.

    As Kapitano says above, those who are opposed to granting people their human rights in this matter seem to struggle to present a coherent argument, and i would suggest that the blog post you directed me to is an example of this incoherence.

  5. bluesilk says:

    I found this post powerful reading. I have a somewhat similar outlook on suicide. I do believe that every individual has a point at which they can take no more suffering, be it mental or physical or both. The difficulty of legislating suicide/assisted suicide is much harder to tackle than the simple humanity of allowing people to end suffering.

  6. Adair says:

    “Even, should I have another drink before driving home?, should I buy this feelgood pill from this stranger?, or should I believe this person who’s promising me a get-rich-quick scheme? If you get any of these wrong, you may never recover.”

    All of these are illegal where I live, at least. That doesn’t mean anyone’s going to *stop* you (just like they won’t stop you if they see you heading into a likely disastrous but totally legal marriage), but people want to make the gesture.

    I think people should have the chance to make the gesture to “save” someone from suicide. Because not everyone who might want to claim the right to die is on their 10th suicide attempt, or has thought it through and experienced enough life to know what things are like. It’s the second or third biggest killer among kids in their teens and early twenties, and I don’t think all of those kids have had a chance to really understand what, “It gets better,” means to them. Additionally, if someone commits suicide in a time where depression is warping their memories of what the good times are like, they may be making a bad decision. (I’ve certainly had plenty of times where for a few hours I thought things were disastrously bad and had always been like that, only to come out of the mood with a surreal feeling and reorient on recent memories of other priorities and things not being so bad, but I honestly couldn’t remember or imagine that when I was in a low. I’d prefer to be protected from myself if something like that was going on.)

    I think a right to die should be provided, but how we go about it should be carefully researched and considered. Basically, look at who’s likely to be glad if they’re not allowed to die, and who’s likely to persist in wanting to die. Maybe even just put a waiting period on it, “We’ll let you die in a year if you still want to, because research shows that most people turn back in a year but the ones who don’t don’t,” if that’s what research shows.

    Yes, I know I’m suggesting we impair an important freedom, and it may well be much more out of my own queasiness than out of what will be recognized as “right” in the hypothetical progressive future. But, hey, gotta crawl before you can run, if total freedom to die is our future.

    And, for what it’s worth, I think we should try a lot harder to provide help, support, and guidance for people making other major life decisions. Not legislated, but made available to people who are otherwise isolated. I think it’s a travesty that we spend years drilling people in math but stifle discussion of the really important issues, leaving people to go on vaguely known common wisdom and their own “gut” feelings.

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