Will this Death be
an "Irrational Suicide"
or a "Voluntary Death"?

  original title:
FOUR DIFFERENCES BETWEEN IRRATIONAL SUICIDE & VOLUNTARY DEATH

SYNOPSIS:

      Irrational suicide differs from voluntary death in four ways:
Irrational suicide is (1) harmful, (2) irrational, (3) capricious, & (4) regrettable.
Voluntary death is (1) helpful, (2) rational, (3) well-planned, & (4) admirable.
   
OUTLINE:

A.  SEPARATING IRRATIONAL SUICIDE FROM VOLUNTARY DEATH

    1.  Will this death be harmful or helpful to the patient?

    2.  Will this death be irrational or rational?

    3.  Will this death be capricious or well-planned?

    4.  Will this death be regrettable or admirable?

B.  CHOSEN DEATH AND THE LAW

C.  HOW FREQUENT ARE VOLUNTARY DEATHS?

Will this Death be
an "Irrational Suicide"
or a "Voluntary Death"?

by James Leonard Park

A.  SEPARATING IRRATIONAL SUICIDE FROM VOLUNTARY DEATH

1.  Will this death be harmful or helpful to the patient?

HARMFUL

    Irrational suicide harms the victim.  
When people kill themselves for any of the foolish 'reasons' we could name,
they are definitely doing harm to themselves.  
Even those who fail in attempting irrational suicide
later often realize that their deaths would have been harmful to themselves
—and possibly harmful to many other people.  

    Before the rise of modern medical technology,
there was little need for such a concept as "irrational suicide"
because almost every time someone chose death,
it was an irrational, self-harming act, which everyone wanted to prevent.  

    Most of us can name a few people who committed irrational suicide.
Don't we agree that they were harming themselves
when they shot or poisoned themselves or jumped from high places?

    Thus laws against committing suicide or assisting in a suicide
did not have to specify that the self-killing was harmful and irrational.  
Almost all self-killings were harmful to the victim.
And virtually all were irrational—out of touch with reality.  

HELPFUL

    The new concept of "voluntary death" did not emerge until it was needed,
which happened with the advent of modern medical technology.
Now we can keep a human body 'alive' for many months and even years
beyond the point at which natural death would have occurred in earlier times.  

    In many cases, we are very glad that modern medical care
can save us from the early deaths that befell our ancestors.
We can even sometimes replace a worn-out organ such as a heart
with a heart from another person who died with a still-functioning heart.

    But in a few cases, the life-supports created by modern medicine
do not really help the patient.  
Rather, they merely prolong the process of dying.
Natural dying is often delayed by the machines of the Intensive Care Unit.  

    Because of these modern developments, we can ask
whether the medical care itself is helping or harming the patient.
And if we decide after looking at all the medical facts and opinions
that death now would be better than death later,
then choosing death is a genuine help to the patient.  

    Other people who aid in making this a peaceful and painless death
will know that they are genuinely helping the patient
more than they are doing harm to the patient or anyone else.
If the potential helpers have any doubts
about whether the proposed death would be harmful or helpful
they should resolve all such questions
before they proceed to support a chosen death.

    Here are four safeguards to separate harm from help:
Psychological consultant reviews the end-of-life plans.
Statements of support from family members.
Member of the clergy approves the life-ending decision.
An ethics committee reviews the plans for death.

2.  Will this death be irrational or rational?

IRRATIONAL

    When others examine the alleged 'reasons' for an irrational suicide,
they usually do not agree that death was the best option.  
People who are not overwhelmed by the temporary problem
are able to see more constructive solutions than committing suicide.  

    People who want to kill themselves because of the collapse of 'love'
are temporarily out of touch with reality.  
They lose all hope for their lives because someone has rejected them.  

    People whose thinking is distorted by drugs or alcohol
sometimes 'decide' to kill themselves for various flimsy 'reasons'.  
Once they recover from the mind-altering chemicals,
they see reality more clearly and they lose the urge to kill themselves.  

RATIONAL

    When others close to the person who is dying
also examine and understand all the facts, opinions, & alternatives
that are leading him or her to choose a voluntary death,
they agree that death is the best option available.

    Terminal illness is a common reason for choosing voluntary death.
If and when we find ourselves with an incurable disease or condition,
and we have already tried all the available methods for recovery,
then it is sometimes the wisest course to choose death.  

    Instead of merely trusting our own sense of reality, however,
we ought to ask for the advice of others who care about us.
And sometimes we should seek a second or third medical opinion.  

    But if we come to a point where all agree that death is inevitable,
then the most rational course of action might be
to discontinue medical treatments and life-supports
and to allow natural death to occur.
When there are no further values to be achieved by extending life,
then it is rational to select the most peaceful pathway towards death. 

    Here are four practical safeguards to separate irrational from rational:
Certification of terminal illness or incurable condition.
Requests for death from the proxies.
Care provided by a hospital or hospice program.
Terminal-care physician reviews the complete death-planning record.

 
3.  Will this death be capricious or well-planned?

CAPRICIOUS
 
    Suicidal people are often responding to a sudden new situation.  
For example, right after being divorced by his wife, a man shoots himself.
If he had been prevented from responding to his immediate loss,
he probably would be able to re-construct his life
without a spouse who has now rejected him.

    But some people who commit irrational suicide
do spend considerable time planning how they will kill themselves.  
However, they do not share their plans with other people
because they fear being prevented from throwing their lives away.  

    Financial or academic failure might trigger an urge to kill oneself.  
But if something allows the suicidal person to live a few more days,
the irrational urge to commit suicide might pass.  

    Many people whose sudden impulse to kill themselves was thwarted
later are grateful for the persons or circumstances
that prevented them from destroying themselves.  
The temporary wish to be dead has disappeared.
And the person who once felt the urge toward irrational suicide
is now ready to continue living.  

WELL-PLANNED

    A voluntary death is organized carefully in advance.  
In contrast to the capricious act of irrational suicide,
the person who is rationally choosing a voluntary death
might be engaged in the planning process for as long as a year.  
He or she has philosophically favored this choice for a long time.  
But when the final factors tip the balance toward the choice of death,
the planning for the final months can be put into effect.

    When terminal illness is the reason for choosing a voluntary death,
there is often a rather long period of medical treatment
before it becomes clear that all possible methods of cure
are not ultimately going to prevent death.

    Then in consultation with our medical advisors and family members,
we can begin the process of choosing the best pathway towards death.  
What things do we want to complete before the end of our lives?
What are the best ways to wind up our practical affairs?
Would it be best to distribute our assets before death?  
Where would be the best place to die?
What would be the best means to draw our lives to a close?

    Obviously, such planning will involve other people,
especially our medical helpers and our family members.  
And if we are suffering from some delusions,
then others will turn us away from an irrational self-killing.
But if all agree that death is inevitable within a short period of time,
then all can begin the careful process of planning a good death.

    When careful discussion and planning lead to a peaceful death,
all will agree that it was a voluntary death and not an irrational suicide.

    Here are four practical ways to separate capricious from well-planned:
Advance directive written by the patient.
Palliative care actually tried by the patient.
Moral principles applied to the end-of-life options.
Review by the prosecutor (or other lawyer) before the death takes place.

 
4.  Will this death be regrettable or admirable?

REGRETTABLE

    Almost all others who knew the person who committed irrational suicide
believe that it was an unfortunate, tragic choice.
And they wonder how they might have prevented this self-destructive act.  

    The family and friends of someone who has committed irrational suicide
often feel devastated, guilty, overwhelmed by the tragedy. 

    In the early years of the right-to-die movement,
the advocates of this right did not concern themselves very much
with the problem of irrational suicide.
They usually put the autonomy of the individual above everything else,
allowing people to kill themselves even for foolish 'reasons'.

    And the methods-of-death advocated by the early right-to-die movement
could be used by persons committing irrational suicide
as easily as by people who were choosing a rational voluntary death.  
Opponents of the right-to-die did not have to look very hard
to find people who had committed irrational suicide
misusing the beliefs and methods of the right-to-die movement.  

    There are literally thousands of easy ways to kill ourselves.
But if we want to prevent irrational suicides,
we should not publicize these methods
to people who might misuse them to destroy themselves.  

    Also, the right-to-die movement should be careful to prevent
suicidal people from appropriating the cloak of respectability and reason
that the right-to-die movement has attempted to create for itself.  

    When Jim Jones led his People's Temple cult into mass suicide,
he encouraged them to "die with dignity".  
He claimed that it was some kind of political act.
But these acts of irrational suicide had nothing to do
with the right-to-die or with achieving a dignified death.

 ADMIRABLE
 
    A voluntary death takes everyone else's feelings into account.  
And when they know all the facts and opinions,
they admire rather than regret the choice for death.
Irrational suicides leave everyone regretful.
Voluntary deaths elicit admiration and respect.

    When we know about the planning and courage
needed for choosing a reasonable death,
we hope that we will have the same presence of mind
when we come to the end of our own lives.  
We admire the foresight and planning
that went into choosing the very best pathway towards death.
People who carefully plan their own deaths
takes the thoughts and feelings of everyone involved into account.
And a rational plan is laid out in advance
for achieving the best possible death,
at the right time—not too soon and not too late—
and by the best means—the method that creates
the greatest possible meaning and dignity
in the eyes of all who will observe the last days.  

    When we learn about a truly voluntary death,
we might be inspired to begin planning our own deaths.
We cannot ultimately avoid death,
but we can begin to plan for the best death we can achieve. 

    These four ways to separate tragic choices from admirable decisions:
Doctor's statement of the condition and prognosis.
Requests for death from the patient.
Waiting periods for reflection.
Informed consent from the patient.

B.  CHOSEN DEATH AND THE LAW

    When the laws about suicide were written decades or even centuries ago,
no attention was given to voluntary death as a wise way to end one's life.  
But as this concept becomes better known, new laws will be written,
modifying the old laws against suicide and assisting suicide.  

    Already the crime of suicide has been removed from the law books.  
But assisting a suicide is still a crime in most places on Earth.  
And whenever we are talking about self-killing
that is harmful, irrational, capricious, & regrettable,
the law should continue to discourage irrational suicide
---and aiding such self-destructive behavior.

    But when the chosen death is
helpful, rational, well-planned, & admirable,
the law should not discourage choosing a voluntary death.
It is a wise and compassionate way to end one's life.  
And since we all must choose some pathway towards death
—or allow the crisis of dying to come upon us without choice—
why not consider the option
of having a well-planned, peaceful, & painless death?

    Choosing a voluntary death is not irrational suicide.
And reasonable persons should agree to revise our laws accordingly.  

    How will you write the last chapter of your life?  
Do you want the option of a peaceful and painless voluntary death?

C.  HOW FREQUENT ARE VOLUNTARY DEATHS?

    5 or 10% of what used to be called simply "suicide"
would be classified as "voluntary death" according to these definitions.
If there are as many as 40,000 'suicides' in the United States per year,
then perhaps 4,000 of these are 'voluntary deaths'. 

    It will probably take some decades for this new terminology
to be used in vital statistics.
But more public discussion of choices at the end of life,
will make "voluntary death" a common expression for everyone to use.

    Which will be the first death-certificate to name officially
the cause of death as "voluntary death"?
And which state of the United States will be the first
to create separate categories for "suicide" and "voluntary death"?

    Altho the new concept of voluntary death might shape hospital deaths,
most of these deaths will continue to be listed
as caused by the underlying disease or condition:
heart disease, cancer, stroke, infection, multi-organ failure, etc.

    But the methods of dying will be shaped by discussion of the right-to-die.
Comfort-care-only, terminal coma,
withdrawing treatment and life-supports, & voluntary dehydration
will become more common as methods of dying.

    Usually these methods of dying within normal medical care
will not be classified as "voluntary death".
But greater public awareness of the right to make choices at the end-of-life
will make such life-ending decisions more acceptable to everyone.

    More than half of all hospital deaths now include life-ending decisions.
Some patients could continue to receive curative care and life-support
until they die despite such technological efforts,
but more commonly, the doctors will explain that the tubes and machines
are not going to save the patient from death.
Such methods of attempting to postpone death can be discontinued.

    Exactly when the last curative treatment was abandoned
will be a part of the complete medical record,
but it will probably not be mentioned on the final death-certificate.
Only the underlying cause of death will be recorded on the death-certificate.
But the specific methods of dying will remain in the medical record.

    And the fact that some patients affirmed their right-to-die beforehand
will allow everyone involved in the final life-ending decisions
to proceed with the most appropriate methods of dying
when it becomes clear that no recovery will be possible.

How has this chapter changed your thinking?

Did you originally think it would be impossible to separate
so-called "irrational suicide" from so-called "voluntary death"?
Did you think that any such distinction
would involve legal authorities making evaluations
based on abstract principles?
Do you now believe it would be possible to invite family members
to take part in the life-ending decisions?
Will you approve voluntary death for people you love?
Will you choose voluntary death for yourself?
Can the right-to-die movement strongly reject irrational suicide
while at the same time affirming voluntary death?

Revised 10-9-2005; 10-11-2005; 10-14-2005; 10-15-2005;
4-5-2007; 8-15-2007; 4-2-2009; 3-12-2011; 12-30-2011; 12-31-2011;

    Authors who support the right-to-die should avoid the following four expressions
because they can easily be misused by the opposition
and because they create confusion in the minds of people in the middle:

"euthanasia"
"physician-assisted suicide"
"hasten"
"medication"

    Click here for some possible alternatives.

 

    Using careful safeguards for making life-ending decisions
is an operational way of saying
"no" to irrational suicide and "yes" to voluntary death,
"no" to mercy-killing and "yes" to merciful death.

Some related on-line essays and chapters:

Death Certificates:
Adding Medical Methods of Managing Dying (MMMD)

Losing the Marks of Personhood:
Discussing Degrees of Mental Decline

The One-Month-less Club:
Live Well Now, Omit the Last Month

Taking Death in Stride: Practical Planning

Pulling the Plug:
A Paradigm for Life-Ending Decisions

A New Way to Secure the Right to Die:
Laws Against Causing Premature Death

Two Approaches to Right-to-Die Laws:
Granting Permission and Banning Harms

Advance Directives for Medical Care:
24 Important Questions to Answer

Fifteen Safeguards for Life-Ending Decisions

Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Will this Death be a "Mercy-Killing" or a "Merciful Death"?

Four Medical Methods of Managing Dying

Methods of Managing Dying in a Right-to-Die Hospice

VDD:
Why Giving Up Water is Better than other Means of Voluntary Death

Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice

Comfort Care Only:
Easing the Passage into Death

Depressed?
Don't Kill Yourself!

Further Reading:

Books Opposing the Right-to-Die

Go to the Right-to-Die Portal.

Go to the Book Review Index
to discover 350 book reviews
organized into more than 60 bibliographies.

Return to the DEATH page.

Go to the Medical Ethics index page.

Read other free books on the Internet.

Go to other on-line essays by James Park,
organized into 10 subject-areas.