Introduction
Suicide
Prevention and the Right-to-Die
Is this book another suicide manual? NO.
In contrast to other books supporting the right-to-die,
every page of this book seeks to prevent irrational suicide.
In the next 12 months, 30,000-40,000 Americans
will kill themselves.
This will be a terrible loss of life,
both for the people who will throw their lives away
and for other people who know them and care about them.
One feature that makes irrational suicide even more
tragic
is that almost all of these needless deaths could be prevented.
If we foresee which people are most likely to attempt to kill
themselves,
we can probably take
protective action to save them from themselves.
The Americans who will kill themselves in the next
12 months
will make this 'decision' to end their lives for a variety of
'reasons'.
Some will commit irrational suicide because of problems with 'love'.
Some will commit irrational suicide because of financial disaster.
Some will commit irrational suicide to harm others.
Some will commit irrational suicide because of weird religious beliefs.
Some will commit irrational suicide due to internal conflicts.
However, a few people who will choose death in the
next 12 months
will have valid reasons
to choose their own dates of death.
Perhaps 90% of all self-killings should be
classified as irrational
suicide.
And perhaps 5% should be classified as voluntary death.
This leave another 5% between
irrational suicide and voluntary death.
Of course, these terms need to be carefully defined:
Irrational suicide is
harmful, irrational, capricious, & regrettable.
Voluntary death is
helpful, rational, well-planned, & admirable.
Chapter 19 of this book elaborates these distinctions:
Will this Death be an “Irrational
Suicide” or a “Voluntary Death”?
And in a deep sense this whole book explores the safeguards
that will be the operational
method for separating
regrettable irrational suicide
from admirable voluntary
death.
Irrational suicide can and should be prevented as
much as possible.
But voluntary death should become a more open and
honest choice.
Careful
thought can combine suicide prevention and the right-to-die.
Forms of the right-to-die can be arranged along a
spectrum:
At one extreme is the suicide-model
for the right-to-die.
At the other extreme is the medical
model for end-of-life choices.
The suicide-model right-to-die begins with the fact
that everyone owns
his or her life,
which includes the right to end
that life.
If we base the right-to-die on affirming the right
to commit suicide,
we seek to make certain that the person really wants to die.
Any convenient means of bringing death might be employed.
The reasons for choosing death might not appear on any medical chart.
But care must be taken to protect any helpers from being charged
with assisting or encouraging an irrational suicide.
Helping someone to choose a foolish death is still a crime
even where suicide itself has been
decriminalized.
If we base end-of-life choices firmly within the practice of
medicine,
then death will be chosen with the knowledge and cooperation of doctors.
The reasons for choosing death will be intelligible to doctors.
For example, if we are dying from incurable cancer,
we might choose to shorten the process of dying.
Logically, the suicide-model right-to-die
has the most direct conflict with everyone who wants to prevent suicide.
Advocates of the right to
commit suicide
set themselves directly at
odds with all efforts to prevent suicide.
But medical-model care can cooperate
with suicide prevention
because the aim of the medical model end-of-life care
is to affirm and preserve
wise medical choices at the end of life.
Holland exemplifies medical model end-of-life care:
Only doctors (not nurses or technicians or laypersons)
are authorized to assist patients in choosing death.
These chosen deaths follow strict controls and reporting requirements.
And assisting an irrational
suicide is still a punishable crime in Holland.
The book you are reading falls mostly into the
medical model
for achieving wise end-of-life medical choices.
The person for whom terminal choices are made is always a "patient".
Fulfilling the proposed safeguards resembles keeping medical records.
All end-of-life choosing is open and above-board—not
secret and hidden.
The concept 'physician-assisted suicide' is deeply
confusing
because it combines the medical model (referring to the doctor)
with forms of human behavior —'suicide'—seldom occurring in hospitals.
Chapter
15
gives a critique of this concept and offers alternatives.
Efforts to prevent suicide are not at odds with the
medical model.
Suicide-prevention can join
hands with medical model end-of-life care.
Created
March 4, 2012; Revised 3-25-2012; 9-11-2012; 1-26-2013; 3-1-2013;
6-1-2013; 6-19-2013;
7-16-2014; 10-8-2014; 5-21-2015; 8-9-2018; 1-22-2019; 6-11-2020;