This may not be a post for everyone, so feel free to look away. When it comes to talk of death and dying, most people do just that, look away.
Google ‘suicide’ and the first entry that comes up is a suicide prevention hotline number, in large pitch font:
Talk Suicide Canada
Hours: Available 24/7/365 for calls; 4 PM—12 AM ET for texts; Learn more
1.833.456.4566
It’s not surprising. A first world country like Canada takes a dim view of suicide – an unnecessary death should be prevented – and heavily links suicide with depression. And who could disagree that progressive societies should channel resources to provide remediation of a debilitating disease such as depression.
On the other hand, Canada now leads the way in providing resources to citizens who are determined to terminate their lives and support them and their loved ones in ameliorating this very difficult process.
Navigating this philosophical and moral question – terminating one’s own life – is exceedingly complicated.
The contemplation of one’s death, as we discussed int the last post, and with equanimity, is challenging enough. But death by one’s own hand is the most challenging thing of all. And made more complicated by the cultural context in which it is done.
Amongst Christian European cultures the sanctity of life tends to trump other societal values. For this reason, a core human value (and it seems in almost every society whether Christian or not), is that one may not take the life of another person. The right to life is a fundamental freedom. Only god may intercede in a life – god giveth, and god taketh away.
Some sects, and even some [Christian] subsects, don’t have the same regard for this value – murder is just another tool for asserting your will and power over obstacles frustrating the achievement of your goals: The Cosa Nostra, and Chinese Triads. And of course, murder by the state in the name of ‘legal’ warfare is mostly seen as justifiable.
Euthanasia
The sanctity of life may be sacrosanct in most human societies, but not always: Amongst pragmatic survivalists, even if Christian, unburdening the tribe or family of a serious liability was once seen as entirely valid and normal, just as drowning a litter of unwanted kittens in a rain barrel was perfectly acceptable.
More than merely god-given, the right to life may also have been a condition of tribal survival: in early, and even recent, desperate, times when the tribe or family was constantly threatened by death and devastation, famine and pestilence, survival of the tribe depended tremendously on the critical mass of the population – hence God’s edict to man to ‘go forth and multiply’, as well as ‘thou shalt not kill’.
So here we have a moral dichotomy: on the one hand the sanctity of life was god-given in order for humanity to thrive, yet on the other hand, humans may freely exterminate anyone who may be a threat to the survival of the tribe – tribal warfare, and elimination of any liability to the tribe such as deformed babies and infirm oldsters. The survival of the tribe trumps all other considerations.
If the survivability-threatened tribe has the right to euthanasia one might also imagine that the tribe would also allow the physically and/or psychologically troubled individual the right to suicide. One might even think of euthanasia and suicide as two sides of the same coin – an exercise in eliminating the weak-links in the tribe. Today we would label those members of society as vulnerable and deserving of our protection but that was not the common view in bygone times, even quite recent bygone times. The deformed babies may have had no say in the matter but the conscious oldster may have been culturally conditioned to accept their fate, though I suspect, as today, not all were so willing. We find it both ‘romantic’ and terrifying, the prospect of the toothless Inuit being sent away on the ice-flows, and the Hindu wives immolated along with their dead husbands[1]. Those accepting of these cultural imperatives were in effect party to their own ends.
It seems most non-doctrinaire people agree that the question of ‘life’ is really a function of the quality of life. No-one looks forward to living in a long vegetative state, nor the obverse, a sentient but pain-riddled life. The problem is, who is to determine what is the appropriate standard for quality of life? And if more than one party is involved, how to resolve the dispute? In euthanizing a non-sentient entity, the participant has no say, unless he or she has left clear instructions (and most dogs lack this capacity). But deciding when the quality of life has reached below a certain threshold it’s still a difficult proposition (even with respect to your dog). Imagine this conversation amongst siblings bedside comatose mom whose quality of life is poor and prognosis worse.
“I think we ought to let Mom go,” says son Johnny.
To which daughter Jenny says, “yeah, I guess you’re right.”
To which Mom chimes in, “I can still hear you.”
As a civilized society we have almost no difficulty ending the life of an irredeemably injured or sick animal. But euthanasia presents a slightly different dilemma when it comes to terminating a sentient human.
Suicide
Euthanasia[2] and suicide[3], and now it’s blended cousin, assistance in dying, in recent western societies have been highly controversial subjects. (Abortion is a similarly controversial topic, almost euthanasia for the unborn, though the interests of the pregnant woman over those of the fetus may predominate in this discussion.) The core beliefs underpinning these values are deeply held, even if not fully examined and understood, more as rote belief. This value-set raises a moral dilemma for many: is it the responsibility of society to protect the interests of the individual over society?, or of the society over the individual?. Your position on this question may depend heavily upon the prevailing values held by society at the time you lived.
The ethical dilemmas posed by questions of euthanasia and suicide are further complicated by our attitudes to freedom of choice. In modern times, especially in Western cultures, individual freedom is seen as a fundamental value – people should be free to decide what they want out of their lives… where to live, how to earn a living, who to love. But soon we discover that in our freedom-loving society, society imposes many constraints on this freedom; usually individual freedom is constrained in one fashion or another by the rule that our individual acts may not harm or unduly impose on the freedom of others. (Powerfully subjective word that, unduly.)
When it comes to the fundamental right to life, no person, nor the state, may take the life of another person, and thus terminating the potential contribution of that life to society; on the other hand, freedom of choice as a fundamental individual value also means that an individual may choose to extend his/her life, or choose self-destruction.
This sanctity of life notion, accordingly, gets in the middle of societies’ views on suicide. If you have no right to end another’s life, equally, you have no right to end your own life. If the gift of life is the gift of god, you may not return to sender. (I suppose the gift of sex is also another condition imposed by an all-powerful god. Sex is designed by god to ensure the survival of the species; accordingly, thou shalt not sow thy seed upon the ground. Suicide and masturbation are condemned for similar reasons.)
Beyond the gift of god argument, attitudes to suicide may vary with cultural norms. In some cultures it is seen as the ultimate in cowardice, and selfishness. In others, suicide is seen as the failure of society to rescue the suicidal individual from the social and psychological demons she or he is living with. In yet other societies it is seen as the height of honour. (In this last respect I think of the Japanese samurai ritual of seppuku. One of the saddest moments in all of opera is when Cio-cio-san sings the plaintive aria, un bel dei, only to later discover that her lover, Lieutenant Pinkerton, is not coming back for her and their son; she subsequently gives up her son to Pinkerton and his American wife. Butterfly reads the inscription on her father’s knife: “Who cannot live with honor must die with honor.” and ends her life by hara-kiri. It is a very powerful moment, but I wonder if audience members of different beliefs get the same meaning from that moment.)
But mostly, suicide has been seen as a tragic end to an unhappy existence, and an outcome that society should do whatever it can to minimize.
In an earlier Travels With Myself blog post, when I was in my own depths of depression, I talked about suicide as a solution for escaping life’s hard moments, the depression and hopelessness that often happens in deep grief. The post: The Question of Suicide, was answered this way: Leave it a question, it’s not the answer.
I haven’t changed my view on that – suicide is not the solution to an episode of depression – but now I see there may be circumstances where suicide may in fact be the answer to some of life’s ultimate challenges. To me, life is sufficiently precious that it should be valued, honoured and purposeful. But this can’t be an ‘unqualified’ statement. Life must have a certain level of quality to justify its continuance. Wikipedia informs us that the highest incidence of suicide is amongst septuagenarians; that gives me little comfort but doesn’t surprise me. But what about octogenarians? I suppose when you get to be that old you’ve forgotten what was bothering you.
Suicide, on the other hand, presents many problems of its own for the person contemplating it. It’s not so easy to do as to think. Even to think is hard for a mentally-well sentient person; the decision to end one’s life may be fully rational but the irrational will to live is hard to overcome.. Even when determined, the brain tends to panic when the lungs find it hard to breathe. And how does one find the means, and carry it out? Lethal drugs and chemicals aren’t so easy to get ahold of; and how many do you need to take? [there are few instructions]; and are you sure it will be a gentle and painless death? Physical self-destruction is almost certainly going to be painful, even if only momentarily, and it’s certainly going to be messy.
And what of the people who discover the body? Oh dear, this is an offence the self-afflicted deceased has been very mean about. Pity the person who discovers the body. And what of the loss, now the complicated loss, the surviving family and friends now have to deal with? One could argue that the death of a loved one deals pain regardless, but somehow suicide seems more of a betrayal.
Offing oneself presents many problems. So modern society, very recently, has turned its attention to it: on the one hand offering more and more early interventions for people who are mentally/emotionally distressed and contemplating suicide, and on the other, coming to the aid of those who do not want rescuing, determined to end their own lives: delegating the deed to others – Medical Assistance in Dying. Canada now leads the way in this truly difficult dilemma.
And this will be the topic of the next edition of Travels With Myself: MAID.
Doug Jordan, reporting to you from Kanata, Canada
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[1] I wonder if husbands of deceased wives experienced the same fate?
[2] Euthanasia, from the Greek eu (positive, good) and thanatos (death); not to be confused with Asian young people.
[3] Suicide, from the Latin, sui (self), saedere (to kill); usually not associated with a good death.
