The Corner

Health Care

Prevention Is Right Answer to Assisted-Suicide Requests

We only seek to prevent some suicides these days. If a suicidal person lives in a state where assisted suicide is legal, and is qualified to receive prescribed poison with which to overdose, they will probably never receive prevention interventions.

That’s an abandonment. In Scientific American, Michael Shermer reviews a book about suicide and describes how prevention can benefit any suicidal person. From, “Why Do People Kill Themselves?” (my emphasis):

Like most human behavior, suicide is a multicausal act. Teasing out the strongest predictive variables is difficult, particularly because such internal cognitive states may not be accessible even to the person experiencing them. We cannot perceive the neurochemical workings of our brain, so internal processes are typically attributed to external sources. Even those who experience suicidal ideation may not understand why or even if and when ideation might turn into action.

This observation is reinforced by Ralph Lewis, a psychiatrist at the University of Toronto, who works with cancer patients and others facing death, whom I interviewed for my Science Salon podcast about his book Finding Purpose in a Godless World (Prometheus Books, 2018). “A lot of people who are clinically depressed will think that the reason they’re feeling that way is because of an existential crisis about the meaning of life or that it’s because of such and such a relational event that happened,” Lewis says. “But that’s people’s own subjective attribution when in fact they may be depressed for reasons they don’t understand.” In his clinical practice, for example, he notes, “I’ve seen many cases where these existential crises practically evaporated under the influence of an antidepressant.”

Assisted suicide advocates claim this has nothing to do with their cause because the terminally ill just don’t want to die in agony.

But that’s more fear mongering to win a political debate than reality. The actual reasons people commit assisted suicide or ask for euthanasia–verified from the published statistics from Oregon, Netherlands, and elsewhere–usually has little to do with physical pain. Rather, people ask for suicide help because of existential issues, such as fears of being a burden or being remembered poorly by their loved ones after going through a natural dying process (one of Brittany Maynard’s two primary reasons for wanting to die).

Don’t get me wrong: These are crucial issues that should be taken very seriously. The good news is that they can often be remedied:

In consulting suicide attempt survivors, Lewis remarks, “They say, ‘I don’t know what came over me. I don’t know what I was thinking.’ This is why suicide prevention is so important: because people can be very persuasive in arguing why they believe life—their life—is not worth living. And yet the situation looks radically different months later, sometimes because of an antidepressant, sometimes because of a change in circumstances, sometimes just a mysterious change of mind.”

Exactly. I have met such people who would be qualified for assisted suicide. Indeed, my last hospice patient (I was a volunteer) died peacefully in his sleep of ALS. When I first met Bob, he described being suicidal and wanting to go to Kevorkian (this was in the 90s). His family refused to cooperate and he was so glad! He told me that after some months of just wanting to be dead (because he could not properly support his family anymore and felt abandoned by his priest), that he had “come out of the fog” (his words). He later wrote about how the assisted suicide movement corroded his morale and was harmful to the wellbeing of terminally ill people. Please read it here.

When we accede to an assisted suicide request of a person with a terminal illness, we send the insidious message: “Of course you want to die. I would too in your place.” That’s potentially devastating. And families dragged into the death spiral may support their loved one’s suicidal wishes thinking they are being supportive–when they are unintentionally confirming the patient’s worst fears and unaware that with proper care, their loved one could, one day, be thankful they did not commit suicide.

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