Suicidal tendencies

Mrs. Calvin’s bladder wouldn’t stop burning. Every few minutes she felt a strong urge to urinate that she could never fully relieve. When she finally received a diagnosis of interstitial cystitis, she hoped an effective treatment would soon follow. But after years of visiting several specialists and trying many medications and procedures, nothing worked. Her once expansive existence, filled with dreams and plans, now centered on her bladder.

Mrs. Calvin (a composite person based on some of my patients) decided to make an appointment with her long-time internist to have a difficult conversation. At 76 years old, she had lived a full life. But now she couldn’t see anything that provided enough pleasure or purpose to justify continuing to live with her constant pelvic pain. Would he as her doctor help her end her life?

At the annual meeting for the American Association for Geriatric Psychiatry (AAGP), New York University (NYU) psychiatry professor Robert McCue reported that cases like Mrs. Calvin’s are becoming more common. One educational session focused on how physicians should respond to patients who ask about “rational suicide.” McCue noted that the term “rational suicide” is used to describe a person with free choice and decision-making capacity who decides to end his or her life.

The physician-assisted suicide (PAS) laws in Oregon, Washington, and Vermont permit doctors to prescribe a life-ending medication to adults who are found to have decision-making capacity and a terminal illness that will lead to death within six months. But now groups such as the Society for Old Age Rational Suicide (SOARS) are advocating that people without terminal conditions also be granted means for committing suicide. At the AAGP meeting, NYU psychiatry professor Meera Balasubramaniam said “more and more individuals are expressing the wish to end their lives when they’re doing well.”

Switzerland’s permissive suicide laws may reflect what’s in store if legal efforts to make suicide more acceptable and accessible are successful. A study published in the Journal of Medical Ethics on Switzerland’s so-called suicide tourism found that foreigners are increasingly traveling there to end their lives. The country’s statute allows nonphysicians to help people kill themselves and does not require the presence of a terminal illness. The organization Dignitas is Switzerland’s largest provider of assisted suicides for foreigners. A 2014 survey by the University of Bern found that of the 1,301 suicides orchestrated at Dignitas between 2003 and 2008, 16 percent had been for people who were physically healthy.

The debate about the moral acceptability of suicide is not new. The ancient Stoics held that when one was no longer capable of living a flourishing life, suicide is justified. The Roman Stoic Seneca, who himself committed suicide, claimed that “mere living is not a good, but living well,” and therefore a wise person “lives as long as he ought, not as long as he can.”

The Stanford Encyclopedia of Philosophy notes “the advent of institutional Christianity was perhaps the most important event in the philosophical history of suicide.” The early church fathers opposed suicide, and the influential theologian Augustine wrote that “God’s command, ‘Thou shalt not kill,’ is to be taken to be forbidding self-destruction.”

A study of people who committed suicide using the Oregon law found that among their most common reasons for doing so were worries about loss of dignity. This suggests one way Christians can counter the growing movement to legalize suicide is confidently affirming that even the frail, aged, and least productive among us are deeply loved and valued by God.