SUICIDE AND MENTAL ILLNESS: A RATIONAL RIGHT?

Comments on:  Rachel Aviv, The Death Treatment:  Should the incurably depressed be euthanized?, June 22, 2015, The New Yorker:

http://www.newyorker.com/magazine/2015/06/22/the-death-treatment

In the United States great controversy has surrounded the legalization of physician-assisted suicide.  The United States Supreme Court in Washington v. Glucksberg (1997) refused to find a fundamental right to physician-assisted suicide, leaving the choice of whether or not to permit the practice with States.  Since then, four States have legalized physician-assisted suicide, with Oregon being the earliest and hence the prototype law.   Even with legalization in Oregon occurring more than fifteen years ago, the number of people who use the law is modest (although rising).   The law permits a doctor to prescribe self-administered lethal medications to a terminal patient who makes several such requests.   If either the prescribing or consulting physician believes the patient’s judgment is impacted by a psychiatric or psychological disorder, a referral must be made for a psychological exam.   Under the law, no lethal medication can be prescribed if the patient is “suffering from a psychiatric or psychological disorder or depression causing impaired judgment.” 

According to The New Yorker, Belgium has taken the concept of a right to die much further than Oregon.   Under Belgium’s approach to physician-assisted suicide, patients do not need to be suffering from a terminal illness.  Physicians often directly kill the patients, which would be forbidden in Oregon where the patient must perform the final act of self-administering the lethal medication.   Further, mental illness, rather than a reason to refuse lethal medication, becomes the justification for causing death. 

The New Yorker article is filled with startling glimpses of what Belgium’s approach means in practice.  For example, a professor of psychiatry “approved the euthanasia of a twenty-five-year-old woman with borderline personality disorder who did not ‘suffer from depression in the psychiatric sense of the word….It was more existential; it was impossible for her to have a goal in this life.”   Her parents had begged the doctor, “’Please, help our daughter to die.’”  (pg. 62)  In another case parents expressed concern with the euthanasia of their bipolar daughter whose “pessimism” they believe would have passed in a few months.  (pg. 64)

Another prominent physician defended applying euthanasia to patients who are “’tired of life,’” often due to a combination of “small ailments” and because of being alone without family to care for them.  (pg. 60). 

The New Yorker explains that the Belgian approach to euthanasia is viewed as “an accomplishment of secular humanism, one of seven belief systems …officially recognized by the government.”  The government pays for “humanist counselors” as the “secular equivalent of “clergy, to provide moral guidance in hospitals, prisons, and the armed forces.”  Children in state schools are also taught humanist values in ethics courses from first to twelfth grade, with the topic of euthanasia introduced as early as second or third grade.  (“Religious students” can instead pursue “theological studies.”)   A prominent physician advocate and practitioner of euthanasia gave lectures in which, “[o]ver pastries and coffee,”  he “would discuss euthanasia  with teenagers,” with the lecture advertised on the web site of a youth organization. 

Yet, a prominent psychiatrist advocating euthanasia also “believes that the country’s approach to suicide reflects a crisis of nihilism created by the rapid secularization of Flemish culture….Euthanasia became a humanist solution to a humanist dilemma.  ‘What is life worth when there is no God?...What is life worth when I am not successful?”

Of course there are a myriad of secular responses one could make to Belgian’s “secular humanist” approach to euthanasia.  It seems irrational to allow psychiatric illness to be grounds for rational suicide.  Indoctrinating children and teens into a positive view of suicide seems counter-productive when so many---perhaps most?---adolescents at some point pass through an intense crisis or desire to die.  Killing patients because they are alone and feel hopeless seems more like an abandonment (or even a homicide) than it does compassionate treatment.

Yet, the Belgian example does bring home the implications of a fully “secular” humanist worldview, for in the end the Belgian approach seems not so much rational but ideological, a reflection of a rigid denial of any value or existence beyond our momentary experiences, and an attempt to find dignity in being able to control the terms of one’s exit from existence.   At one point Rachel Aviv, the author, confesses to Vermeersch, “recently voted the most influential intellectual in Flanders,” that she is afraid of death because she is afraid of “not existing.”  Vermeersch replies:  “Millions and billions of years you did not exist---what was the problem?”   When Aviv objects that she has now formed relationships, he responds “brightly” that our relationships are “finished” after death, returning us to “the state you were before conception.”   For Vermeersch, it seems, it is our capacity to exercise choice and control that make both existence and non-existence palatable.

It has often been said that believing this life is all we have would make us value it more.  Under the Belgian approach, it seems, it is not so much our lives that we value, but our control over our lives, and our success at getting what we want from moment to moment.   If we cannot have life the way we want it, we do not value it.   Of course for the believer in God and an afterlife, this life also is not an ultimate value, but a beautiful, yet often painful, gift that points to the giver as the ultimate source and destination of our existence.  

The Belgian experience also points us to the difficulty of a society being truly religiously neutral.  As Belgium increasingly develops the implications of its dominant humanist ideology, the results are a seemingly cradle to grave indoctrination in the beauty of killing the sick, hurting, alone, mentally ill and vulnerable.   This is no more religiously neutral than holding onto the traditional prohibitions of killing which were founded upon a belief that human beings lacked the authority to take innocent human lives---even their own.   From a legal point of view all arguments are “secular” or can be shaped into secular legal language; from a cultural point of view, there is a religious root and direction in policy and the law.   What direction, pray tell us, should we go in?

David Smolin