Madness, Social Issues, Violence

Informed Consent, Suicide, and the Ethics of Agency

If you use the internet, then you saw a lot about Robin Williams this summer. Or perhaps more accurately, you first saw a lot of people speculating about the impiety of suicide while posting links to crisis hotlines, and then after that a lot of people mourning the loss of a great actor. I don’t know Robin Williams–I never even met him briefly in a San Francisco park–so I can’t say much about him personally. However, to take the general case, say a man has struggled with a depressed outlook on life alongside drug and alcohol problems for many, many years. He has also created a prodigious body of work and positively affected the lives of millions. (Yes, there may be a debt to the world that we inherit by virtue of being born, but he has paid his.) He begins to develop Parkinson’s, a non-fatal but neurodegenerative disease that greatly affects one’s daily life in the long run. I would think that such a person has really tried to beat his demons, and lost. In my mind, his suicide seems like a sad but nonetheless thoughtful, informed decision. It is not my place to say he should have chosen differently.

Romeo and Juliet, on the other hand, were not practicing informed suicide. In their case–and in the case of most non-adults–I would think anti-suicide intervention not only reasonable, but necessary. Hospice care, on the other hand, is predicated on the idea that a person suffering from a terminal illness–including the illness of life, which shows symptoms of getting old–should be permitted to make their own end-of-life decisions. For example, a family member of mine has recently decided not to pursue additional treatment for his aggressive brain tumors. Surgery to remove the tumors could cause serious loss of cognitive functions, and he doesn’t want to spend his final days constantly traveling to and from the hospital in mentally diminished states. By declining the available “treatments”–which may or may not be effective in the battle against cancer–he chooses to end his life earlier than what otherwise might be possible. This seems like another informed kind of suicide.

I think a person has a right to informed suicide. This may be disturbing for family members and those secondarily affected, but in a democracy, we grant that people have the right to do many things regardless of whether others find it disturbing. Realistically, however, some liberal families are deeply disturbed by their Republican counterparts not even because of their actions but on accounts of their values. The same goes for how some conservatives feel about liberals. I think it’s none of my business either way. People have a right to their own thoughts and values, and they should generally be allowed to live in accordance with these values. Being a social creature means dealing with people you don’t necessary like. In the case of politics, however, we think of how the State affects an individual’s life; in a democracy, people are presumably expected to inform how the State functions, by way of voting. This means that if I don’t believe in government assistance, my vote affects not just me, but other people in this country. Thus given the reality of centralized State laws, functions and regulations, many people conclude that individual beliefs and values may go beyond the personal sphere and become socially destructive–too many liberals means too many hand outs; too many conservatives means too much marginalization of the poor. When we are deeply concerned about people forming their own opinions and enacting these opinions in ways that I do not like, we may begin to wonder whether democracy is the most reasonable kind of government after all.

Now what of my thoughts? I wonder whether they are socially destructive. By expressing my empathetic support for specific cases of informed suicide, do I get blood on my hands? True, I have no suggestions as to how informed suicide “should” be regulated in terms of the law, but that is part of my point. I think the level of blanket approval or condemnation required in the creation of laws is too abstract to be of much use; the same could be said of morals, which are also too coarse and too stubborn to allow nuance. I think there are cases when it’s necessary to encourage an individual to reconsider their decision making process, to ask them to wait longer before making such a permanent decision. There are also times, however, when this is a stupid request.

The question of whether a person should be granted permission to kill themselves also touches on the issue of equality. Believing that all beings are created equal, we deem each individual to have their own subjectivity, and suggest that no one perspective is more valid than any other. If I decide that my life is untenable and not worth living, should this perspective be granted as valid? Furthermore, should I be permitted to act on this perspective, by ending my own life? This is a matter of agency, about making fundamental decisions as to how I choose to live (or not). If you believe there is an after life and I do not, we can’t both be right. But when we accuse one another of having an invalid perspective, be wary of propagating hegemonic thought control.

The social reality of equality is, of course, a farce. People are not born into the same circumstances. This may lead us again to reconsider the fundamental assumptions of democracy, but in the specific case of this life-and-death issue called suicide, who do we permit free-thinking agency and who do we deny? The great debates about abortion are also related to these issues–can a woman decide whether or not she will give birth? At what point does a new being gain agency, capable of flexing their own desire to live? Some of the early birth control proponents were supporters of eugenics, reminding us that oppressed groups are often oppressed precisely because their subjectivity is somehow seen as less than. On the other hand, Toni Morrison’s Beloved evokes questions related to the moral permissibility of infanticide, and reminds us that infanticide was incredibly common on the global scale until relatively recently (i.e. until Christianity advocated for the inherent worthiness of all beings). Although another contentious issue, we also permit capital punishment, granting that some individuals may lose their right to life. We celebrated the death of Osama bin Laden, and when Ariel Castro killed himself, I for one did not weep.

What if a person just doesn’t derive satisfaction from life? I think of the M.A.S.H. theme song:

the game of life is hard to play
I’m gonna lose it anyway…
Suicide is painless
it brings on many changes
and I can take or leave it
if I please.

If a person decides that their life is no longer worth living, we may say they are “mentally ill” and therefore incapable of trusting their own judgments and decisions. This is a strange idea. I personally reject the whole notion of “mental illness” as inextricably tied to the biologic disease-model, which mistakes brain correlation with etiological causation, and serves as a biased advertisement for insurance-company supported pharmaceutical cures (which don’t always provide effective relief, for the record). If suicide was the product of faulty thinking caused by some organic illness, however, shouldn’t possible treatments also include the right to decline treatment in the same way that cancer patients are permitted end-of-life decisions?

Of course, death is always a sad event, but so is life. Both activities involve compromise. A person may kill themselves as an act of rage–fuck you world–and that is still an act of rage, righteous or not. I have known many people to end their own lives, and I have also known people who live life on the edge and die as a result. These events are difficult to face. Death leads me to question the viability of life–what’s the point of living if it’s all going to end anyway? It is also sad to live in a world where there is so much suffering. It is endlessly frustrating to see our own helplessness and inability to change the world, our relative impotence amidst the social conditions that lead to such intense suffering. In my own perceived ethics of suicide, each person would try to live for a longtime before giving up, loved ones would not be so surprised by the death, and necessary life arrangements would be made in advance. Well, yeah, she killed herself. It really fucking sucks, but it’s not a big shock… she thought about dying for years. Perhaps in the final analysis, life is a mixture of inherited circumstances, some malleable and others immobile; developing a sense of agency is about taking responsibility for our own decisions and their perceived as well as unforeseen consequences. To be or not to be–permitting myself to ask this question, without fear of social or moral condemnation, perhaps that is all I have.

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