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Suicide, Euthanasia and the value of life

This started out to be a balanced review about suicide, and the various positions that you can take over it, but it appears to have become something much more wide-reaching.

Like abortion, suicide has a long history. It has been with us since records began, and shows no signs that it was new then, or that it is going away now. During this long history, there have been a number of positions taken by different groups to what the attitude of society to suicide should be, and I will try here to summarise them.

One of the oldest positions is that suicide is "against nature", and therefore morally wrong. This position has some problems associated with it that are usually to do with inconsistency. If you hold the view that if something is against nature and thus wrong, you have to deal with the fact that almost all medical intervention is at least as against nature, and thus similarly wrong. Some religious groups (most notably the jehovah's witnesses) do indeed hold this view, and perfectly consistently refuse most medical intervention as well.

A related, and often not sufficiently differentiated view is that life is sacred, and thus suicide is morally wrong. This argument is also used against "assisted suicide", also known as euthenasia. Again, the main problem with this is due to inconsistent application of this position. A lot of the people who hold this view also hold the view that it is wrong to prolong the suffering of their pets, but can't see that the two views are inconsistent. However, again there are groups who have a perfectly consistent viewpoint, and manage to live by it.

Another similar view is that intelligent life is sacred, and thus the pets don't come under the same rules as people. Again there are groups that quite happily live according to these rules, but it does seem to me to be a very weak position, which seems to just want to avoid the problems associated with the previous position.

A problem with this comes when society adopts any of these views, as most of the historical examples that I can find include both capital punishment, and the position that unsucessful suicides "volunteer" for it.

Once you get past the "life is sacred" viewpoint, the entire area takes on a much murkier feel. This is because once you remove the sanctity of life as a catch-all position, you move into having to deal with the practical problems of that position. From this point on, you enter the position where life is valuable, but not invaluable. This has various problems associated with it, and even more problems if a society has any this viewpoint.

If you have got this far without cringing at the relaxation of the constraints, you are now ready to deal wth the hard problems that go along with taking a practical approach to suicide. When life is no longer invaluable, you have then accepted that self-termination is a valid option, but you probably (as a society) want to put some constraints in place to try and minimise unnecessary loss of life. This is an admirable position to take, but you have to be careful of extremist positions.

The most obvious step to take is to try to spot suiciders before they actually commit suicide. Obvious as this is, in most societies that dislike suicide, and try to prevent it, this option is not implemented. This can be for a number of reasons, but mostly it is because no one in control has thought of it, or having thought of it has the power to implement it. This is a shame, as a lot of people contemplating suicide are doing so either to get attention due to low self-image, or because they see it as the only way out of an untenable situation. In most cases, these people can be helped with appropriate advise and support, but they are usually not spotted until they try to commit suicide, and even then, there is often no support system in place to give them what is to them a valid alternative. Of course if you do have people watching other people and reporting their actions and thoughts to "the authorities", then there are massive civil liberties problems to be dealt with.

If you do spot a suicider, this raises further problems. If they are sent for review, it may be that there is no acceptable alternative, due to there being a real problem there that is making life intolerable, with no solutions currently available. In this instance, it would be better to support the people with the problem, and do what you can to try and help them find a solution to their problem. The "orphan drug" issue in America is a good example of this.

In most countries, there exists a perfectly reasonable rule stating that if you are going to give drugs to people, then they should go through a testing procedure so that you know the side effects, at which point, they may be granted a licence so that they are no longer classed as experimental. The problem comes due to the situation that drugs are either licensed, or not. This causes the problem due to the fact that the testing procedure is expensive, and for some conditions it is impossible to get the cost of developing this drug back from sales of the drug. These "orphan drugs" are then left unlicensed, and the inability to get them for serious medical problems results in a lot of unnecessary suffering, resulting in unnecessary suicides. This can be solved by having multi-level licensing arrangements, and the users giving informed consent to taking these "experimental" drugs.

When you have dealt with these relatively simple cases, you start getting to the harder ones. These are due to the fact that medical technology works by slowing down the process of death, thereby giving the sick person a chance to recover. This technology is so sucessful that most medicines are no longer thought of in this way. However, the recent advances in "life support" technology and medical science generally have left us with the situation where some people who would have died with a minimum of suffering can have what at one point would have been a few hours of suffering extended to weeks or even months or years. I am not advocating getting rid of this technology, but the current view by doctors that they have the responsibility to extend life "whatever the cost" leads to a lot of needless suffering.

These "terminal" patients need handling differently from other patients, and in some places this has been recognised with the use of the "Do Not Resuscitate" or "DNR" flag on patient records. This cooperation between the doctor and the patient to relieve suffering is a welcome advance for some people, but there have been cases of people having DNR put on their file because they are over a certain age, rather than because they have some terminal condition, or a personal ethical problem with medical intervention.

This abuse of power needs serious controls on it, like the use of "living wills" which are stored with your records and tell the doctors what treatments you are prepared to have, and which ones you are not. Unfortunately, even the enlightened countries operating a DNR policy don't usually have anything more than token controls in place, so the potential for abuse is significant. Almost all societies have not yet accepted living wills as a valid idea, and this causes a lot of unnecessary problems.

Once you have accepted the use of a do not recusitate policy, most of the objections to "assisted suicide" also become invalid, as the apply equally well to the DNR policy. The only extra problem that you have is the same one that you have for suicides and DNR, that of abuse. Abuse by relatives is got around by requiring a psychological examination to determine that the patient is making a well reasoned decision, and this should probably be applied to DNR as well. Abuse by doctors and hospital administrators can be got around using living wills and compulsory inquests.

last modified 01:53 2003/08/14