Is there such a thing as rational suicide and, if so, should the thought that people can suicide rationally suggest we change public policy?
In the current public discussion on the involvement of Exit International and Philip Nitschke int he death of a 45 year old Western Australian man I have argued that, while some literature does exist that suggests that rational suicide is possible, that this should remain int he realims of academia and not be allowed to influence suicide prevention.
Dr Peter Saul discusses the issue on The Conversation website:
Seven Australians will die today as a result of suicide, the leading cause of death in young Australian men. So the media interest surrounding one in particular, that of 45-year-old Nigel Brayley's suicide, needs some explanation.
The sensational midnight meeting that led to the suspension of euthanasia campaigner Dr Philip Nitschke's medical registration for his role in that suicide was certainly newsworthy, though Nitschke's activities do not wholly depend on his license to practice medicine.
Most likely interest is driven by the linked ideas of a "right to die" and "rational suicide", terms that have been used repeatedly by Nitschke in explaining his support for Brayley's actions. Neither idea is new (both stem from libertarian ideas of individual autonomy), nor is the drug Nembutal, which Brayley used, a new or unique means to achieve death through suicide.
But there's a back-story here that's essential to making sense of the theatre surrounding Brayley and Nitschke.
The right to die and rational suicide
First "the right to die". This right is not listed in the Universal Declaration of Human Rights. Article 5, which prohibits torture and inhuman treatment, certainly implies a right to relief of suffering at end of life, and it finds legal support in many jurisdictions (including Victoria).
But the language of rights is any case bewildering, as it imposes an obligation on others (your right to die becomes my obligation to kill) and invariably engages with opposing rights. Consider the role of a doctor in a botched suicide attempt, for instance.
While it has served as useful shorthand for supporters of the evolving idea of providing exceptions to the Crimes Act in certain cases of deliberate killing by commission or omission, the "right to die" is ethics reduced to a bumper sticker and does little to further our understanding.
And as a statement of the bleeding obvious - we all are born with a right to die that cannot be infringed. Only the suffering associated with our dying can be changed.
Rational suicide, on the other hand, has been with us for millennia. Acceptance that there are some circumstances where you should kill yourself or knowingly allow yourself to be killed is widespread in most cultures, including western Christian ones.
Few advocates of suicide could have been more cogent than a former dean of St Paul's Cathedral, the poet John Donne:
If man knew the gaine of death, the ease of death, he would solicite, he would provoke death to assist him by any hand which he might use.
Arguments against rational suicide based on a revealed truth that our bodies and lives do not belong to us do not convince philosophers or the broad public that suicide could never be a rational choice. And a scientific assumption that all suicide is due to mental illness is unproven and unprovable.
So rational suicide exists, but does that make it right? Suicide may be rational (that is, it may have clear and understandable reasons) but Nitschke's conclusion, that we should accept it and educate people on how to carry it out painlessly, is deeply flawed.
For all the millennia that rational suicide has found supporters, it has encountered systematic opposition based broadly on the idea of public interest.
Your life and the public interest
This "public interest" led to the criminalisation of rational suicide in England in the 13th century (you had to be considered sane to be prosecuted; about one in eight were).
Punishment was also meted out to surviving family members, who were stripped by the Crown of all their belongings, an early function of the coroner.
In his 1825 Commentaries on the Laws of England, Sir William Blackstone called suicide a: crime against God and nature, as well as a crime of depriving the King of a subject.
Though suicide was decriminalised in England in 1950 (and 17 years later in Australia), we still use the word "commit" with suicide, a term otherwise reserved for murder and sin.
Nowadays, the law prohibits suicide in more specific settings, guided by a US case that suggested, among other things, that "protection of the interests of innocent third parties" and "maintaining the integrity of the medical profession" could weigh against self-determination.
Philosophers vigorously disagree, but most continue to see contemporary reasons to question rational suicide, some arguing that the idea is nonsensical, while others argue that intervention to prevent suicide is warranted in any case, as an assessment of rationality is difficult to make.
The pragmatic findings that suicide commonly has an impulsive element, and that failed suicide may be associated with good quality survival, lend weight to the view that attempting to prevent suicide is a greater good than making it safer and more accessible.
The historical evidence that suicide rates vary with the philosophy (zeitgeist) of the times, with surges during the Age of Enlightenment and more recently with the Romantics, urges some caution in adopting an unqualified libertarian stance that privileges autonomy over all else.
At a time when extreme libertarian philosophers still find free will "unintelligible", there are grounds for caution in embracing libertarianism as a the principle upon which we judge acts of terminal self harm.
Rational suicide may exist, but is as sad as that driven by mental illness. It deserves our attention and our compassion, but not our complicity.
Anyone seeking support and information about suicide can contact Lifeline on 131 114 or beyondblue 1300 22 46 36
Peter Saul is a senior specialist in intensive care at John Hunter Hospital in Newcastle, and Director of Intensive Care at Newcastle Private Hospital. He is a founder of the Clinical Unit in Ethics and Health Law at the University of Newcastle, and advises the NSW Ministry of Health through the Clinical Ethics Advisory Panel.