Mental Illness

Studies indicate that 93-94% of those committing suicide suffer from some identifiable disorder. During the period of their obsession with the idea of killing themselves, suicidal individuals tend to think in a rigid, dichotomous way, seeing everything in “all or nothing” terms. They are unable to see any range of genuine alternatives.

Suicide attempters tend to maximize their problems, minimize their achievements, and ignore the larger context of their situations. During the time of their disorders, they usually see life as much more traumatic than it actually is and view temporary minor setbacks as permanent ones.

Furthermore, studies and descriptions of suicide attempters who were prevented from killing themselves, demonstrate that most suicidal people have neither an absolute nor an irreversible determination to die. One study of 886 people who were rescued from suicide attempts found that five years later only 3.84% had gone on to kill themselves. A Swedish study with a 35-year follow-up found that only 10.9% later killed themselves.

Some psychologists believe that a suicide attempt is often a challenge to see if anyone cares. If physician-assisted suicide is legalized, the message perceived by suicide attempters is not likely to be, “We respect your wishes,” but rather, “we don’t care if you live or die.”

The Terminally Ill

Most terminal patients seek suicide not because they are ill, but because they are depressed. A scientific study of people with terminal illness, published in the American Journal of Psychiatry, found that fewer than one in four expressed a wish to die, and all of these had clinically diagnosable depression.

Although their disease may not be treatable, the depression is treatable and it is the depression, not the disease, which makes such persons suicidal. Compassionate counseling and assistance provide a positive alternative to euthanasia.

In 1969, psychiatrist Elisabeth Kubler-Ross outlined the five stages of the dying process – denial, anger, bargaining, depression, and acceptance. Since that time, Dr. Kubler-Ross has worked with thousands of dying patients and their families to help them deal with the dying process. In a recent interview, she stated, “Lots of my dying patients say they grow in bounds and leaps, and finish all the unfinished business. [But assisting a suicide is] cheating them of these lessons, like taking a student out of school before final exams. That’s not love, it’s projecting your own unfinished business.”

Despite their benign motives, those who encourage or assist in these suicides are helping to steal the last precious moments of these patients’ lives.

Pain Control

A healthy response to patients in pain is not to kill them, but to make sure that current pain controlling medicine and technology are better used. According to the Washington Medical Association’s Pain Management and Care of the Terminal Patient manual, “adequate interventions exist to control pain in 90-99% of patients.”

Despite our ability to control pain, there are some patients who needlessly suffer. This is due to many factors, including poor pain assessment by doctors, patient reluctance to report pain, and patient hesitance to take and physician reluctance to prescribe appropriate medication. These are based on myths about addiction, tolerance, and side effects. For example, some fear addiction to opioid medication. However, research shows that only 0.04% of patients treated with morphine become addicted.

We have the technology and medicine to effectively control pain. Instead of trying to legalize the killing of patients in pain, the public should be making sure that doctors are taught, and use, effective pain management.

Societal Implications

The main reason people in a 1991 Boston Globe survey said they would consider ending their lives if they had “an incurable illness with a great deal of physical pain” was that they “don’t want to be a burden” to their families. In an era of medical cost concerns, “unproductive” users of medical services often see themselves as drains on the economy. If assisting suicide for those with terminal illness is legalized, the so-called “right to die” may actually become a “duty to die.”

Legalizing assisted suicide will also lead to non-voluntary euthanasia. Court precedents have been set that will allow the killing of those who cannot make their own decisions. Attorney Walter Weber wrote in the Journal of Suicide and Life-Threatening Behavior, “…[T]he [‘substituted judgement’] doctrine… requires — a substitute decision maker, whether the court or a designated third party, to decide what the incompetent person would choose, if that person were competent…Therefore infants, those with mental illness, retarded people, confused or senile elderly individuals, and other incompetent people would be entitled to have someone else enforce their right to die.”