Ways to Go: Considering Assisted Suicide When You're Not Actually Dying

Who should be allowed to decide to end the life of a depressed person, and what are the stakes?

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Complex Original

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Physician-assisted suicide is surely arriving. I give it a decade before the first world is totally onboard. It's already legal in some countries in Europe, like Switzerland, Germany, and the Netherlands. It's legal, though highly restricted, all along the West Coast of the United States and in Vermont. Eloquent essays by those desiring self-chosen mortality are being joined by choruses of doctors speaking up about the horrible consequences of how we treat old people. We extend human lives past the point of a kind of misery that we put down dogs for feeling.

Generally speaking, I'm way, way in favor. If I get serious Alzheimer's, I'm out. Most of my recreational activities are private obsessions, and I can't imagine stumbling through my mind as if through a dimly lit paper maze. I don't consider a life where I can't remember my loved ones a life at all. However, I have concerns. It's not because of God or religion, but I do share with Christians a serious concern about euthanasia: the danger of the slippery slope.

The slippery slope argument goes like this: So assisted suicide is approved for the 70 year old with untreatable pancreatic cancer. But then the government gets sued by someone who wants to end their life despite not having a fatal diagnosis—a 65 year old with some disease where she constantly exfoliates in chunks. After she wins that suit, more litigation follows, this time from a 60 year old who suffers from brutal, life-long depression, which isn’t improving as he watches his friends die of heart disease. Eventually, the argument goes, assisted suicide will become a legal option in all cases—anyone so inclined may merrily petition their doctor for an end. And if that becomes a reality, what can be done to combat it?

On first glance, this seems like a ridiculous opinion, along the lines of "If we let gay people marry, all of your nephews will start dating hamsters." Obviously, a system in which you could apply for suicide as easily as renew a driver’s license seems about as plausible as free government-issued heroin. But on second glance—well, read this investigation into Belgian euthanasia by Rachel Aviv, of the New Yorker, if you want to have a bad day. Aviv’s piece focuses on a clique of charismatic Belgian doctors who are very pro-euthanasia; one of them discusses it with teenagers over a light brunch. They portray euthanasia as a sensible solution for a painful life: a totally voluntary surrender to a not-at-all-scary eternity. You’ll learn about the euthanasia of a 25-year-old woman who suffered suicidal thoughts stemming from borderline personality disorder—a disorder which is persistent, but often treatable. You will read about lives ended because of the pains of anorexia or chronic fatigue syndrome—young patients deemed irrecoverable.

My experience of having my life saved by trivial inconveniences is not unique. I'm dating someone who didn't self-harm during a bout of pretty serious opiate withdrawal because she has a very high-maintenance dog.

Given that I have manic depression, if I had one of these Belgian doctors, I would probably be dead.

Frequently I wonder why I never killed myself, much as I'm very thankful that I didn’t. At my worst, the world would seem poisonous on a basic level. The walls of the bedroom I rarely left seemed no less drab than whatever life I may have lived outside them. The sunshine crossing the floor was a conspiracy against the continued project of my existence; it tortured me with the false promise of something more. Realistically, I was one of the most fortunate people in the whole world: a white 23-year-old with screwy but not terrible grades, living in a sleepy neighborhood where a lot of yoga happens. But after I dropped out of school in the thrall of mania’s fireworks-like charm, the novel I thought I was writing disintegrated in the predictable swoop of depression, leaving me a drop-out staring bleary-eyed through a deli window. (The only writing I got done was one poem about how a rotisserie chicken sizzling in its little glass house reminded me of my smallness.)

Depression is a state of intoxication like any other, so, in a way, speculating about what exactly prevented my suicide is futile: It's like wondering why I destroyed my smartphone with a hammer when I was wasted on cheap Chardonnay to the point of forsaking my whole prefrontal cortex. However, I can't help but feel like I never committed suicide only because suicide is so inconvenient.

At my worst, I felt suicidal because I thought myself a burden. So I didn't want to kill myself at home, making myself a further burden to the roommates who would have to figure out what to do with what was left of me after they found me. I didn't want to throw myself off a Chinatown condo, because there was always the risk of failure—either through intervention or physical happenstance. Failing to commit suicide in such a public way would have been embarrassing.

Gun-based suicide always appealed to me—the idea of a pistol’s weight, bringing with it a high probability of success—but in Canada, where I live, getting a gun takes some doing. Among other chores involved, you’ve got to pass a background check which specifically focuses on mental health, a background check I would have failed resoundingly. Were I a U.S. citizen, the story could have been very different.

Rather than a well-considered grappling with the less desirable properties of living, suicide seems to be something you just find yourself doing.

With typical Internet thinkpiece arrogance, I'd like to propose my idea about how to avoid a Belgian-style situation: Make obtaining the permit for legal assisted suicide very, very annoying.

This might sound like a joke. It's not. My experience of having my life saved by trivial inconveniences is not unique. Friends of mine have had the very same experience. I'm dating someone who didn't self-harm during a bout of pretty serious opiate withdrawal because she has a very high-maintenance dog.

Along with my girlfriend, there's also the whole Israeli army. As an experiment in reducing the suicide rate, in 2006 the military stopped letting soldiers take their standard-issue guns home on the weekend. From an American perspective, that might not sound like such a big deal, but Israel has a different gun culture. The gun laws are strenuous. There aren’t many civilian guns lying around: 7.3 for every hundred people, as compared to 113 in the States. So, in practice, the military was completely shutting down the extracurricular gun access of most of its personnel. The result was an instant 40% drop in army suicides. They call it “means restriction”: protecting people by reducing their ability to instantly do something grave.

Similarly powerful was the British government's decision to phase out coal ovens—the kind Sylvia Plath used. That dropped the UK suicide rate by a third.

All of this evidence points in one direction: Sometimes suicidal people who wouldn’t go to the trouble of climbing a mountain for the sake of jumping off it will take an open window if it’s offered. Rather than a well-considered grappling with the less desirable properties of living, suicide seems to be something you just find yourself doing. More evidence: Of those who live after jumping off the Golden Gate Bridge, 90% go on to lead suicide-free lives. The moment of wanting suicide was almost as brief as the leap from the railing.

Assisted suicide in the right circumstances is humane; I can only imagine you’ve seen someone you love disappear while retaining a functioning face. But ending a physically healthy but depressed person’s life is something else. Lots of people who think they’re gone forever come back.

So, here’s my suggestion: Allow for an easy path to assisted suicide for those with terminal diseases or a fast-approaching total cognitive breakdown—for example, somebody with progressive dementia who wakes up one day without the memory of their children. Let anybody else petition for euthanasia for any reason, but make the process incredibly cumbersome. Make them personally fill out many extremely complicated forms that they can only access at a tiny office staffed by barely-competent people somewhere in the suburbs you can only get to with one bus that's always late. Make it like a year-long tax law trial. Offer them a love-hungry terrier.

If they flunk any part of it, or even miss one of their appointments by five minutes, the whole convoluted mess must begin over again.

It’s a kind of absurd solution, but not unlike TRAP laws that pro-lifers advocate. The process would effectively screen the temporarily suicidal, while still providing rights for those with truly serious long term health problems.

In Aviv’s New Yorker feature, Dirk De Wachter, a Belgian professor of psychiatry who has the power to approve or reject euthanasia requests in that country, says that he "has repeatedly been confronted by patients who tell him, 'I am an autonomous decision-maker. I can decide how long I live. When I think my life is not worth living anymore, I must decide.' " For the record, I would like to state that if Dirk De Wachter seriously thinks statements like that provide a teflon reason to end a life, he is a foolish person and I wish him ill.

None of us are totally autonomous decision makers. We are continuously buffeted by our genome. Emerging data seemingly indicates that abnormal behavior is induced by the lack of certain gut bacteria. Any majorly stressful could trigger depression—even a car crash. If you're in favor of Belgian-style suicide, you're defending the idea that someone who gets super bummed after a car crash suddenly has a coherent justification for removing themselves from the earth.

I'm sure there are people without physical illnesses who will never be well. But I can't shake the fact that I used to think I was one of them. 

Apparently, De Wachter was anti-euthanasia until a woman whose death application he denied set herself on fire. That's a horrible thing for Dr. Dirk's conscience to bear. But that's one case. The fact that a few people will commit graphic suicide even if they're denied legal euthanasia is no argument for approving more people.

So what are these doctors thinking?

I'm sure there are people without physical illnesses who will never be well. But I can't shake the fact that I used to think I was one of them. In 2012, nobody could have convinced me otherwise. Even if I could have seen the future, could have seen day I had today, eating noodles with new friends under the beautiful Bangkok afternoon sun, I would have hated my future self for being satisfied by dumb things like buddies or soup.

The funny thing is, I still basically agree with my former self about life being meaningless. Three years after being diagnosed with bipolar disorder, I don’t feel like I have anything like the meaning of life. What I have is a good psychiatrist who isn’t particularly fond of euthanasia. I’m just a meat machine in a world not designed for me specifically, doing the stupid calisthenics that make me happy, taking the little pills keeping my neurochemistry vaguely friendly. Somehow my feelings about life’s pointlessness have become merely a fact among facts, like a weird person I hang out with. I have the same soul that, in 2013, was crying out to be extinguished. I'm really glad nobody listened.

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