The Right To Die and Mental Illness

Assisted suicide and right to die advocacy are pretty hot topics right now. More and more states are making it legal for physicians to assist the terminally ill in ending their lives. For secular activists, it’s become fairly clear that being able to choose how and when you die is an important right, especially when the alternative is intense suffering and low quality of life.

Many people have started to recognize that simply being alive is not always inherently good if it involves too much bad stuff, and that we need to provide people with options if their lives are going to be miserable. Of course there is still debate on the issue, but the idea that terminally ill patients who are suffering have a right to die has become a common concept and for most people at least seems on the table as a possibility.

But there’s one set of illnesses that seem to be entirely off the table when it comes to questions of assisted suicide: mental illnesses. There do seem to be some pertinent differences between physical illnesses and mental illnesses: mental illnesses can often leave one vulnerable to manipulation or abuse, which would make it even more difficult to ensure that no one took advantage of the legality of assisted suicide. Often those who have mental illness feel guilt at being a burden, which might lead to a self-selecting kind of mini-genocide. And perhaps most importantly, there really isn’t such a thing as a “terminal” mental illness, one that will inevitably lead to the death of the individual afflicted.

But I’m not wholly convinced that these differences are the most pertinent elements of whether or not someone has the right to die, and the right to die with dignity.

The thing that is most pertinent in most of these cases is that an individual is in serious amounts of pain and distress, and it is highly unlikely that the situation will change. Also important is that an individual has decided that the pain is more than they can tolerate (no one else is allowed to make that choice for them). The vast majority of patients with terminal illnesses don’t seek out assisted suicide, but those who are in serious amounts of pain or suffering are more likely to. We’re all going to die eventually, so the simple fact that an individual has a more clear time frame of when that will happen doesn’t change the moral status of what it means to allow them to choose death sooner.

What is relevant is the suffering and loss of self that comes with some illnesses. Those concerns are just as relevant to mental illnesses as they are to physical illnesses. Of course mental illnesses might introduce some additional complications: it’s incredibly difficult to determine whether a mental illness will respond to treatment or whether someone will later recover. Many people who attempt suicide say that afterwards they are happy they failed, but there are also many people who make multiple attempts at suicide. We simply don’t know as much about mental illness as we do about physical illness, and so it might require more regulations and documentation of the long lasting nature of a problem before assisted suicide becomes a legitimate choice.

But the nitty gritty of what it means to practically put into place laws and regulations that ensure those who seek out assisted suicide are not taken advantage of or manipulated, are offered all available treatments, and are not pressured into any decisions are separate from the question of whether people have the right to die as they so choose.

It is inhumane to force someone to continue on in a situation that causes them unbearable pain. That is true even if the unbearable pain is an unremitting mental illness. The automatic way that people discount mental illness from the conversation when talking about the right to die seems to be another circumstance in which the severity of mental illnesses is downplayed, another case of “it’s all in your head” or “if you just try hard enough you’ll get better.” There is no recognition that sometimes treatments don’t work, just as they don’t for physical illnesses. The question of how much pain is too much pain is just as relevant for mental illnesses as it is for physical ones.