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.

Suicide Rates Up: Why?

Over at Mint Press News, there’s a story up about the increase in suicides over the last decade or so. The statistics are pretty grim: in some demographics suicide has risen by as much as 30% from 1999 to 2010. The article goes into a further breakdown of who is committing suicide and posits that the economic downturn could be related: when people are feeling depressed, they just can’t handle the economic stress of being unemployed or underemployed.

As a theory, this makes a great deal of sense, and probably is contributing to the rise in suicides, but as with any trend, this is likely a great deal more complicated than a simple cause and effect between economics and mental health trends. The article does mention that public access to mental health services has gone down in recent years, but does not go into a great deal of depth about that.

First and foremost, we are severely lacking in adequate mental health care in the United States, and attitudes towards mental illness are suspicious at best. While in the past there has not been a great deal of support for mental healthcare access, or even much by way of understanding of mental illness, today it is highly stigmatized and viewed as a sign of someone who is dangerous or unstable. In the past, suicide was often not considered an option: religious beliefs told many individuals that they would not go to heaven if they committed suicide, or that it was selfish and proud to commit suicide. In essence, suicide was considered one of the worst sins because it was considered playing God with your own life. While the negative attitudes towards suicide are still prevalent, many of these religious beliefs have lost some of their hold. So while we still are lacking in mental healthcare, we no longer have the attitude that suicide is never the answer.

Another large difference between modern health and health in the past is that we are living longer: our physical health gets a great deal of attention throughout our lives, but at no time is our mental health given the same consideration. While in the past, if someone tended towards depression they may have had to stay strong for a shorter period of time, longer lives may make it harder to fight off suicidal feelings. When staying alive past infancy is a struggle, and when you’re likely to lose your life to any number of diseases or violent actions, the idea of taking your own life becomes less pressing.

In addition, quality of life when we age is not ideal: suicide among the elderly has also gone up, and mental health problems for those who are elderly and losing their ability to live their lives as they desire are common. Depression can’t be treated in the same ways among the elderly (a recent study suggested that while exercise is often helpful for depression, it is ineffective for those in long-term care situations), and assisted suicide is also on the rise. The boomers have been committing suicide at extremely high rates, and their attitudes towards suicide are far more lax than other demographics.

I have personally heard friends say before that they would rather commit suicide than live past 70. The attitude that life in and of itself is something we should be grateful for has started to subside and we as human beings have begun to demand more: fulfillment, health, and satisfaction. We absolutely cannot ignore the fact that many of these rises in suicide rates are happening in first world countries where our lives are lasting longer, but the quality is not necessarily improving.

In addition, there are a myriad of other potential factors in an increase in suicide rates. One that may not often come up is that particularly in America, nearly everyone operates on a sleep deficit. Lack of sleep can severely impact mental health and quality of life, however almost no one looks at it as related to mental health statistics. Access to firearms, dangerous chemicals, or other methods of suicide could be related (we know that men, who use firearms more often than women, are statistically far more likely to have successful suicide attempts). We also see that bullying has been linked to suicide in young people recently, particularly with the advent of online bullying, which allows bullies to infiltrate every aspect of their victims’ lives.

So while economics probably does play a large role in the uptick in suicide, I would hesitate to point to a cause/effect relationship between the two, because mental health is a hugely complex issue with a wide variety of factors playing a role. These are just a few potential elements that could be contributing, but I believe that we should explore as many of them as possible to help improve the lives of those who might be in danger of suicide.