Choosing Death: Philosophical Observations on Suicide and Euthanasia

The Significance of Suicide

We clearly attach a different significance, morally, emotionally, and philosophically, to suicide than to murder. But what is that special significance? As Fairbairn has shown (see his article in this issue; also Fairbairn 1995), terms like suicide and euthanasia cover a number of morally and practically different situations. What we usually have in mind when we talk about suicide, though, is direct and more or less deliberate action to take one’s own life by, for example, overdosing, putting one’s head in the gas oven, jumping from a high building, etc. And if we ask how, apart from the obvious way, that differs from taking someone else’s life, the answer seems clear. To choose to kill oneself, even to attempt to do so, is to deny that life has a value which ought always to be preferred to death; to choose to kill someone else is quite compatible with, indeed normally implies, giving a high value to life. If one kills someone else maliciously (not, for example, as an act of mercy, which could be regarded as a form of proxy suicide), then one’s motive is precisely to deprive the other person of that supreme good. There is a kind of contradiction about killing oneself maliciously in that sense.

But if that denial of life’s value is what is significant about suicide, then it is something which suicide shares with other choices which we might make. For instance, those who choose euthanasia, whether active or passive, necessarily have the same view: they regard ending it all as preferable to going on living in their present condition. So too, though in a less obvious way, do those who choose to neglect themselves in ways which they know will result in their death, if continued, like those who refuse to eat or drink (for whatever reason), with the full knowledge that prolonged starvation and dehydration will kill them. Much more doubtful is the case of those who accept potentially fatal risks, who may well be motivated precisely by a love of life, which they regard as not worth having without this spice. Sometimes, however, people may accept such a risk precisely because they hope to die, and then their choice reflects the same preferences as the suicide.

It is just for this reason that suicide and its relatives are of particular interest both to the psychiatrist and the philosopher. People choose in some sense to commit suicide or to refuse life-sustaining treatment, but psychiatrists may be called on to decide whether such choices are always and necessarily the outcome of clinical depression (or another mental disorder), or whether they can in some cases at least be rational. In the latter case, how we can decide which choices are of which kind? And whether it can ever be rational to prefer death to continued life is also a profound philosophical question, touching on the very meaning of human life itself. As Albert Camus has said, “There is but one truly serious philosophical problem and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy” (11).

Can Suicide Be Rational?

There is a natural tendency to think that someone could choose to take her own life only if, in the words of the coroner’s verdict, “the balance of her mind was disturbed.” As Burgess and Hawton note in this issue, this attitude on suicide has been widely influential in medical thinking. The will to live seems to be biologically programmed into human beings, as into other animals, so that frustrating that will seems to require a pathological perversion of human nature. This, indeed, is one reason why such Christian philosophers as St. Thomas Aquinas have condemned suicide, on the grounds that it is contrary to the inclination of nature, and so to natural law (Beauchamp and Perlin 1978, 103). But what we naturally wish to do is not always what is rational, or in our best interests, to do: it is natural, for example, for...