Suicide Prohibition: The Shame of Medicine

Introduction

1 Introduction 1 Birth and death are biological events, the consequences of antecedent actions or occurrences. In the animal world, both events are pure happenings, outside the scope of the organism’s understanding or influence. The development of human consciousness and intelligence creates conditions that enable humans to bring these events under their partial or even complete control, depending on their understanding of the biological processes involved, their moral-religious attitudes toward exercising such controls, and their willingness or unwillingness to assume personal responsibility for doing so. Birth control is a familiar term and common practice, prohibited or permitted, discouraged or encouraged, by governments, depending on their religious beliefs and economic-ideological interests. Death control is analogous to birth control. Nevertheless , the term is unfamiliar. If implemented by the government— in war or execution for crime—the practice is considered a matter of morality, law, and politics, not medicine. If implemented by the individual on himself—in suicide—the practice, as I showed in the preface, is widely regarded as a matter of medicine, a mental illness treated by deprivation of liberty and coerced drugging.1 Moreover, as I note later, in the United States judicial killing (execution by injection) is medicalized, and in National Socialist 2 • Suicide Prohibition Germany, so was practically all state-sponsored murder, including the Holocaust. Let us not forget Robert Servatius’s defense of his client Adolf Eichmann in his trial in Jerusalem: “It [killing by gas] was indeed a medical matter, since it was prepared by physicians; it was a matter of killing, and killing, too, is a medical matter.”2 The medicalization of judicial killing may be said to have begun with the guillotine, making execution ostensibly painless. It led to execution by a kind of debauched general anesthesia, first by the inhalation of a lethal gas, then by the intravenous injection of lethal drugs. Self-killing proved to be even better suited for medicalization. After the Second World War, medical control of the suicidal person—called “suicide prevention”—became an important part of the profession of psychiatry. The formal medicalization of physician-permitted or physician-provided voluntary death—called “physician-assisted suicide”—soon followed. Typically, PAS is simply the semilegal bootlegging of barbiturates by doctors. Medical ethicists and civil libertarians view it as progress in patient autonomy. I see it as just the opposite.3 Death is an unavoidable event: its occurrence is not in our hands, but its timing may be, if we so choose. Because we approve of birth control, we do not reflexively attribute mental illness to its practitioner, do not impugn his competence to engage in the practice , and do not engage in “contraception prevention” to protect him from harming himself. In contrast, we disapprove of suicide, reflexively attribute mental illness to its practitioner, impugn his competence to engage in the practice, and engage in “suicide prevention ” to protect him from harming himself. Although the deleterious economic and social consequences of irresponsible procreation are demonstrably greater than the deleterious consequences of irresponsible suicide, we treat the opportunity to procreate, but not the opportunity to practice death control, as if it were an inalienable right. We regard the Introduction • 3 coercive regulation of personal birth control as morally odious and legally impermissible. I believe we ought to regard the coercive regulation of personal death control similarly. The Bible writers wisely reminded us that life is a cycle of birth, growth, decline, and death: “To every thing there is a season , and a time to every purpose under the heaven: A time to be born, and a time to die” (Eccles. 3:2). There comes a time when a woman is too old to have a child. If she does not want to end up childless, she must have a baby while she can, perhaps earlier than she might feel ready for the task. Unless we die in a timely fashion, there comes a moment after which we are unable to kill ourselves. If we do not want to die a lingering death after a protracted period of pathetic disability, we must kill ourselves while we can, perhaps earlier than we might feel ready to do so. 2 We are not responsible for being born. But from the moment we acquire the power of self-reflection, we are, increasingly as we age, responsible for how we live and how we die. The option of killing oneself is intrinsic...