My view of assisted suicide is kind of mixed (against it but in certain circumstances…), but I do think it would be better if we as a society weren’t looking to help end people’s lives but to help them manage their pain and suffering and improve their lives if at all possible. I think we need to greatly improve mental health care for sure, whether it be treatment, helping the mentally ill manage their lives, or look for cures.
Yes, his death would have caused grief / bereavement anyway, so we’re talking about the additional pain for others of the specific mechanism of his death.
I don’t agree that that is necessarily greater than the years of suffering he clearly anticipated coming his way. Let’s put it this way: anyone that really cared about him would not want him to experience misery just to selfishly have him around.
Now, you may argue that another possible scenario is he gets treatment and has a wonderful month/year/rest of life. Sure. But of course he had been through many treatments over many years. Clearly those treatments were not effective for him.
No, it doesn’t. EvidenceWithoutFaith is right to call that out as a non sequitur.
All I’ve said is that beyond a certain amount of pain, and with the probability of improvement below a certain level, suicide is understandable, and not necessarily irrational.
And no-one’s disputed that
The closest anyone’s come to disagreeing, is suggesting that mental pain is different from physical pain, with the implication being that the latter is worse and/or less manageable.
I’ve already mentioned why I don’t think this is necessarily true, but I don’t want to dig further into that until someone actually comes out and states that’s their position.
That presupposes two things:
That any misery would be continual and completely unrelieved with no more good days ever, which is possible but not universal in depression, and certainly not proven in this case.
And secondly, that the amount of suffering can be objectively quantified and that somehow the collective misery experienced by him killing himself could be totaled up and measured against his personal misery - which simply isn’t possible to do.
That’s like saying we should’t bother treating a diabetic because we can’t permanently fix the diabetes and there will be times when his blood sugar gets too high.
Depression can be a chronic disease. That means life long treatment. That doesn’t mean there is no point to treatment. I have relatives who have struggled with depression who lived out natural lifespans and did not die of their mental disorder. Death is not an inevitable outcome of depression and should not be treated as such.
I’m not presupposing that. I’m supposing that the net result of living on may have been misery for him. IOW accepting his decision.
By analogy to the torture example, maybe occasionally the prisoner has wonderful dreams or whatever. Doesn’t make his situation suddenly worth living.
No, not presupposing that either.
You can speculate that perhaps X is bigger than Y while at the same time conceding that there is no practical way to measure X or Y. And note of course that by analogy you are saying Y is bigger than X; speculating that perhaps his suicide brought more pain into the world that it took out. Why is it OK to argue it one way but not the other?
A better analogy would be someone who’s tried various diabetes medicines and still has no confidence his blood sugar will come down.
Never said this and don’t think it.
What are your ethics then? No one who has argued against euthanasia in this case has given a straightforward answer to this. Is it wrong to end someone’s life who would have suffered more than they felt happiness if they had continued to live, and who wills it so?
Do not dismiss the question on the grounds that we cannot know if these assumptions are true. It is a hypothetical question posed in order to see what your ethics are. Everything is assumed. If you can’t answer a simple hypothetical with all variables known, then you couldn’t possibly hope to have an answer either way when there are countless variables to consider; Many of them unknown.
First of all, I am NOT against euthanasia in every potential case. I just truly feel it is a last resort.
For “ethical” euthanasia, I would require the following:
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There be a non-fixable problem (terminal illness, non-survivable situation, untreatable disease/condition that causes extreme suffering, and so forth)
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Every possible treatment, rehabilitation, and mitigation has been attempted.
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The subject of the euthanasia is willing and consenting.
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The subject is competent to make decisions regarding their own welfare.
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If the subject is not competent then the deciding party much have zero conflicts of interest (no possibility of inheritance of large sums, for example)
This does mean a LOT of depressed/suicidal people will NOT qualify for years, likely not ever.
Basically, I very, very much err on the side of life. I also was the strongest possible safeguards that no one will be pressured or railroaded into ending their lives for the benefit of someone else.
But this is the reason why the criteria you’ve given, though on the face of it useful, doesn’t actually get us anywhere.
Every suicidal person is going to think all those criteria are met.
Now on criteria 4: that the person is of sound mind, the popular meme in western culture right now is that if you are in great physical pain that’s a rational reason to want to go. But any other reason is irrational.
So, great, we can just assume many people are being irrational without needing to look at things case by case. Convenient for us, but I don’t think true in reality.
Because while no doubt some suicidal people who get treatment then realize they almost made a huge mistake and life’s great now yadda yadda, others will remain quite sure of their decision and just try again at a later date.
In my own case, I don’t want to commit suicide at this time, but nor do I see my attempt (5 years ago) as a mistake. I can, and have, talked it through with anyone supportive enough to listen, and not heard any compelling argument for why I was wrong to consider this action.
I did specify “in this case”. It’s not that important for the discussion, but your use of caps urged my correction 
Depression is definitely a non-fixable, albeit sometimes treatable with varying efficacy, disease that can cause extreme suffering. So it qualifies under this condition in certain cases.
This is a catch-all for any type of euthanasia; Much less depression. You are limiting it to empirically tested treatments correct? For medications you have SSRIs, SNRIs, TCAs, MAOIs, Wellbutrin, Remeron, Desyrel, and possibly more. I’m open to the idea of forcing the patient to try several high efficacy medications, but you want them to try every single one? I did a search on different depression medications in the U.S. and came to this list of what I counted to be about 50 different medications, and some of them can take months to get the full effect
I don’t know what you mean by every type of rehabilitation and mitigation, but it sounds very vague. You could always come up with some idea for a person in severe pain to try instead of letting them end it. Could you be more specific? I don’t see any euthanasia policies that could adhere to such a standard.
Of course. Even if I knew the person would suffer less if they were dead; I would never advocate overriding their individual will. Not everyone is a utilitarian, and I respect that. I don’t respect some kind of potential will they might have if they weren’t sick or unable to consent. It isn’t the reality of the situation.
What is unfortunate though, is that the people in the most amount of pain are the least likely to be competent enough to make a rational decision. Furthermore, if the 4th and 3rd criteria are met, then why have a need for any other criteria? The subject is competent enough to make a rational decision to end their lives. Why impose your ethics onto them? Do your ethics call for overriding their ethics regarding their own lives? I would only try to impose my ethics on other people if they weren’t in a position to be able to communicate and enforce their own.
That takes away a lot of close family being able to decide for their relatives since they would be most likely mentioned in the will. Either way, since competency isn’t an issue as long as they have a non-interested party, then it’s not relevant whether depressed individuals are competent as long as someone impartial vouches for them.
It’s likely no one would qualify under your conditions.
You never gave a direct answer to my question, but judging from your conditions I’m going to surmise your ethics are something like this:
It’s much, much worse to end someone’s life who would have felt more joy than suffering than to force someone who will feel more suffering than joy to continue living.
That would explain the need for the extremely rigorous conditions that would need to be met for euthanasia to take place. Maybe I’m strawmanning, but if you’re not going to answer I’m gonna take a stab at it.
I really want to say that if anyone out there is reading this and considering suicide; Don’t make any rash decisions just because you may have read some arguments endorsing it in some cases. I’m only making arguments for extreme examples; The kind of people who already know they’re done with this life and aren’t interested in what anyone has to say about it. If you’re hesitant about the idea and trying to find reasons to do it; It’s probably that you don’t really want to do it. It’s definitely not a decision to make alone and something you should be talking to people you trust about.
National Suicide Prevention Lifeline: 1-800-273-8255
Ok, end of PSA.
Thanks for sharing your experience. If you don’t mind my asking…I’m not quite sure I understand what you mean when you say you don’t see it as a mistake. Can you elaborate on that a little? You say you do not seek that path now, which would suggest that there’s something about your life that you find makes it worth living. While not faulting the decision-making process of “5-Years-Ago-Mijin,” are you glad that s/he did not complete the attempt?
In the “this case”, by which I presume you mean Robin Williams, there is no way any member of the public has enough information to judge whether or not his suicide was “justified”.
Now, if a close member of the family states for the record “we tried everything but nothing worked and we’re content that he’s at peace now” I’d accept that but they haven’t. I anticipate they won’t.
In certain cases. I happen to think those cases are extremely rare. Obviously, other people have a different opinion.
No. I am fine with clinical trials, testing of new treatment protocols, and don’t limit it to just pharmaceuticals.
Appropriate medications for their particular condition. Depression treatment should not be one size fits all. Different patients exhibit different symptoms. One might have a great deal of anxiety and another none at all, for example. That would certainly effect treatment. If one SSRI is completely ineffective that may be sufficient to discard the rest. I’m not a psychiatrist, so I’m happy to let actual doctors make treatment decisions rather than attempt to draw up plans myself.
And, yes, I do expect trying multiple approaches that will, indeed, take years to cycle through. Why should we give up quickly when a human life is at stake?
So much these days comes down to just drugging people. While that will work for some “talk therapy” counseling also helps, as does behavior modification (Mr. Williams is on record stating that bicycling brought him relief - one of the things apparently dreaded about Parkinson’s is that at some point he would no longer be able to ride a bike, cutting him off from an activity that actually helped his mental as well as physical state).
Electro-convulsive therapy is definitely not something to rush into, but modern applications are less damaging than the early ones. I personally know three people who have undergone ECT. While it didn’t completely cure any of them it did permanently moderate their level of depression. It did not seem to affect their mental capability - indeed, after one of them underwent the treatment she was finally able to get back into college and eventually an accelerated doctorate-level course which she graduated from with highest honors. She went from being a nearly permanent inpatient to a fully functioning human being due to a multi-modal approach. Of course, it didn’t happen overnight - it took a few years. But while she still has issues she has never again sunk to such levels. Without ECT yes, she almost certainly would have killed herself and missed out on some very good years. I consider that a win, don’t you?
Mind you, I’d never suggest it as a first line of treatment, not even for the suicidal - there are serious risks. Then again, we impose risky treatments for other diseases all the time, why should depression be an exception when it’s life-threatening?
I think it’s important to determine if there really is a desire to no longer exist, or if it’s a matter of escaping pain. If removing pain also removes the desire to die then the problem isn’t an unbearable life, it’s unbearable pain. Remove the pain and the person wants to live again. That’s why I advocate trying to relieve the pain.
Now, if someone’s pain is relieved and they, for some reason, can’t bear the treatment side effects or something and they still want to die that’s another matter. However, that determination can only be made after a considerable time period.
Yes, that is a problem, and for physical illness as well as mental.
We faced this issue with my mom in her final months. She kept stating she wanted to go home to die. Well, you had a seriously debilitated woman with early dementia and a long history of depression (granted, the only suicide attempt I am aware of on her part occurred 40+ years before her death - after which she finally got treatment and things got a lot better with no recurrence of that level of depression). What the hell do you do?
Fortunately, mom had many years ago set up the legal framework for dad to act on her behalf. Dad checked in with the rest of us, and the doctors, and decided that in this case taking her home and making her comfortable was the proper course of action. It was a difficult decision, but aided because when she had been in a much better physical and mental state she had clearly made her wishes known. For a couple decades. Mom was a little obsessive sometimes about future planning.
When a depressed person is highly functional (most of them do go through such periods) if they made provisions for the possibility of not being competent sometime in the future this would make such decisions a hell of a lot easier, don’t you think? But almost no one does that when they’re young and healthy.
Here’s an example of where I think it would be in error to euthanize a competent person:
Said person is in a Tragic Accident and their spinal cord is severed, leaving them permanently paralyzed. It is common for people to want to kill themselves shortly after such an accident, so common it is considered normal and someone not expressing such a wish might actually be of more concern than someone who does. But we don’t kill them and normally don’t withdraw life-saving treatment absent a clear advance directive to do so. Why? Because the vast majority of such people accommodate their disability after rehab and actively want to live again. Even when severely impaired, such as being dependent on a respirator to breathe.
So - yes, said person might be mentally competent and wish to die, but it would be unethical to kill them prior to rehab because we know that usually they’ll feel very differently after those few months.
So - someone attempts suicide and winds up in the ER. Clearly they have a death wish, right? But until they undergo treatment no, it would be unethical not to try to revive them and/or restrain them from hurting themselves. Unless maybe it’s known they really have tried every available treatment and it’s their 50th attempt. That would, again, be an extremely rare exception.
If a close relative/person mentioned in the will is appointed the person with power of medical decisions by the patient, or if there is none such and it would normally fall to a relative, have a third party involved (probable court-appointed) to double-check the decision making. There’s precedent when it’s a matter of physical illness. I think this is a solvable problem, I just want a strong safeguard against relatives killing relatives for fun and profit.
Competency is not quite as binary as the law seems to imply. I think there’s a spectrum involved. People don’t (normally) go to bed completely competent and wake up a drooling vegetable, after all.
Even people like my mother, who had a dementia diagnosis, or my nephew who is, regrettably, brain-damaged due to an accident may be consulted about their wishes and desires even if they are not legally fully competent to manage their own affairs. Judging the level of competency in a depressed individual would, I think, be important in making such decisions. My post is long enough, though, so if you want me to expand on that it will have to be later.
Very few. Probably after a decade or two of treatment attempts across the full range of what’s currently available.
Please do NOT attempt to “explain” my thinking or put words in my mouth.
I’m sorry if my answer isn’t simple enough for you. I don’t think killing a human being should be a simply matter. I value life a great deal, as should be apparent.
I would impose similar conditions for euthanasia for physical conditions as well.
No, I don’t much like the concept of euthanasia. At best it would be the lesser of two evils. I think there is far, far too much room for abuse of it, although I am pleased that where such things as assisted suicide are legal it seems to be rare and, as noted upthread, many people elect not to use it after all, they’re just comforted by having an “out” available. Which is fine. I can live with that. I don’t expect the world to be perfect.
You’ve sort of answered your own question in that I haven’t found anything that makes life worth living, and everything’s continued as before (despite making a number of big changes to try to turn my life around).
The only difference now is, I have no feeling of urgency to immediately end things.
Thanks. I think I would find that terribly frustrating. Correct me if I’m misreading, but it sounds like you do as well.
What’s different between then and now? What defines the “urgency” for you?
No, by “in this case” I mean euthanasia applying to the case of depression.
Yes, all those thing you mention are empirically testable methods.
Of course treatment options are best left up to a psychiatrist. It’s more the question of are the amount of options between a patient and euthanasia so great that euthanasia isn’t realistically ever going to happen in the case of depression?
Years I could get behind. Decades; not so much. Might as well not even consider it an option. Something needed that rarely wouldn’t even be provided for. We tend to put our support where the demand is.
Yup, all that sounds fine.
I do consider that a win, and maybe that would be another step between euthanasia and the patient. It’s known as a last resort option for depression, but it does seem to have special efficacy in certain cases. Maybe it would be the last resort treatment before the real last resort option.
I agree that should be a priority at first, but if it’s apparent that nothing is working then think of all the needless pain they’ve gone through. It is a case of the lesser of two evils, but the more pain they go through; The more suicide would have been a lesser evil.
I’m genuinely sorry for your loss, and I’m not able to comment on it further than that.
Yes, planning for your own body and mind breaking down is not only very important, but very hard for some people to do. It makes me want to write somewhere that if I go into some vegetable state; Jut pull the fucking plug. That’s just me, though. I’m sure other people would have different things to write.
Yes, but your example isn’t anything like what I’m advocating. People who have extraordinary hardships feel extremely depressed, and aren’t able to handle their new limitations. After a while; Their emotions rebound as a defense mechanism, and they start to look at things positively. They also start adapting to their new life. Depression affects the very ability to rebound in this way. It’s like a continuous state of when your example felt like they wanted to kill themselves. It’s just not comparable. It’s not that I like the idea of euthanasia. It’s that depression can be so terrible.
I agree. It’s another variable in the equation that needs to be accounted for.
I don’t think people set on killing themselves are going to wait that long.
I wasn’t trying to put words in your mouth. Sorry, I know it came off as rude, but it’s really relevant to the conversation. I should have posed it in the form a question. If you can’t explain your ethics in a broad sense; I don’t see how you could hope to have a firm grasp of them, or how to apply them in a specific way. Do you lean towards utilitarianism?
I don’t disagree with any of this except for the abuse part. I see it as a system that would have a relatively small amount of abuse compared to other current systems. I don’t see how it could be abused to a great extent.
I think people have a right to suicide, and it doesn’t need to be qualified.
For some, treatment (mental or physical), failed suicide attempts, family interference, etc, are only prolonging the torture. It’s cruel. Let those people who want to die, die, for whatever reason. Mijin’s made his own case for this.
If it’s a non-terminal situation they’re facing, like paralysis or mental illness, maybe require a one year waiting period. Then let them go.
I believe Robin Williams knew what he was doing when he committed suicide, and I respect his decision. I also know Robin Williams tried to slit his wrists, and when he couldn’t accomplish that, hung himself, which is a terrible (if quick, due to blackout) way to die. Undignified.
He should have had a less traumatic and humiliating option available to him, and perhaps a celebration of his life beforehand, as the OP mentions.
The treatment for my friend, referenced above, took about 15 years.
Treatment takes TIME, folks. Lot of it. That’s why I laugh when someone goes into rehab for a mere 30 or 60 days. It’s a joke. That’s not a cure, that’s just a start. Most mental illness takes a couple of years to adequately treat and I’m not talking about just depression. People grossly underestimate what’s required.
By the way - hers is a case that if ECT had NOT helped, if she had been in the same state as before that treatment, I would have said would be a candidate for allowing her to die. I don’t feel it would be appropriate to give further details about someone else’s illness but that was a level of suffering that amounted to unrelieved torture - which might be why ECT was authorized in her case.
Fortunately for all concerned, it was possible to help her significantly.
I believe he knew what he was doing but saying you “respect” his decision sounds like you approve of his decision and you can not possibly have all the information to pass judgement on what he did.
I neither respect nor disrespect it. That’s because I know I’m not privy to what would be required to pass judgement here.
I respect anyone’s decision to choose suicide over continued treatment. Why would I exclude Robin Williams from that?
Because sometimes people make dumbass decisions. Like choosing homeopathic woo-woo over actual medical therapy when diagnosed with cancer. Just an example. I don’t have enough information to judge whether or not that was the case here. Neither do you.
That sparks an interesting question; Do you believe people should have the right to choose homeopathic remedies instead of empirically tested ones? The results of their decision are effectively the same as the euthanasia options. Would you physically force them to take the empirically tested treatments against their will?
Assuming an adult person of sound mind who is fully informed of the available choices… yes, you have a right to refuse medical treatment in many/most circumstances. Even if that means your death.
(In the case of mental illness “are you of sound enough mind to make such a decision?” is a valid question given that your decision making organ is the one malfunctioning.)
I’ll still think you’re a dumbass for making certain choices, but I’ll defend your right to be a dumbass.