Terry Pratchett : Choosing to Die

[Mikey]

Well, it's a loaded question: while depression is indeed a mental disorder, I don't consider someone who is depressed to not be sane. Indeed, I know some psychotics who are quite "sane" in that you could have an intelligent, well-spoken conversation with them and you'd never know they were psychotic - at best, you might guess at some mild form of personality disorder.

However, I get the gist of what you're asking (I also get that you're continuing to refine your question and will probably do so until you can't help but get the answer you want.) Sure; there are several drugs on the market of which suicidal thoughts or urges are side effects, either on their own or in combination (ironically, the most prevalent of these drugs are antidepressants.) I may not be healthy, but my diabetes has nothing to do with my back - take it out of the equation, and I still have excruciating, 24/7 pain. If I had another bad lumbar disc, I don't know what I'd consider. TBF, this is exacerbated by my diabetes insofar as I can't take corticosteroidal spinal injections, which are the preferred treatment for my back condition. All in all, though, one could ignore my diabetic condition and I could still envision a scenario in which I might consider all sorts of things.

Alcoholism can induce suicidal thoughts, as can habitual drug use (depending on the drug) independently of the depression that one can realize from being an addict. And don't forget that a common symptom of depression is an inability to recognize one's own depression for what it is.

To sum up, based on what I think you're trying to get rather than the letter of your question - nope. If there is no palliative medical use for suicide, then the desire for such is itself an indication of a need for psychiatric care - NOT for some trigger-happy Mengele to start killing people whose deaths wouldn't qualify as euthanasia.

[Deepcrush]

Mikey, very well said.

Now with that painful admission out of the way. My thoughts are that I'd rather have a doctor aiding the person rather then having that person gut themselves in their efforts.

[Mikey]

Why? If someone wants to kill themselves without any palliative reasoning, why should a doctor help him? Why not a firefighter or a marketing representative? And why not let them kill themselves on their own - are you afraid that someone might hurt himself in the course of killing himself?

[Deepcrush]

Because a doctor could allow a peaceful death that a normal person alone couldn't provide. It's a matter of someone dying in a calm and safe (safe for others I mean) environment.

A person stressed with no easy way out of a situation will often take drastic actions to reach their goal. Suicide by cop, suicide by firearm, suicide by fire, auto suicide (car) are all high risks to those around them and not just the person wanting to die.

Allowing professional support prevents a great deal of these risks.

IMO.

[Tsukiyumi]

Oddly, I was just thinking that jumping from a tall building certainly presents a major risk to people on the ground. The other ones you listed are just as dangerous (to others).

[Lighthawk]

Have to agree with Deep on this one.

If not a doctor, then who? I suppose you could send them to whatever facility handles the execution of prisoners, assuming the person lives in a state with the death penalty, but that seems kind of callous to me.

[GrahamKennedy]

However, I get the gist of what you're asking (I also get that you're continuing to refine your question and will probably do so until you can't help but get the answer you want.)

In the broad and rather obvious sense that the answer I want is one that reveals what you think about the issue I'm interested in, yes, I'll refine the question until I get the answer I want.

To sum up, based on what I think you're trying to get rather than the letter of your question - nope. If there is no palliative medical use for suicide, then the desire for such is itself an indication of a need for psychiatric care.

Thank you.

I'm not sure if I agree or not, frankly. I had fairly settled thoughts on people ending their life before I hit that statistic, but the idea I always had in mind was the one everyone talks about, of people suffering. And one of the points I mentioned was the one raised a couple of times in the documentary - that for some diseases, you really can't wait until it's actually destroying their quality of life because by then they can't make the decision any more. So you have relatively healthy people killing themselves well before they have to. That, I can also get and accept.

But people killing themselves because they're basically fed up with life... I'd not considered that. I honestly am not at all sure what to make of it. I'm gonna ramble a bit with my thoughts thus far.

On the one hand, as a core idea I tend to think that the state shouldn't restrict people's freedom without compelling reason. Even with mentally unbalanced people the law here is that we can only restrict their freedom if they are a danger to themselves or others. But there's the rub - if you want to commit suicide then you're obviously a danger to yourself by definition.

But the question is, what if you're a danger to yourself but NOT crazy? People do dangerous things all the time - extreme sports and whatnot - but we don't stop them because it's a danger to them. But taking a risk of injury or death isn't really like a certainty of death.

So it seems to me that the deciding issue here is, can a sane person want to kill themselves? (And that was what I intended to ask in the first question by the way, I just mistyped it. hence the 'refined" one.) I genuinely don't know. It seems to me that it's a dangerous path to go down to have the state say to people "If you believe X then you are by definition insane and your rights should be restricted," pretty much no matter what X might be.

There have been two occasions in my life when, if I'd had a glass of poison right there in front of me, I might very well have drank it. I suppose most people have such moments at one time or another. I got over it, and I'm glad I did... but I'm not sure I have the right to tell other people that I think that they will get over it too and therefore they must do as I say. In the end, who owns your life if not you?

I just don't know what to think. I'll have to mull it over more.

I'm very glad I watched the documentary, though.

[Mikey]

I too have been in that same place. I think the telling factor here is as follows, considering that we are discounting for this question the agreed-upon situation of terminal, painful conditions for which assisted suicide is a last palliative resort: in the absence of that condition, the desire to suicide is of itself an indication of a mental issue which could be treated... IF we don't have doctors going ahead and happily killing those subjects before examining treatment for the indicated condition.

This is the crux of the issue I had which GK and Lighthawk didn't understand. If a person goes to a physician to ask for help killing himself, and that person has no condition for which suicide could be construed as euthanasia, then that physician's job and moral obligation is to get that subject psychological treatment. Doing otherwise is a failure to fulfill one's oath and responsibility as a physician.

[Lighthawk]

But if the person doesn't want treatment? Or if they agree to try it but come back looking to die after just one session?

I'm not trying to say that a doctor's first reaction to "I want to kill myself" should be a jolly "Why certainly, drink this!". Some kind of effort should be made towards offering the individual alternate and less permanent solutions. But really, all I've been trying to say is that if a person wants to kill themselves, and there is no law prohibiting it, then who better to go to than a medical doctor?

[Deepcrush]

I don't believe the issue is "should a doctor just let someone off the street walk in and suck poison". To me the issue is that there needs to be an outlet for those who are looking for options. To be fair, I can kill a person any number of ways with any number of objects down to the battery cover on a tv remote. This aside, I don't walk down the street get in a fight and instantly kill the other guy. This is because I was trained with options. I see suicide as being no different. If the "only" response we have is to dope someone up and dismiss them for not viewing life the exact way you want them to then why should they bother with asking for help in the first place.

Options are generally the key. Show them all the options and work with the person to find the best option for THEM. Not for you (not pointing at anyone, just in general reflection), but for the person asking for help. A simple truth is that the "moral high horse" is only of any value to a person trying to make themselvs feel better about their choices and most often ignores or even harms the needs of the person you're pushing it on.

[Mikey]

Yes, yes, I agree with the general point you guys are making - suicide shouldn't be illegal. However, a physician has no place in it outside of euthanasia - for which there is a palliative medical reason. We might as well say that the Ku Klux Klan are the people to go to to learn tolerance and understanding, because they have experience with the other side of the issue.

Is it harder to commit suicide without a doctor's assistance? Yes, probably... tough shit. Lots of things I do every day are harder without the assistance of someone who has no place in assisting me. "Because I want it" is no valid reason for making people do things for me that they have no place doing.

[Deepcrush]

First off, not all doctors are the ones who tap your knee or give you a pill for colds. Trying to remove them from the issue is rather stupid since the person's problem may be something a doctor could fix without killing them.

Next, the KKK rant, I'm not sure what you think they have to do with anything involving mental health or why you bothered bringing them up for anything other then a chance to stomp your feet. The use of medical professionals when talking about the medicial profession is generally important.

[GrahamKennedy]

If we (as a society) agree that healthy sane people should have a right to kill themselves then it really comes down to what's the most acceptable way of doing that.

It's obvious to me that just leaving people to off themselves is the wrong way to go. People just don't know enough about it - hell, one of the commonest methods is to OD on paracetamol, because movies and TV have made us think that you just drop off to sleep. Yet paracetamol overdose actually takes several days of horrific pain to kill you. Many other methods are drawn out and painful, even if they go right, and most are far from certain. Then there's the mess they often leave and the impact on those who have to clear it up - no, just leaving them to it is a silly thing to do.

So the answer pretty much has to be some sort of place people can go to for killing themselves where they can be given some sort of poison. And somebody with medical training pretty much has to be the one to do that. There are medical issues here - advising the user what to expect, determining the dose (one can often evade death from poison by drinking too little or too much), etc.

I can buy that it shouldn't be something for a full medical doctor to do, but for me that's more to do with the thought that a fully qualified doctor probably isn't necessary. Somebody with the same sort of training level as a nurse, perhaps.

[Mikey]

First off, not all doctors are the ones who tap your knee or give you a pill for colds.

Very good. "Stop" signs are red, also. Now, if you have anything useful to add I'd love to hear it.

Trying to remove them from the issue is rather stupid since the person's problem may be something a doctor could fix without killing them.

Exactly what I've been saying all along, thank you. Since we're now discussing a situation of suicide, rather than euthanasia, the doctor's job is to fix the issue or obtain help from the proper specialist - NOT kill someone.

Next, the KKK rant, I'm not sure what you think they have to do with anything involving mental health or why you bothered bringing them up for anything other then a chance to stomp your feet.

Yes, yes, tough guy. Now try reading the analogy I made instead of skim three words, and we can talk about it.

The use of medical professionals when talking about the medicial profession is generally important.

Rather it would be, if that had anything to do with the point. What we're talking about is in fact physicians assisting suicide outside of euthanasia - that is, outside of situations in which suicide would be a viable (if extreme) palliative option.

In general, Deep, skimming three buzzwords from someone's post and then shouting about them - without bothering to understand the actual post - doesn't make you look like you're winning an argument. Just a bit of a tip for you. If you have trouble with the big words, just ask.

It's obvious to me that just leaving people to off themselves is the wrong way to go.

How so? If we're talking about the hypothetical sane person you mention, why is that the wrong way to go? If someone wants to kill themselves and then takes steps to do so, then they should obviously have to deal with the issues that stem therefrom. If it's painful, if it doesn't work because the subject does it wrong, etc.... tough shit. If you don't want to deal with the things that might come from an attempted suicide, then don't attempt it; conversely, if you're going to attempt it then you have to deal with everything that goes along with the attempt. My back is sore from fixing my fence but society didn't send any help, not should it have; so why should they send help if I decided to kill myself to make sure there wasn't any pain involved?

[Deepcrush]

So you throw a fit, get called on it and then throw another? Good job, be proud, I'm sure we'll take you so much more seriously now.