Suicide And The Right To Die

In Florida last week, after a flurry of legal activity and media coverage, Terri Schiavo finally breathed her last. In Dublin, coincidentally or otherwise, the news emerged that an Irishman in his 30s had travelled to Zurich, late in 2004, to undertake an assisted suicide under the guidance of the Dignitas organisation.

And then, as the weekend rolled around, the ageing pontiff, Pope John Paul II, shuffled quietly off this mortal coil. He hadn’t been well for a long time – and yet his death came rather quickly in the end. It was interesting that no one asked if there was more that might have been done to keep him alive.
Death has been in the news. This is no bad thing. Far too little thought is given to issues relating to death, and the role that medicine and religion have played in defining and controlling discussion of these. Far too little thought has been given to whether or not the purpose of medicine is to keep people alive, irrespective of what they either want – or would want if they were sentient enough to have a view either way. And if there has been too little thought, there has been even less debate.
And no wonder. To a large extent, the right to die has been a taboo subject, certainly in Irish society. Suicide is depicted always as a tragedy, and one that might have, could have and probably should have been avoided. But, of course, this is not always the case. There are people for whom life is intolerable. They make a decision to bring an end to it, and they do it successfully. There is almost inevitably an element of tragedy inherent in this, but that doesn’t render the decision to commit suicide either morally wrong or unjustifiable.
Suicide is often depicted as a cowardly action – but this is merely a reflection of the dominant Christian-based ideology, which sees life as a ‘gift’ from God and therefore a decision to end it as outside the competence of the individual concerned. In truth, while every suicide is different, and there is no possibility of generalising about it with any degree of accuracy, it does in fact make as much sense to see the act as a courageous one, in which people take the ultimate responsibility for themselves and for their own lives.
I say this, having been close to a number of suicides. The effect can be devastating on those who are in the position of having known people intimately, who commit suicide. Especially where there is no specific prior warning, it is a terrible experience, being left to bury the dead – but that is not sufficient reason to suggest that any particular suicide is wrong, or that it is not the right choice for the individual concerned to have made.
There are complexities here, and it would be blind or stupid to imagine otherwise. Clearly, to take an obvious example, there is an enormous difference between a teenage suicide and one carried out by a mature adult. The younger the person, the greater the extent to which we are likely to feel that the decision was impulsive, uninformed and, finally, heart-breakingly wrong. There is immense scope for repairing the hurt, loneliness or alienation felt by a boy or girl at 16, 18 or 20. It is important, no it is essential, that this is the message conveyed to teenagers at all times, and in the best and most convincing way possible, by parents, teachers and society in general.
When it does happen, there is a feeling, which is impossible to escape that it might have been otherwise, if only we – or someone, anyone – had intervened at the right time and in the right way. Where a teenager is concerned, parents in particular, and brothers and sisters too, are inevitably left with that ghost, and have to live with it. It can be desperately, tragically hard and it destroys some people – understandably so.
Even knowing this, it is my belief that we have to see suicide as a right, and if it is exercised to respect that, absolutely. Maybe if we did so, it would be easier for those who are left to keep on keeping on after their child or loved one or friend has gone, to come to terms with the grief and the sense of having been abandoned.
Things become more complicated where the medical profession is involved – and especially where an intervention has been made that is keeping an individual alive and may do so indefinitely. In that sense, the Terri Schiavo case was genuinely a difficult one, especially given that her husband and her parents took opposing positions on whether or not the tubes through which she was being fed should be removed.
There is nothing that suggests to me that keeping Terri Schiavo alive, given her medical condition and the absence of any remotely realistic possibility of recovery, would have been more caring or compassionate than making the decision to bring her life to an end: or to put it differently, if ever I am in a condition like that of Terri Schiavo, where the brain has been damaged catastrophically and the possibility of recovery has been assessed as minimal-to-none, I want the plug to be pulled, without ceremony. There it is now, on the record so that there can be no confusion or doubt.
The initial medical intervention in the Terri Schiavo case was made in good faith on the basis that there was a hope of recovery. This happens all the time in medicine. But that act of faith and optimism should not transform itself into a sentence to life of an entirely meaningless kind for the patient, simply because a tube was inserted or a ventilator attached in the first place. Asked now, how many people would want to be kept alive in a vegetative state for 10 or 15 – or even 5 – years? Almost no one would really want this for themselves or wish the effects of it on their family. Yet this is what happens.
A doctor from Beaumont Hospital, quoted in a recent newspaper report, made the point simply but persuasively that prolonging the life of a patient was often not for the best. “Just because we can do something doesn’t mean that we should,” he said.
In a similar spirit, I believe that it is entirely appropriate that any individual who is suffering from an ailment that disables them from administering a lethal dose for themselves should – if they so wish – be entitled to elect to have an assisted suicide. There was a very moving article in the Irish Times at the weekend, by Win Crew, in which she told the story of her husband Reg, who had been suffering from Motor Neuron disease. She described the reasons for his decision – like the one made by the disabled Irishman whose story hit the news last week – to use the services of the Swiss organisation Dignitas to end his life, and why she felt it was her duty to him to cooperate. Win Crew’s perspective was an eminently sensible, loving and dignified one – and she is now committed to advancing the case for Voluntary Euthenasia in Britain.
I know that it is a hugely emotive issue, but it is good that, at last, it is being discussed, here and in the UK, in a serious, rational and relatively un-sensationalist way. In Britain, a bill is before the House of Lords, which would provide for Assisted Dying, under certain conditions. This is a huge step forward. It will be interesting to see what the tenor of the debate surrounding the bill is, as a gauge of the progress we have made in relation to understanding what is at stake – rather than merely clinging desperately to absolutist moral positions in a world that has moved on hugely in medical and technological terms.
The point is that this an issue with which almost all of us are likely to have to deal, at some time in our lives. Medicine is now capable of artificially keeping people alive long past any curative purpose. It is a form of craziness that goes on routinely in Irish hospitals and old people’s homes, and which is born of an often unconscious, and unthinking zealotry. One senior, concerned nurse recently advised a friend that if his father, already suffering from dementia, got pneumonia, he should resist any efforts to insert a feeding tube. “If they insert a tube,” he was told, “it might be there for ten years or more” – during which time the man would exist only in the realm of the ancient, but still living, dead.
It’s an issue with which we can be faced at any stage of our lives, as a result of illness or an accident, to someone close to us. The dominant Catholic ethos of medicine in Ireland means that often the decisions are made on presumed moral or ‘ethical’ grounds that are woefully misplaced and inappropriate. It is about time that the issue was debated openly – and that those who want the right to die are finally given a voice.