Suicide

Suicide or self-destruction means in ordinary language “the act of killing oneself deliberately” (intentionally or on purpose). Indeed, that’s what we read in the Oxford dictionary and the Oxford dictionary of philosophy , which seems to be confirmed by the etymology of the term “suicide”, a term introduced around mid-17th century deduced from the modern Latin suicidium, ‘act of suicide’. Traditionally, suicide was regarded as immoral, irreligious and illegal in Western culture. However, during the 17th century this Christian view started (...) to change as a consequence of the rise of modern science . Generally speaking, Spinoza does not write much on death. His name does even not occur in the Oxford Philosophy of Death, although he had had very particular ideas on the nature of death. However, he even had much more particular ideas on suicide. Moreover, he states in the fourth proposition of the third part of his masterpiece, the Ethics, that self-destruction is simply impossible: Nulla res, nisi à causâ externâ, potest destrui. (shrink)

لا شك أن حقيقة موتنا هي أهم حقيقة عنا، على حد تعبير الفيلسوف الأمريكي «تود جيفورد ماي»؛ قد يكون الموت مأساويًا وتعسفيًا ولا معنى له للوهلة الأولى، لكنه في الوقت ذاته يفتح أمامنا الحياة الكاملة التي لم تكن لتوجد بدونه! فكيف يمكن أن نعيش في مواجهة النفي التام؟ كيف يجب أن نفكر في الموت؟ وهل يجب على الأطباء، الذين يُتهمون أحيانًا بأنهم دجالون يبيعون وهم الخلود، أن ينتبهوا أكثر لفلسفة الموت؟.

My project examines the pedagogical approach of the Stoic Epictetus by focusing on seven vital lessons he imparts. This study will deepen our understanding of his vocation as a Stoic educator striving to free his students from the fears and foolishness that hold happiness hostage. These lessons are (1) how freedom, integrity, self-respect, and happiness interrelate; (2) real versus fake tragedy and real versus fake heroism; (3) the instructive roles that various animals play in Stoic education; (4) athleticism, sport, and (...) game-playing as analogies for striving to live virtuously; (5) place, time, and progress in the journey to self-realization; (6) how to live with death and exit life fearlessly; (7) how teaching wisdom is one of several ways the Stoic sage loves others. (shrink)

Recently, psychologists have developed indirect measurement procedures to predict suicidal behavior. A prominent example is the Death/Suicide Implicit Association Test (DS-IAT). In this paper, I argue that there is something special about the DS-IAT which distinguishes it from different IAT measures. I argue that the DS-IAT does not measure weak or strong associations between the implicit self-concept and the abstract concept of death. In contrast, assuming a goal-system approach, I suggest that sorting death-related to self-related words takes effort because death-related (...) words trigger avoidance-impulses, which suicide ideation weakens. The DS-IAT taps into weakened automatic responses from the self-preservation system. Additionally, the suggested cognitive structure, illuminated with the selfish-goal theory, explains predictable suicidal behavior. (shrink)

While suicide is typically associated with personal despair, people do sometimes kill themselves in the hope or expectation that their death will advance a political cause by way of its impact on the conscience of others, or in extreme cases simply as an expression of protest against a status quo felt to be unjust. Paradigm cases of such protest suicide may be public acts of self-immolation. This chapter distinguishes between instrumental and expressive protest suicide, examines the possible motivations behind them, (...) their possible moral justification, and their potential contribution to the meaning of the suicide’s life. It argues that when the value of the aim pursued by way of instrumental suicide is proportionate, killing oneself promotes it sufficiently, and other morally acceptable options are exhausted, instrumental protest suicide can be morally permissible and consistent with human dignity. It can even be an admirable act of self-sacrifice, provided that the agent’s motivations are suitable. Some of the standard moral objections to suicide don’t apply to such cases. But protest suicide remains morally risky, because one might be mistaken about the worth of one’s cause or the availability of alternatives, and because even these extreme acts typically have limited effect. (shrink)

Schopenhauer repeatedly claims that suicide is both foolish and futile. But while many commentators have expressed sympathy for his charge of foolishness, most regard his charge of futility as indefensible even within his own system. In this paper, I offer a defense of Schopenhauer’s futility charge, based on metaphysical and psychological considerations. On the metaphysical front, Schopenhauer’s view implies that psychological connections extend beyond death. Drawing on Parfit’s discussion of personal identity, I argue that those connections have personal significance, such (...) that suicide does not allow one, as Hamlet hopes, simply “not to be.” On the psychological front, I argue that a distinction between agents’ intentions and underlying desires makes room for Schopenhauer to claim that paradigmatic suicidal agents ultimately desire the opposite of what suicide accomplishes. I conclude by showing how the resulting account of futility can buttress the charge of foolishness as well. My interpretation still leaves Schopenhauer vulnerable to certain objections, but shows that his account is significantly more defensible than previous commentators have realized. (shrink)

Is it possible to donate unpaired vital organs, foreseeing but not intending one’s own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on “double effect donation.” Where we disagree with these authors is that we see double-effect donation not as a morally praiseworthy act akin to mar- tyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...) avoiding the aim to kill; not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double-effect donation falls foul of the first condition of double-effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such don- ation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. (shrink)

Is it possible to donate unpaired vital organs, foreseeing but not intending one's own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on 'double effect donation.' Where we disagree with these authors is that we see double effect donation not as a morally praiseworthy act akin to martyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...) avoiding the aim to kill: not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double effect donation falls foul of the first condition of double effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such donation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. (shrink)

The kinds of real or natural kinds that support explanation and prediction in the social sciences are difficult to identify and track because they change through time, intersect with one another, and they do not always exhibit their properties when one encounters them. As a result, conceptual practices directed at these kinds will often refer in ways that are partial, equivocal, or redundant. To improve this epistemic situation, it is important to employ open-ended classificatory concepts, to understand when different research (...) programs are tracking the same real kind, and to maintain an ongoing commitment to interact causally with real kinds to focus reference on those kinds. A tempting view of these non-idealized epistemic conditions should be avoided: that they signal an ontological structure of the social world so plentiful that it would permit ameliorated classificatory schemes to achieve their normative aims regardless of whether they defer to real-kind classificatory schemes. To ground these discussions, the essay appeals to an overlooked convergence in the systematic naturalistic frameworks of Richard Boyd and Ruth Millikan. (shrink)

A wide body of psychological research corroborates the claim that whether one’s life is (or will be) meaningful appears relevant to whether it is rational to continue living. This article advances conceptions of life’s meaningfulness and of suicidal choice with an eye to ascertaining how the former might provide justificatory reasons relevant to the latter. Drawing upon the recent theory of meaningfulness defended by Cheshire Calhoun, the decision to engage in suicide can be understood as a choice related to life’s (...) meaningfulness insofar as an individual can see no point in investing her agency in her anticipated future. These meaning-based reasons relevant to suicidal choice either cannot be reduced to the reasons of well-being that philosophers have typically used to analyse suicide decisions or at least forms a distinct class of reasons within those that contribute to well-being. (shrink)

Among contemporary philosophers, David Benatar espouses a form of pessimism most closely aligned with Schopenhauer’s. Both maintain that human existence is a misfortune, such that each of us would have been better off having never existed at all. Here my concerns are twofold: First, I investigate why, despite these similarities, Schopenhauer and Benatar arrive at divergent positions regarding suicide. For whereas Benatar concludes that suicide is sometimes a moral wrong to others but is prudentially rational in a wider array of (...) circumstances than we ordinarily expect, Schopenhauer largely sets aside questions of both interpersonal morality and prudence to argue that suicide is self-contradictory or futile because it does not undermine the metaphysical facts concerning the place of will in human life, facts ultimately responsible for our unfortunate condition. Second, I consider Schopenhauer’s attempt to show that suicide is a mistaken response to human suffering. Under any of several plausible interpretations of Schopenhauer’s argument that suicide is a futile exercise, his reasoning is unconvincing. Drawing upon Schopenhauer’s admiration for ‘ascetic’ suicide, I then propose an alternative expressive route for Schopenhauer: that suicide is usually mistaken because it fails to manifest integrity in light of the unfortunate truth about the human condition. (shrink)

Exploring the Philosophy of Death and Dying: Classical and Contemporary Perspectives is the first book to offer students the full breadth of philosophical issues that are raised by the end of life. Included are many of the essential voices that have contributed to the philosophy of death and dying throughout history and in contemporary research. The 38 chapters in its nine sections contain classic texts and new short argumentative essays, specially commission for this volume by world-leading contemporary experts. Exploring the (...) Philosophy of Death and Dying introduces students to both theoretical issues as well as urgent practical issues raised by human mortality, enabling instructors to adapt it to a wide array of institutions and student audiences. As a pedagogical benefit, PowerPoints, discussion questions, and test questions for each chapter are included as online ancillary materials. (shrink)

In this paper, I am dealing with the phenomena of “life” and “death.” The questions that I attempt to answer are “What is life, and what is death?” “Is it bad to die?” and “Is there life after death?” The method that I am using in this paper is that of phenomenology. The latter I understand as an inquiry into meaning, that is, what makes this or that phenomenon as such. Thus, I am approaching the phenomena in question from the (...) point of view of their meaning in the first place. I claim that ordinarily we constitute phenomena of “life” and “death” in a twofold way. When it comes to “life,” one can specify “life-as-biological,” and “life-as-a-possibility” senses. The former I understand as a cluster of biological processes that unfold in physical time. By “life-as-a-possibility,” I understand a cluster of projects, potentials that depend on our subjectivity. I claim that we essentially perceive life-as-biological through life-as-possibility. When it comes to “death,” I argue that we essentially constitute this phenomenon in a similar manner. On the one hand, we perceive “death” in the “death-as-biological/physical” sense which signifies the end of the organism’s biological processes. On the other hand, we constitute “death” as the “existential/practical death”/“death-of-possibility.” By that I mean an annihilation of all possibilities, and projects. In short, it is a situation when one’s life suddenly loses all its meaning and value: death of meaning. I argue that what constitutes the significance of “death-as-biological” for us is what I call the “existential/practical death” or “death-of-possibility.” I use the phenomena of mourning and suicide to illustrate my point better. -/- Reflecting on whether it is bad to die, I claim that if we accept the hypotheses I am defending in the paper, it appears that death is bad because it entails the loss of all possibilities. I also want to show that people’s desire for immortality is in fact reasonable, because the more one lives, the more possibilities one is able to realize. In other words, people’s desire for immortality is grounded in the essential understanding of the phenomenon of “life” as a possibility. -/- Reflecting on whether there is life after death, my answer is twofold. Since there is no scientific evidence of life after physical/biological death, I think there is no reason to believe in such as well. But when it comes to the question whether there is life after the existential/practical death, my answer is positive: “Yes, there is!” I try to show that it is always possible to find the meaning of life even in the light of the most terrible events. In this sense, there is always a light in the end of the tunnel. (shrink)

An updated version of this encyclopedia entry on the concept of what, if anything, makes life worthwhile.

This chapter presents new findings about Maria von Herbert's life. Building on this, an interpretation is offered of what she means when she calls upon Kant "for solace ... or for counsel to prepare [her] for death". It is then argued that Kant's reply is more satisfactory than is commonly appreciated, as he explicitly defines the roles which he is prepared to adopt – that of a "moral physician" and of a "mediator" -- and thus the standards by which to (...) judge his reply. Having said that, his letter does not address what has been viewed as a challenge to Kantian ethics. It is a matter of dispute what exactly this challenge consists in. This chapter identifies the challenge and the terms in which it is most productively stated. Finally, it provides sufficient reasons to establish that a portrait that resurfaced in November 2016 does indeed depict Maria von Herbert. (shrink)

Emil Cioran offers novel arguments against suicide. He assumes a meaningless world. But in such a world, he argues, suicide and death would be equally as meaningless as life or anything else. Suicide and death are as cumbersome and useless as meaning and life. Yet Cioran also argues that we should contemplate suicide to live better lives. By contemplating suicide, we confront the deep suffering inherent in existence. This humbles us enough to allow us to change even the deepest aspects (...) of ourselves. Yet it also reminds us that our peculiar human ability—being able to contemplate suicide—sets us above anything else in nature or in the heavens. This paper assembles and defends a view of suicide written about in Cioran’s aphorisms and essays. (shrink)

There is a growing trend among some physicians, psychiatrists, bioethicists, and other mental health professionals not to treat physician-assisted suicide (PAS) as suicide. The grounds for doing so are that PAS fundamentally differs from other suicides. Perhaps most notably, in 2017 the American Association of Suicidology argued that PAS is distinct from the behavior that their organization seeks to prevent. This paper compares and contrasts suicide and PAS in order to see how much overlap there is. Contrary to the emerging (...) view that emphasizes their differences, I argue that there is significant overlap such that we ought not to separate PAS into its own category, making it diverge from how we think about and address suicide more generally. I start by examining several prominent theories of suicide and argue that PAS fits squarely within them. I then examine several apparent differences between PAS and other kinds of suicide and argue that these differences are merely apparent or they do not justify treating PAS as a fundamentally different kind of thing from suicide. (shrink)

Suicide, as one of the leading causes of death for the adolescent population, both in Chile and globally, remains a complex and elusive phenomenon. This research studies the association between positive and negative affect in relation with suicidal ideation and suicidal attempt, given that affectivity is a fundamental basis on which people make evaluations on their satisfaction with life. First, it examines the reliability, structure, and validity of Watson’s positive and negative affect scale (PANAS) scale in a representative random sample (...) of Chilean high school students (N= 4,568). The scale evidences strong reliability coefficients and a confirmatory factor analysis, excluding one positive (excited) and one negative (nervous) item. The scale shows a satisfactory goodness of fit. Secondly, it investigates the association of PANAS positive and negative affect scores with suicidal ideation as well as reported attempt in adolescents, controlling for the potential effect of age and sex (N= 420 high school students). Low positive and high negative affect, but not sex and age, show a significant association with suicidal ideation. Suicidal ideation totally mediates the association of affect with suicide attempt, as expected. Results are discussed regarding prevention and it considers how positive and negative affect can be relevant as indicators for prevention and treatment using widely available technology. (shrink)

This book aims to address in a novel way some of the fundamental philosophical questions concerning suicide. Focusing on four major authors of Western philosophy - Kant, Schopenhauer, Nietzsche, and Wittgenstein - their arguments in favour or against suicide are explained, contextualized, examined and critically assessed. Taken together, these four perspectives provide an illuminating overview of the philosophical arguments that can be used for or against one’s right to commit suicide. Intended both for specialists and those interested in understanding the (...) many complexities underlying the philosophical debate on suicide, this book combines philosophical depth with exemplary clarity. (shrink)

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A substantial portion of Adam Smith's discussion of Stoicism in TMS VII is dedicated to the Stoic “principle of suicide,” according to which suicide is sometimes morally required. While scholars agree that Stoicism exercised considerable influence over Smith, no recent work has explored his views on suicide, despite the central role it plays in his treatment of Stoicism. I argue that Smith opposes the principle of suicide on both epistemic and moral grounds, providing an important critique of Stoicism. I also (...) show how Smith departs from other early modern accounts of suicide by offering a notably humane analysis of this tragic act. I conclude by considering what Smith's discussion of Stoicism and suicide tells us about his moral theory, and I forward a reading of Smith as a skeptic. (shrink)

Sadly, there are people in very bad medical conditions who want to die. They are in pain, they are suffering, and they no longer find their quality of life to be at an acceptable level anymore. -/- When people like this are kept alive by machines or other medical treatments, can it be morally permissible to let them die? -/- Advocates of “passive euthanasia” argue that it can be. Their reasons, however, suggest that it can sometimes be not wrong to (...) actively kill some patients, i.e., that “active euthanasia” can be permissible also. This essay reviews these arguments. (shrink)

In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution depends on “a deep and difficult” question about comparing the worseness of two possible (...) scenarios: letting someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential. (shrink)

Why do we consider killing and letting someone die to be two different things? Why do we believe that a doctor who refuses to treat a terminally ill patient is doing anything less than administering a lethal substance? After all, the consequences are the same, and perhaps the moral status of these acts should be judged accordingly. -/- Reviewed: Jonathan Glover, Questions de vie ou de mort (Causing Death and Saving Lives), translated into French and introduced by Benoît Basse, Genève, (...) Labor et Fides, 2017, 386 pp. (shrink)

Many philosophers, psychologists, and medical practitioners believe that killing is no worse than letting die on the basis of James Rachels's Bare-Difference Argument. I show that his argument is unsound. In particular, a premise of the argument is that his examples are as similar as is consistent with one being a case of killing and the other being a case of letting die. However, the subject who lets die has both the ability to kill and the ability to let die (...) while the subject who kills lacks the ability to let die. Modifying the latter example so that the killer has both abilities yields a pair of cases with morally different acts. The hypothesis that killing is worse than letting die is the best explanation of this difference. (shrink)

In 1995, a Swedish pilot study of Dialectical Behaviour Therapy (DBT) was launched to investigate its therapeutic efficacy and cost-effectiveness as treatment for Borderline Personality Disorder (BPD) in suicidal women. In the same year, a sweeping reform of psychiatric care commenced, dramatically reducing the number of beds by the end of the decade. The psychiatry reform was presented as an important factor prompting the need for a community-based treatment for Borderline patients. This article suggests that the introduction of DBT in (...) Sweden, and its relationship to the reform, can only be adequately explained with reference to the wider political shift occurring at the time, whereby the Swedish welfare state and its guiding ethos of egalitarianism were abandoned in favour of a neoliberal ‘choice revolution’. With the new liberalism, hard work and individual responsibility replaced the idea of a Swedish ‘people’s home’, a nationwide community and social support network. This language was reflected in DBT, which sought to teach patients the ‘skills’ necessary ‘to create a life worth living’. In this context, therapy was constituted as a form of ‘work’ that the patient had to undertake to improve. Moreover, DBT rejected the prevailing view of Borderline patients as ‘manipulative’ and ‘aggressive’, suggesting instead that they were ‘helpless’, ‘weak’ and unable to regulate their emotions. This new Borderline persona fit neatly into the new liberal discourse: she could be taught to become a rational and independent person able to cope in a society that valued individual responsibility over social support. (shrink)

This article explores theoretical conditions necessary for “quantum immortality” (QI) as well as its possible practical implications. It is demonstrated that the QI is a particular case of “multiverse immortality” (MI) which is based on two main assumptions: the very large size of the Universe (not necessary because of quantum effects), and the copy-friendly theory of personal identity. It is shown that a popular objection about the lowering of the world-share (measure) of an observer in the case of QI doesn’t (...) work, as the world-share decline could be compensated by the merging timelines for the simpler minds, and also some types of personal preferences are not dependent on such changes. Despite large uncertainty about MI’s validity, it still has appreciable practical consequences in some important outcomes like suicide and aging. The article demonstrates that MI could be used to significantly increase the expected subjective probability of success of risky life extension technologies, like cryonics, but makes euthanasia impractical, because of the risks of eternal suffering. Euthanasia should be replaced with cryothanasia, i.e. cryopreservation after voluntary death. Another possible application of MI is as a last chance to survive a global catastrophe. MI could be considered a plan D of reaching immortality, where plan A consists of the survival until the creation of the beneficial AI via fighting aging, plan B is cryonics, and plan C is digital immortality. (shrink)

In the end‐of‐life context, alleviation of the suffering of a distressed patient is usually seen as a, if not the, central goal for the medical personnel treating her. Yet it has also been argued that suffering should be seen as a part of good dying. More precisely, it has been maintained that alleviating a dying patient’s suffering can make her unable to take care of practical end‐of‐life matters, deprive her of an opportunity to ask questions about and find meaning in (...) and for her existence, and detach her from reality. In this article, I argue that the aims referred to either do not support suffering or are better served by alleviating it. When the aims would be equally well served by enduring suffering and relieving it, the latter appears to be the preferable option, given that the distress a patient experiences has no positive intrinsic value. Indeed, as the suffering can be very distressing, it may not be worth bearing even if that was the best way to achieve the aims: the distress can sometimes be bad enough to outbalance the worth of achieving the goals. Having considered an objection to the effect that a patient can have a self‐regarding moral duty to endure the distress she faces at the end of life, I conclude that the burden of proof is on the side of those who maintain that the suffering experienced at the end of life ought to be endured as a part of dying well. (shrink)

Steven Nadler has argued that Spinoza can, should, and does allow for the possibility of suicide committed as a free and rational action. Given that the conatus is a striving for perfection, Nadler argues, there are cases in which reason guides a person to end her life based on the principle of preferring the lesser evil. If so, Spinoza’s disparaging statements about suicide are intended to apply only to some cases, whereas in others he would grant that suicide is dictated (...) by reason. Here, I object to Nadler’s interpretation by showing that it conflicts with Spinoza’s metaphysical psychology. Even given Nadler’s interpretation of the conatus doctrine, the possibility that reason could guide a person to commit suicide is incompatible with the conatus of the mind. Spinoza holds that the mind cannot contain an adequate idea ‘that excludes the existence of our body’. Yet, as I argue, in order for reason to guide a person voluntarily to end her life, she would need to have an adequate idea representing her death – an idea that excludes the existence of her body. For this reason, Spinoza's system rules out the possibility of rational suicide. (shrink)

In this chapter, we consider, and reject, the claim that all elderly patients’ desires for suicide are irrational. The same reasons that have led to a growing acceptance for the rationality of suicide in terminal cases should lead us to view other desires for suicide as possibly rational. In both cases, desires for suicide can and do materialize in the absence of mental illness. Furthermore, we claim that desires for suicide can remain rational even in the face of some mental (...) illnesses so long as four criteria are met: individuals must demonstrate rationality, have realistic information and judgments about their life-world, be in a state of mind (e.g., their emotions and will) that is not be severely compromised by mental illness, and make choices that are congruent with their fundamental values and critical interests. We conclude that some rational suicides can be ethically justifiable. (shrink)

Spinoza (1632-1677) writes in the fourth proposition of the third part of his masterpiece, the Ethics (1677), the bold statement that self-destruction is impossible. This view seems to be very hard to understand given the fact that in our western world we have recently been confronted with an increasing number of suicides, all of which are - per definition – ―actions of killing oneself deliberately‖. Firstly, this article aims at showing, based on the last chapter of the first part of (...) the Cogitata metaphysica (1661), that Spinoza might have applied the mechanical analogy of a body in motion in his views on life. This interpretation allows to resolve the paradox of suicide in Spinoza. Secondly, this paper gives a new interpretation of one of the three categories of suicide (the ―Seneca category‖), which the Dutch philosopher distinguishes in E4p20s, making a link with his definition 39 of timor. (shrink)

Prof. Cohen and I answer six questions: (1) Why do we lock people up? (2) How can involuntary civil commitment be reconciled with people's constitutional right to liberty? (3) Why don't we treat homicide as a public health threat? (4) What is the difference between legal and medical approaches to mental illness? (5) Why is mental illness required for involuntary commitment? (6) Where are we in our efforts to understand the causes of mental illness?

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated (...) to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

Suicidal ideation would often appear to relate to ideas about life’s meaninglessness. In this chapter, I consider the suicidal thoughts of an elderly person in light of the recent philosophical discussion on the meaning of life. I start by distinguishing between two importantly different questions about life’s meaning and explaining how they differ from certain other issues sometimes treated as questions about the meaning of life. Then I address the two questions about life’s meaning in turn, connecting them to the (...) example case. After that, I briefly consider how the elderly person’s committing suicide would appear from the viewpoint of the philosophical debate on life’s meaning. I conclude by summing up how the philosophical discussion on the meaning of life I have referred to might help a person like the one in the example case. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully to (...) ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)

Many participants in debates about the morality of assisted dying maintain that individuals may only turn to assisted dying as a ‘last resort’, i.e., that a patient ought to be eligible for assisted dying only after she has exhausted certain treatment or care options. Here I argue that this last resort condition is unjustified, that it is in fact wrong to require patients to exhaust a prescribed slate of treatment or care options before being eligible for assisted dying. The last (...) resort condition effectively pits one right of patients, their right to refuse medical treatment or interventions, against another patient right acknowledged by advocates of assisted dying, the right to die. Drawing on an analogy with the legal notion of an unconstitutional condition, I argue that the last resort condition unjustly demands that an arguably more fundamental right—the right to refuse medical treatment or intervention—be foregone in order to acquire a less fundamental right—the right to die. I then address three rationales for the last resort condition and find that they subject individuals to arbitrarily stringent standards for exercising the right to die, standards to which those who seek to end their lives by voluntarily ending life-sustaining treatments are not subject. Subjecting those who seek assisted dying to the last resort condition therefore wrongfully infringes on their right to refuse medical treatment or interventions. (shrink)

Thanks to recent scholarship, Kant is no longer seen as the dogmatic opponent of suicide he appears at first glance. However, some interpreters have recently argued for a Kantian view of the morality of suicide with surprising, even radical, implications. More specifically, they have argued that Kantianism requires that those with dementia or other rationality-eroding conditions end their lives before their condition results in their loss of identity as moral agents, and requires subjecting the fully demented or those confronting future (...) dementia to non-voluntary euthanasia. Properly understood, Kant’s ethics has neither of these implications. wrongly assumes that rational agents’ duty of self-preservation entails a duty of self-destruction when they become non-rational. further neglects Kant’s distinction between duties to self and duties to others and wrongly assumes that duties can be owed to rational agents only during the time of their existence. (shrink)

This book provides novel perspectives on ethical justifiability of assisted dying in the revised edition of New Directions in the Ethics of Assisted Suicide and Euthanasia. Going significantly beyond traditional debates about the value of human life, the ethical significance of individual autonomy, the compatibility of assisted dying with the ethical obligations of medical professionals, and questions surrounding intention and causation, this book promises to shift the terrain of the ethical debates about assisted dying. The novel themes discussed in the (...) revised edition include the role of markets, disability, gender, artificial intelligence, medical futility, race, and transhumanism. Ideal for advanced courses in bioethics and healthcare ethics, the book illustrates how social and technological developments will shape debates about assisted dying in the years to come. (shrink)

Hunger strikes potentially present a serious challenge for attending physicians. Though rare, in certain cases, a conflict can occur between the obligations of beneficence and autonomy. On the one hand, physicians have a duty to preserve life, which entails intervening in a hunger strike before the hunger striker loses his life. On the other hand, physicians’ duty to respect autonomy implies that attending physicians have to respect hunger strikers’ decisions to refuse nutrition. International medical guidelines state that physicians should follow (...) the strikers’ unpressured advance directives. When physicians encounter an unconscious striker, in the absence of reliable advance directives, the guidelines advise physicians to make a decision on the basis of the patient’s values, previously expressed wishes, and best interests. I argue that if there are no advance directives and the striker has already lost his competence, the physician has the responsibility to resuscitate the striker. Once the striker regains his decision-making capacity, he should be asked about his decision. If he is determined to continue fasting and refuses treatment, the physician has a moral obligation to respect this decisions and follow his advance directives. (shrink)

Stoicism is an ancient Greco-Roman practical philosophy focused on the ethics of everyday living. It is a eudaemonistic (i.e., emphasizing one’s flourishing) approach to life, as well as a type of virtue ethics (i.e., concerned with the practice of virtues as central to one’s existence). This paper summarizes the basic tenets of Stoicism and discusses how it tackles the issues of death and suicide. It presents a number of exercises that modern Stoics practice in order to prepare for death (one’s (...) own, or those of relatives and friends). It argues that modern Stoicism is a viable personal philosophy. (shrink)

This paper aims to develop the antagonism between Kant’s and Nietzsche’s views of suicide by focusing particularly on the relation between moralityand life. Whereas Kant establishes a primacy of morality over life and puts forward one main moral argument against the permissibility of suicide, Nietzsche reverses this hierarchical relation and gives to life a primacy over morality. The first two sections will be thus devoted to a critical examination of both positions, while in the third and last section the attention (...) will be focused on the consequences deriving from such approaches. The paper will be concluded by proposing two essential conditions which in the author’s view should be met in order to begin working on a tenable Nietzschean defence of suicide. (shrink)

In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated (...) to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)