What is “appropriate” dying?

And Who Should Forbid ThemInstead of a set of rules where “one size fits all”, or wordily-phrased “rights”, psychologists have looked at a different model: one of, “Is this an appropriate death?”

The most common scenario, where laws are proposed based on certain check-boxes being fulfilled, is deeply flawed. “Two physicians must agree” – yet if the doctors in the area all happen to be opposed on principle, then they are not likely to agree. “Where the patient has six months to live” – and quite apart from the difficulty of determining this, we know that most major headline cases were not terminal: Debbie Purdy, Tony Bland, Terri Schiavo, Ramon Sampedro. Like these cases, when you have a set of fixed rules, the future will often surprise with one that feels morally right but doesn’t fall within the strict ‘rulebook.’

Exit’s response was to commission a University study on feasibility. The researchers found that the best type of law reform, instead of ‘legalising’ certain types of assisted suicide outright, would simply be to enact powers to the Courts that would allow them to make exceptions to the rule against assisted suicide.

The confusion over law-making stems not from how and when assisted suicide should be allowed, but something more basic: the question of, what is an appropriate death? The indicators would provide clues for all possible deaths, not just assisted suicides.

Psychologist David Lester, from the Center for the Study of Suicide in New Jersey, built on the work of Avery Weisman and Thomas Hackett in considering the sort of criteria that lead us to conclude that a death is ‘appropriate.’

  1. The role of the individual. There is a temptation to just call this ‘autonomy’ whereas it may not be quite that simple. A person struck by lightning has no autonomous role in the death, whereas a suicide, whether through very understandable causes or through a lack of social support and a place to live, might or might not be judged ‘autonomous’ – depending how in control we think that person is. But if a person does play a large role in their own death, that would indeed be a factor to consider.
  2. Consistency in lifestyle. One person might always have been of the outlook, “Just leave it up to the doctors.” If they suddenly changed their mind and sought assisted suicide, it would seem less consistent than someone who had firmly believed in their ‘right to die’ for a long time.
  3. Timing. We use phrases like, “It was his time.” Someone who is very ill, without the prospect of decent recovery, or someone who is very old, may seem more convincing to us than a young healthy person.
  4. What about the kind of death? Someone who dies alone and isolated, unable to leave their house, suggests to us something inappropriate. Violent deaths such as road accidents also seem inappropriate (although Ernest Hemingway’s suicide by firearm seemed at least consistent with his lifestyle). Natural death, when a person’s body just gives up, usually seems appropriate. Psychological death, when the brain has completely ceased to function but the body goes on, can in many ways be sensed as death but does not have the finality of physical death. Assisted suicide in cases where the above conditions are recognised tend to be seen as more appropriate than when such conditions are absent.

Further reading
Robert Grimminck, 10 Heartbreaking Right-To-Die Cases
Exit website, Cases in History
Grace Murano, 8 Most Controversial Cases of EuthanasiaBBC News Assisted dying: What does the law in different countries say?
Exit website, A draft bill
Wikipedia Suicide Legislation
American Psychological Association, Psychological research can inform state policies on the controversial measure.

Further References
Weisman A, Hackett T, Predilection to Death: Death and Dying as a Psychiatric Problem
Lester D, Psychological issues in euthanasia, suicide, and assisted suicide

 

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