Many of this site’s readers send me angry emails or texts. They post challenging comments. Some are so passionately opposed to suicide prevention that they resort to harassment. I have received threatening missives and phone calls from numerous people. Some urge me to kill myself.
A common argument is that people should be free to die by suicide without intervention by others, no matter what:
“For some people there is little to be done sadly and if they want to exit life then I completely understand and I believe they should be helped: either by medical personnel or at least by giving them access to pain-free means. This is the humane, moral and decent thing to do and it respects their autonomy and human dignity…”
That comment, by a reader named Zara, raises good points. It is just one comment among many that have caused me to question myself:
By advocating for stopping people from suicide except in the context of terminal illness, am I wrong?
Why don’t people, regardless of terminal illness, have the right to end their own life, without anybody interfering, interrupting, or otherwise intervening?
What if the suicidal person’s mental or physical suffering truly is intolerable and with no end coming soon, if ever?
Is it inhumane to stop a suffering person from ending their life?
Why?
Why not?
The Most Difficult, if Fleeting, Question
People who long for suicide typically want to escape unbearable torment. They experience deep emotional or physical pain, or existential malaise, or fear, or trauma, or psychosis, or material hardships like poverty, or something else so powerful that it snuffs out the biologically ingrained will to live.
They feel hopeless that things will ever change. Indeed, they do not simply feel hopeless. They are convinced their situation is hopeless.
People intent on suicide often want to end their lives for very compelling reasons.
I think of all this, and a troubling question settles on me. I dedicate my work to suicide prevention, but even I wonder, if momentarily:
Why not let them die by suicide?
Suicide Prevention and the Greater Good
In preventing suicide, yes, we are trying to help the suicidal person. We know, based on years of research about suicide attempt survivors, that even intensely suicidal people are likely to regain the desire to live. As I describe in the post “Where Are They Now?: The Fate of Suicide Attempt Survivors,” most people who survive a suicide attempt do not later die by suicide.
But we are not only helping the suicidal person by working hard to prevent suicide. We also are helping people who care about the suicidal person.
Suicide hurts the living. We strive to prevent suicide not only to save the suicidal person from dying prematurely and unnecessarily. We also strive to prevent suicide to save children from losing parents, parents from losing children, partners from losing love, and communities from losing valued individuals.
As Jennifer Michael Hecht wrote in her book, Stay: A History of Suicide and the Arguments Against It: “The whole of humanity suffers when someone opts out.”
In seeking to prevent one person’s suicide, we also seek to prevent even more suicides. People who lose someone they love to suicide are at higher risk for suicide themselves. One suicide can lead to another, what is called “suicide contagion.”
Please let me be clear: In describing the harm that suicide does to others, I am not blaming the suicidal person. Rather, I blame the forces that lead to suicide, just as the blame for a person’s death to cancer belongs to the cancer, not to the person who died. In this regard, the person who died by suicide is suicide’s victim – but not the only one.
A World Without Suicide Prevention
Some people lament that suicide prevention measures deprive people of the ultimate liberty – that is, the freedom to die on one’s own terms.
Consider the alternative: A society where people are not stopped from dying by suicide. Where parents and children and friends and lovers watch, without recourse, as tragedy unfolds. Where there is no pathway for keeping a suicidal person safe without the person’s consent, even though the chances are very high that the person will recover the will to live if given the chance. Where friends, family, and professionals are not allowed to prevent what might be preventable.
A society that tries to prevent suicide sends the message to people who suffer, and to those who love them, that their lives matter. That suicide is not the answer. That people care and can try to help. That things have a good chance of getting better.
No doubt, we need to do more as a society. On a large scale, people need more resources and more reasons to want to stay alive. If society treated people better – if there were more jobs, better access to health care, and less violence, for example – fewer people would want to die.
Society needs to do more for suicidal people besides keep them alive and miserable. But letting people kill themselves without providing any means for prevention isn’t a solution, either.
Questions In Search of Answers
More emails from strangers will come to me, missives full of challenges, perhaps even anger. I know this. I anticipate some of the comments:
You are selfish. Why should one person suffer so that others don’t?
Why should people stay alive to help society when society doesn’t provide enough help to people who stay alive?
Who decides what is best for the suicidal person? For society?
Those are good questions, and maybe I will tackle them in future posts.
What are your answers?
Copyright 2018 by Stacey Freedenthal, PhD, LCSW. Written for SpeakingOfSuicide..
Your vision of a world without suicide prevention has not come true in Belgium and the Netherlands, two countries that have legalized physician-assisted suicide for people suffering from constant and incurable pain (whether physical or mental). Suicide prevention efforts, as well as psychiatric hospitalizations and antidepressant prescriptions, did not decline following the introduction of these laws. In fact, the suicide rate in both countries has come down, not up, after legalization.
Furthermore, public opinion remains strongly in favor of keeping these laws in place. There is no constant public outrage from the families and friends of those that choose to die by assisted suicide. This is because the people who ask, and get approved, for assisted suicide are in acute pain (which, in mental health cases, often includes continual self-harm) and their loved ones understand that this is not only the sufferer’s choice to make, but that it is also a valid choice under the circumstances.
The number of people in both countries that are approved for assisted suicide on the grounds of mental suffering remains tiny (less than 100 each year). Furthermore, some of those who get approval eventually decide not to go through with the suicide, so the final number of psychiatric euthanasia deaths is even smaller. In other words, legalization did not result in a “suicide epidemic”, “suicide contagion”, or anything remotely like that.
The following short documentary (which you may have already come across) might change your perspective on the matter: https://www.youtube.com/watch?v=SWWkUzkfJ4M
Been a bit since I have been here. I will speak only from my own experience.
Suicidal or not Suicidal?
I once asked my son if I died what would he do? Without a doubt, he said he would kill himself. Clearly, within a second he imagined pain and loss. Yet he never gave one thought of how I would feel if he died. As a mother trying to survive the suicide of my 22-year-old son, in my case, I have a direct cause for his suicide. It really does not matter. The end result is the end result. He left a two-page letter and one thing he stated that is vivid to me is it would be selfish for him to stay alive unhappy than to be at peace in heaven.
Should he have killed himself? NO!
The view he had formed based on the meds being prescribed was wrong. The end result was wrong.
In my case, my son was given an overwhelming sick-making amount of drugs. His issue was sleep. After much education about Benzos & SSRI, Antipsychotics I am left with amazement about the lack of education given when prescribing these types of meds. There are no tests that can clearly state how this class of drugs work, instead it is a hypothesis that this class of drugs works a certain way.
So I pose a question? If drug manufacturers state to take a certain way every day at a certain time. yet that very drug is prescribed by a doctor to take on an as per needed basis. You can not take BENZOS OR SSRI’s like this. Yet, everyone I talk to has told me this is how they are advised to take their meds. So are doctors setting people up for a fall? Suicidal? not suicidal? Although I realize not everybody is on meds. Yet meds are the go-to for most, not all, but most doctors.
My son took his life as he was withdrawing from these very meds.
I understand people are depressed for varying reasons. But as the mother of a son who took his beautiful life, I urge you to continue to seek help and don’t take your life.
The effect of this will never leave me, I will not get over it. The person I was moments before the police knocked on my door, also has died. Each day I learn how to live, In the early days, I had to relearn how to breathe, and eat. Today I speak out against suicide.
Whether you believe it or not Suicide is not a personal experience. It affects everyone in your life forever! You may think its only you but you are wrong.
I go to a group once a month and I see so many hurting, devastated people left behind from a loved one’s choice to end their life. The depths are so deep.
I also urge you to go to a suicide survivor class and see first hand what suicide survival looks like. You might change your mind.
As in every area of human endeavor, mistakes are made in choosing suicide as well, but the fact that some suicides, such as this, are clearly based on erroneous premises does not mean that all of them are. If things can creatively be changed for the better, by all means, do so, and all our ingenuity should always be applied to find every avenue to make it possible for ourselves to live. But life traps many people in absolute dead-ends, from which there is no possible escape, no rescue, no relief, ever, and when it is obvious that people are trapped in some situation they can never leave which they also find intolerable, then suicide may be the only rational way out.
I am so sorry to read of your loss.
The very sad truth here is that the pharmaceutical industry does not care about the people that die using their products. Nor do the physicians that prescribe them. They all hide behind the defence that it is the choice of the patient whether or not to take prescribed medications and thereby make informed decisions about their side effects. It is a complete non-sense. Most people trust their physicians and follow their advice. And most people have no idea the harm that pharmaceuticals can do to them.
I’m not a doctor but I have been on both Benzos and SSRI’s (going off SSRI’s now).
Unless there’s an SSRI that is different from any of the ones I have heard of, “As needed” is absolutely not how you should take them and whoever prescribed it that way should not be practicing medicine. I think, at least I hope, that not many doctors are doing this and the ones that are, are GPs and not mental health specialists. Or maybe it’s a situation where they’ll prescribe 10mg of something with the idea that they’ve told the patient to start at 5mg and go up at their own discretion. But yes, you absolutely do need them every day.
Benzos are different though. I’m an ‘as needed’ and I would never, ever, ever take Benzos daily. There are some people who need them daily but Benzos are not to be trifled with. The withdrawals alone, with nothing external, can kill you. I know a guy who died from that. Even small interactions can be fatal. The stories I’ve read about Benzo addiction are terrible. They’re the worst.
That said I agree some doctors are staggering in how irresponsible they are. I once talked to a girl who had been placed on 5 mg of Lexapro. She’d been on it for some time, and I forget what exact symptoms she mentioned but it sounded almost exactly like seratonin syndrome and I got her to go to the ER, who told her pretty much the same things I did and got her off the meds.
Where was her doctor? He wasn’t replying to her. Doctors oftentimes do nothing in terms of follow up or even answering questions in a timely manner.
I myself am in a position where I lost my physician without warning, so I have to go off my meds. When I got off Lexapro a few years ago I tapered too fast and was almost incapacitated by the withdrawals. Where would I be now if I was on a 20mg Lexapro dose (which I was), and had nothing stockpiled in the event of an emergency? Or if I was on a daily Xanax dose? I’d be completely screwed. It takes months to get a new doctor if one leaves, and again, there’s no follow up with anyone other than a message “Call 911 if you are having an emergency”.
I think some of the lack of accountability is because the mentally ill are seen as fundamentally flawed and if something happens to them, it’s on them. A suicidal person goes to a doctor, they try some meds. Something happens to interrupt the flow of meds and the suicidal person kills themselves. No one questions the series of blunders that led to this, the physician fills his 4 O’clock appointment with someone else, and life goes on for everyone except for the suicide victim and the survivors. It’s a horrible situation with common sense solutions, psychiatrists should have assistants who do follow up work and make sure no-one falls in the cracks, but no-one in a position of power seems to care about it.
I hope you’re doing better now.
Everyone who experiences prolonged suicidal ideation, with no relief after attempting counselling and medications, should have the right to end their life in a humane manner. Nobody knows my mind, my circumstances, and my resolve, better than myself. Not having a choice to make my departure a peaceful one only adds to my depression.
Anyone can put a spin on anything. Life is that subjective. We all live in our little bubbles. We can never really hope to be truly understood.
But trying to make out that suicide is always a mistake is just wrong. We need to accept that some people may indeed be better off out of this world.
Evolution has made us conditioned to avoid death. Those people that seek death over life must therefore be deeply troubled. Sometimes this is temporary. Sometimes it is not. Sometimes it can be resolved. Sometimes it cannot.
In recent years there have been a couple of very high profile cases of young adults that had autism talking their own lives. I wonder about this, as I was once in the same situation, though I did not know it at the time. I wonder if their lives might have got better or whether their decisions have saved them from a lot of suffering. We can never know. I can say that my decision to try to live has led to a depth of despair that I could never have imagined.
There needs to be some balance in this debate. It is not all black and white.
So many people defend suicide prevention by saying that most who attempted are later glad to be alive.
The flaw in the argument seems obvious. Those who are, or would be, glad they succeeded are not here to tell us!
It makes sense that those with less ambivalent feelings about dying would be more likely to succeed.
I think preventing impulsive suicides makes sense. But if someone has really thought it through and still want to do it after, say, three months, they should be given painless means to do so.
In my opinion, for whatever reason. It is a matter of autonomy and respect for other person, who often has quite accurate and realistic idea of how much hope he or she had.
Totally agree. Well stated.
There are both. The people who attempted suicide and are glad to be alive. And the people who attempted and wish they had succeeded but have reasons they didn’t have then not to attempt again, and wish they had succeeded still. I’m sure it goes both ways. That of those who succeed a good number of them (can’t begin to guess percentages) don’t want to succeed. Either they weren’t trying to kill themselves but did so through their actions kind of by mistake. Or they regretted their choice as soon as they saw it’d mean death. And there are those who will be happy they succeeded and be relieved that they don’t have to continue living. I don’t know who we should be catering for. For those who aren’t trying, or those who are. For those who won’t regret or those who will. I do’t know if there is ever any ‘right’ answer.
Eliza,
That’s an excellent point — just as some people who survive a suicide attempt regret it, some who didn’t survive regretted it in their final moments. We know this happens. There have been cases with physical evidence that the person struggled (and failed) to live after taking action to end their life. And we know of people who jumped off the Golden Gate Bridge and survived and said the moment their feet left the bridge, they knew they’d made a terrible mistake.
This is for people who have lost a loved one to suicide: I’m sorry, I know it’s upsetting to think that your loved one might have experienced regret or emotional pain in their last moments. When I published an essay about my own change of heart in the midst of a suicide attempt in my 20s, someone posted a comment on Facebook about how much it upset them to have to imagine that their loved one wasn’t at peace when they died. I’m very sorry, and yet I think it can be valuable for people at risk for suicide now to consider the possibility that they’ll change their mind when it’s too late.
Anyway, back to your comment, Eliza – thank you for sharing here.
I don’t think the issue can be settled empirically. Some may regret having attempted suicide, others may regret having survived a suicide attempt, but still the questions of the right to suicide and the potential wisdom of suicide for some people remain open.
Oskar,
Very true. There are definitely those who regret surviving. We do know that from research and also I know that from my own clinical work. As Eliza said, regret goes both ways.
Exactly!!